South African Journal of Physiotherapy最新文献

Background: Public-private partnership (PPP) for the delivery of health services is known to improve access to healthcare, yet little is known about its utilisation for rehabilitation services, particularly in sub-Saharan Africa (SSA).

Objectives: As a first step to generating evidence to develop a PPP model for physiotherapy service delivery in South Africa, our study mapped and described available research evidence on PPP models for rehabilitation services in the global literature.

Method: The Arksey and O'Malley framework guided our scoping review. Published research on rehabilitation and PPP was searched in five databases from 2000 to August 2022 using keywords, Medical Subject Headings (MeSH) and Boolean terms. Two reviewers independently completed the titles, abstracts and full-text screening of the articles and data extraction from the included articles. A narrative synthesis was conducted, and summaries of the findings are reported.

Results: Nine articles were included from a total of 137 obtained from the evidence searches. Of these, five were from Australia and the others from Hong Kong, Denmark, Bangladesh and the Netherlands. All the included articles showed evidence of PPP models for physiotherapy service delivery.

Conclusion: Our study suggests that PPP models for physiotherapy service delivery exist, particularly in high-income countries (HICs). It also highlights limited research in low- and middle-income countries (LMICs).

Clinical implications: There is a need for primary studies to generate further evidence and develop innovative PPP models for rehabilitation services for the populations who need them most as part of efforts towards improving access to healthcare in LMICs.

Background: Community reintegration is one of the ultimate goals of stroke rehabilitation. The increasing burden of stroke morbidity by other non-communicable diseases in Nigeria indicated the need for our study.

Objectives: The authors explored the factors contributing to successful community reintegration among Nigerian stroke survivors.

Method: We conducted an explorative qualitative study design to achieve this aim using in-depth semi-structured interviews with 12-purposively sampled stroke survivors.

Results: Three overarching themes emerged: restriction of participation experienced by stroke survivors, activity limitation as pointers to the quality-of-life experience of stroke survivors and enablers or barriers to community reintegration for stroke survivors. Among the core, sub-themes included incapability of returning to work, difficulty performing domestic activities, social isolation or separation, recreation and leisure time. Enablers of community reintegration included creating a positive mindset, encouragement and social support, while barriers included mobility and speech or language challenges.

Conclusion: Stroke survivors have challenges in returning to work and experience varying levels of activity limitation, which affects their quality of life with identifiable enablers or barriers to community reintegration.

Clinical implications: Stroke survivors with severe functional deficits should be monitored closely and given further rehabilitative assistance to aid functional recovery, thereby facilitating community reintegration.

Background: One in three women in South Africa suffer from urinary incontinence. Effective management is influenced by patients help-seeking behaviour and services offered by healthcare professionals within the healthcare system. Current practice towards urinary incontinence management in South Africa is unknown.

Objectives: Our study aimed to describe and compare urinary incontinence practice and knowledge of nurses and physicians (practitioners) working in primary healthcare settings, measured against the NICE 2013 guideline and explore attitudes and beliefs towards urinary incontinence management.

Method: Cross-sectional study using a self-designed online questionnaire. All primary healthcare practitioners in the Western Cape were eligible for the study. Stratified random and snowball sampling was used. Data was analysed in consultation with a statistician using SPSS.

Results: Fifty-six completed questionnaires were analysed. Practitioners had an overall knowledge score of 66.7% and practice score of 68.9% compared to NICE 2013 guidelines. A lack of knowledge regarding urinary incontinence screening, following up on patients and conducting bladder diaries were noted. Pelvic floor muscle training and bladder training education was recognised as initial management but only 14.8% of practitioners referred patients to physiotherapy. Half of the sample reported being uncomfortable with urinary incontinence, although the majority wanted to learn more about urinary incontinence.

Conclusion: The knowledge and practices of practitioners working at a primary healthcare level in the Western Cape are not congruent with NICE 2013 guidelines.

Clinical implications: Data can be used to inform intervention planning to address urinary incontinence management at a primary healthcare level in the Western Cape.

