Rehabilitation services of persons with disabilities : experiences of patients and service providers in a rehabilitation centre in the Western Cape Province

Magister Scientiae (Physiotherapy) - MSc(Physio)Rehabilitation is important for persons living with disabilities as it contributes to their sense of autonomy, self-worth, social participation and improving their quality of life. Improving the quality of rehabilitation services requires the incorporation of patients' perceptions with those of service providers regarding these services. Different studies have revealed that persons with disabilities have experienced inaccessibility of rehabilitation services with regards to inaccessibility and unavailability of transport, inadequate provision of information related to their disability. Lack of staff and skills training are the main experienced challenges encountered by the service providers in the rehabilitation service provision. Hence, the current study aims at exploring the persons with physical disabilities and service providers' experiences regarding the rehabilitation services provided at Bishop Lavis Rehabilitation Centre. A qualitative study design was used for data collection. Eleven participants among patients were conveniently selected for the focus group discussion and three key informants among the service providers participated in the in-depth interviews. The focus group discussion and the interviews were tape-recorded and transcribed verbatim and the data was thematically analysed using pre-determined themes. Permission to conduct the study was sought and granted from the Senate Research Grant and Study Leave Committee at the University of the Western Cape, the Western Cape department of Health as well as the facility manager of Bishop Lavis Rehabilitation Centre. Written informed consent was obtained from the participants prior to the focus group discussion and interviews. The results indicated that patients experienced problems of accessing transport to and from the rehabilitation facility. The taxis and buses were either inaccessible or unavailable for persons with physical disabilities. Poor referral systems, shortage of staff, lack of skills training were among the main challenges that arose in the interviews with the service providers. Due to the workload that service providers encountered, they sometimes lacked time to interact and communicate with patients. Participants in both groups reported positive responses regarding patient participation and involvement in the rehabilitation sessions and interaction between patients and service providers. Though some patients expressed the review that the dissemination of information related to group sessions was inadequate, most of the participants in both the focus group discussion and the in-depth interviews stated that, patients were adequately informed on their conditions and treatment. The study concludes by highlighting the need to improve rehabilitation services in terms of increasing the capacity of service providers, equipment, training of service providers and providing transport services for persons with disabilities. There is a need for those planning the rehabilitation services and policy makers to recognise the challenges encountered by those receiving rehabilitation services as well as those providing these services as discussed in this study. Hence, this will help in developing appropriate, accessible and cost effective rehabilitation services that meet the needs of persons with disabilities

Profile of injuries among sitting volleyball players with disabilities in Rwanda

Background: Sports injuries are some of the risk of paralympics sport. Injuries are somewhat high compared with injury rates in able-bodied athletes. Injuries might have an impact on the participation and future health. It is paramount to investigate sports specific injuries to eliminate associated risks.Aim: To identify patterns of injuries among sitting volleyball players in Rwanda.Methods: A prospective quantitative study was conducted among 158 sitting volleyball players competing in the 2013-2014 season. The research team composed by physiotherapists used the data collection process following the consensus on injury definitions and data collection procedures. The ethical clearance and permission were obtained from relevant bodies. ANOVA or the Mann–Whitney U-test were used for continuous variables while Chi-square or Fisher’s exact tests were used for categorical variables.Results: All the 158 players aged 25±6 years participated in the study; with male predominance (66.5%). Fifty-eight players (37%) sustained at least one injury. Nearly half of injuries (n=43) were mild, consistent for both male and female. There was no statistical difference in the patterns of injuries comparing male and female participants.Conclusion: Sitting volleyball players with disability in Rwanda sustained a high prevalence of injuries. The fingers, hands and wrists were the most injured body parts. However, the health and integrative advantages should outweigh the risk of adverse effects associated with participation in sports such as injuries.Keywords: Sitting volleyball, People with disabilities (PWDs), Injur

Strategies for specialty training of healthcare professionals in low-resource settings: a systematic review on evidence from stroke care

