Exploring the need for lower limb prosthetic guidelines in South Africa's private healthcare sector.

Abstract

Background: Evidence based guidelines can assist with prosthetic component selection and clinical intervention. There is limited evidence on lower limb prosthetic prescription guidelines in the South African private health care sector.

Objective: To explore the need for lower limb prosthetic prescription guidelines in the South African private healthcare sector.

Methodology: Three main funders of lower limb prosthetics in the South African private healthcare sector (Road Accident Fund (RAF), Workmen's Compensation Fund (WCA), and Council of Medical Schemes (CMS)) were explored using a case study design. Data were collected from six regulatory documents, sixteen purposively sampled prosthetic users, who received services from these funders, and seven key informants. Documents were assessed with the Appraisal of Guidelines for Research & Evaluation II (AGREE II), across six domains. Data from users and key informants were collected with telephonic, semi-structured interviews guided by interview schedules. Interview schedules were self-developed and tailored for each participant group. AGREE II data were analyzed descriptively. Inductive thematic analysis was used for interview data.

Findings: Across cases, the "Scope and Purpose" domain scored the highest: 50% (WCA), 47% (CMS), and 22% (RAF). "Editorial Independence" scored 0% for all three cases. Other challenging domains were "Applicability" (WCA: 17%, CMS: 6%, RAF: 6%) and "Rigour of Development" (WCA: 8%, CMS: 25%, RAF: 0%). The following three cross-case themes emerged from the interviews: "Guideline Availability and Necessity" showed that guidelines were seldom used and that guidelines could be beneficial; "Purpose of a Lower Limb Prosthetic Guideline" indicated that guidelines can support accessible, equitable, ethical, and transparent services; and "Guideline Development Requirements" explained that an evidence based collaborative process, facilitated by an independent body should underscore guideline development.

Conclusion: Evidence based, standardized, transparent guidelines will be beneficial to direct prosthetic service delivery in the South African private healthcare sector. The guidelines must be applicable, rigorously developed, and show editorial independence.