Background: Injury prevention is a growing focus for golfers in general and for elite golfers in particular. Movement screening has been proposed as a possible cost-effective means of identifying underlying risk factors and is widely utilised by therapists, trainers and coaches.

Objectives: Our study aimed to establish whether results from movement screening were associated with subsequent lower back injury in elite golfers.

Methods: Our prospective longitudinal cohort study with one baseline time point included 41 injury-free young elite male golfers who underwent movement screening. After this, the golfers were monitored for 6 months for lower back pain.

Results: Seventeen golfers developed lower back pain (41%). Screening tests that were able to differentiate golfers who developed and those who did not develop lower back pain, included: rotational stability test on the non-dominant side (p = 0.01, effect size = 0.27), rotational stability test on the dominant side (p = 0.03; effect size = 0.29) and plank score (p = 0.03; effect size = 0.24). There were no differences observed in any other screening tests.

Conclusion: Out of 30 screening tests, only three tests were able to identify golfers not at risk of developing lower back pain. All three of these tests had weak effect sizes.

Clinical implications: Movement screening was not effective in identifying elite golfers at risk of lower back pain in our study.

Background: Osteoarthritis (OA) ranks fifth among all forms of disability worldwide and primary replacement arthroplasty is the treatment of choice in late-stage OA. The current situation in South Africa is that the waiting lists for arthroplasty are extensive with steep costs. According to many studies, physiotherapists can have an impact on this situation by implementing prehabilitation.

Objectives: The aim of our study is to identify the trends in the literature regarding the content of prehabilitation programmes as well as the gaps.

Method: The methodology will involve a literature search and the methodology as proposed by the Joanna Briggs Institute guidelines. The literature searches will be conducted in electronic databases and peer-reviewed journal studies will be included based on predetermined inclusion criteria. Two reviewers will screen all citations and full-text articles and the first author will abstract the data.

Results: The results will be organised into themes and sub-themes, summarised, and reported as a narrative synthesis.

Conclusion: The proposed scoping review will map the breadth of knowledge available on the topic of prehabilitation in terms of exercise prescription principles, pre-operative optimisation and gaps.

Clinical implications: This scoping review is the first part of a study that aims to design a prehabilitation programme suitable for the South African public health user as the demographic and physical characteristics of its health users are unique and dependent on the context.

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Background: While attention has been drawn to the impact of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of healthcare workers generally, little is known regarding mental health changes over time in frontline and non-frontline physiotherapists during this period.

Objectives: Our study aimed to investigate differences in mental health trends among frontline and non-frontline physiotherapists across three time periods during the pandemic.

Method: Survey-based data were collected from 366 practising physiotherapists across three time periods during the pandemic (Time 1: n = 171; Time 2: n = 101; Time 3: n = 94). Variations in reported mental health of frontline and non-frontline respondents generally and over time were analysed using comparative statistical techniques and trend analysis.

Results: Frontline physiotherapists reported significantly lower levels of general mental well-being and resilience, and significantly higher levels of burnout and maladaptive strategy use. Only frontline physiotherapists' general mental well-being and resilience decreased over time, whereas depression decreased over time for both groups. Anxiety decreased over time for non-frontline physiotherapists but initially decreased and then increased for frontline physiotherapists. Burnout increased initially and then decreased for non-frontline physiotherapists.

Conclusion: Varying mental health trends were found between frontline and non-frontline physiotherapists over time. Nuanced mental health interventions that consider the period of the pandemic and degree of exposure are needed.

Clinical implications: Understandings of the mental health trajectories experienced by physiotherapists across the pandemic can inform long-term, targeted interventions that effectively enhance well-being, retention, and sustainability of practitioners, and thus the care delivered, in the healthcare system.

Background: Although aerobic training (AT) and resistance training (RT) are recommended after stroke, the optimal dosage of these interventions and their effectiveness on balance, walking capacity, and quality of life (QoL) remain conflicting.

Objectives: Our study aimed to quantify the effects of different modes, dosages and settings of exercise therapy on balance, walking capacity, and QoL in stroke survivors.

Method: PubMed, CINHAL, and Hinari databases were searched for randomised controlled trials (RCTs) evaluating the effects of AT and RT on balance, walking, and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs).

Results: Twenty-eight trials (n = 1571 participants) were included. Aerobic training and RT interventions were ineffective on balance. Aerobic training interventions were the most effective in improving walking capacity (SMD = 0.37 [0.02, 0.71], p = 0.04). For walking, capacity, a higher dosage (duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve) of AT interventions demonstrated a significantly greater effect (SMD = 0.58 [0.12, 1.04], p = 0.01). Combined AT and RT improved QoL (SMD = 0.56 [0.12, 0.98], p = 0.01). Hospital located rehabilitation setting was effective for improving walking capacity (SMD = 0.57 [0.06, 1.09], p = 0.03) compared with home and/or community and laboratory settings.

Conclusion: Our findings showed that neither AT nor RT have a significant effect on balance. However, AT executed in hospital-located settings with a higher dose is a more effective strategy to facilitate walking capacity in chronic stroke. In contrast, combined AT and RT is beneficial for improving QoL.

Clinical implications: A high dosage of aerobic exercise, duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve is beneficial for improving walking capacity.

Background: Health services are inaccessible in low-income countries. The National Health Insurance (NHI) bill, linked to primary health care (PHC), was introduced in South Africa to improve access to health services. Physiotherapists contribute to healthcare and improve individuals' health status across their lifespan. The South African healthcare system has many challenges: physiotherapists mostly practising at secondary and tertiary levels of care; a shortage of physiotherapists in the public health systems and rural areas; the omission of physiotherapy in health policies.

Objectives: To explore strategies to integrate physiotherapy services in PHC settings in South Africa.

Method: Our study used a qualitative, exploratory and descriptive approach to collect data from nine doctorate physiotherapists at South African universities. Data were thematically coded.

Results: The themes are to (1) improve societal knowledge of physiotherapy, (2) ensure policy representation of the profession, (3) transform physiotherapy education, (4) broaden the role of physiotherapy, (5) eradicate professional hierarchy and (6) increase the physiotherapy workforce.

Conclusion: Physiotherapy is not well known in South Africa. Physiotherapy is needed to feature in health policies to transform education focussing on disease prevention, health promotion and functioning in PHC. Broadening physiotherapy roles should consider the regulator's ethical rules. Physiotherapists should proactively collaborate with other health professionals to dismantle professional hierarchies. Without addressing the urban-rural, private-public divide, the physiotherapy workforce cannot improve, to the detriment of PHC.

Clinical implication: Implementing the suggested strategies may facilitate physiotherapy integration into PHC in South Africa.

Background: Return to pre-stroke life is of great importance to stroke survivors, their families and communities as stroke affects their ability to perform activities of daily living. It is therefore important to understand the impact of stroke rehabilitation on the community life of stroke survivors in Ghana as there are limited data.

Objectives: Our study aimed to explore and describe the views of stroke survivors on the impact of stroke rehabilitation on their community life.

Method: A descriptive qualitative study was conducted among 15 stroke survivors recruited from three selected hospitals in the Greater Accra Region of Ghana. Individual in-depth interviews were conducted using a semi-structured interview guide. Interview transcripts were analysed using thematic analysis and this gave rise to several themes.

Results: The authors found that stroke left most of the survivors with functional limitations and they required various degrees of assistance to perform their activities of daily living. As the stroke survivors received rehabilitation, most of them mentioned improvements in function. However, most participants were still unable to return to work and enjoy social or leisure activities.

Conclusion: Our study shows that attention needs to be given to the occupational and social management in rehabilitation as much as it is given to the physical management, to improve community integration post-stroke.

Clinical implications: Our study highlights the need to take into consideration the occupational and social aspects of life as part of the rehabilitation process for stroke survivors.