Background: The greatest mortality and disability from stroke occurs in low- and middle-income countries. A significant barrier to implementation of best stroke care practices in these settings is limited availability of specialized healthcare training. We conducted a systematic review to determine the most effective methods for the provision of speciality stroke care education for hospital-based healthcare professionals in low-resource settings. Methods: We followed the PRISMA guidelines for systematic reviews and searched PubMed, Web of Science and Scopus for original clinical research articles that described or evaluated stroke care education for hospital-based healthcare professionals in low-resource settings. Two reviewers screened titles/abstracts and then full text articles. Three reviewers critically appraised the articles selected for inclusion. Results: A total of 1,182 articles were identified and eight were eligible for inclusion in this review; three were randomized controlled trials, four were non-randomized studies, and one was a descriptive study. Most studies used several approaches to education. A “train-the-trainer” approach to education was found to have the most positive clinical outcomes (lower overall complications, lengths of stay in hospital, and clinical vascular events). When used for quality improvement, the “train-the-trainer” approach increased patient reception of eligible performance measures. When technology was used to provide stroke education there was an increased frequency in diagnosis of stroke and use of antithrombotic treatment, reduced door-to-needle times, and increased support for decision making in medication prescription was reported. Task-shifting workshops for non-neurologists improved knowledge of stroke and patient care. Multidimensional education demonstrated an overall care quality improvement and increased prescriptions for evidence-based therapies, although, there were no significant differences in secondary prevention efforts, stroke reoccurrence or mortality rates. Conclusions: The “train the trainer” approach is likely the most effective strategy for specialist stroke education, while technology is also useful if resources are available to support its development and use. If resources are limited, basic knowledge education should be considered at a minimum and multidimensional training may not be as beneficial. Research into communities of practice, led by those in similar settings, may be helpful to develop educational initiatives with relevance to local contexts

Undertaking Rehabilitation Research During the COVID-19 Pandemic: Emergent Strategies From a Trainee-Faculty Workshop

BackgroundThe COVID-19 pandemic has disrupted everyday rehabilitation research. Many academic institutions have halted in-person human research including rehabilitation sciences. Researchers are faced with several barriers to continuing their research programs. The purpose of this perspective article is to report the results of an interdisciplinary workshop aimed at understanding the challenges and corresponding strategies for conducting rehabilitation research during the COVID-19 pandemic.MethodsTwenty-five rehabilitation researchers (17 trainees and eight faculty) attended a 2-h facilitated online workshop in to discuss challenges and strategies they had experienced and employed to conduct rehabilitation research during the COVID-19 pandemic.ResultsRehabilitation researchers reported challenges with (1) pandemic protocol adjustments, (2) participant accessibility, and (3) knowledge dissemination, along with corresponding strategies to these challenges. Researchers experienced disruptions in study outcomes and intervention protocols to adhere to public health guidelines and have suggested implementing novel virtual approaches and study toolkits to facilitate offsite assessment. Participant accessibility could be improved by engaging community stakeholders in protocol revisions to ensure equity, safety, and feasibility. Researchers also experienced barriers to virtual conferences and publication, suggested opportunities for smaller networking events, and revisiting timeframes for knowledge dissemination.ConclusionThis perspective article served as a catalyst for discussion among rehabilitation researchers to identify novel and creative approaches that address the complexities of conducting rehabilitation research during the COVID-19 pandemic and beyond

Experiences of patients and service providers with out-patient rehabilitation services in a rehabilitation centre in the Western Cape Province

CITATION: Kumurenzi, A., et al. 2015. Experiences of patients and service providers with out-patient rehabilitation services in a rehabilitation centre in the Western Cape Province. African Journal of Disability, 4(1):1-7, doi:10.4102/ajod.v4i1.164.The original publication is available at http://www.ajod.orgBackground: Rehabilitation is important for persons with disabilities as it contributes to their sense of autonomy, self-worth and social participation, and improves their quality of life. Improving the quality of rehabilitation services requires the dialogue of patients’ perceptions with those of service providers, in order to recommend informed reform. Objective: The objective was to explore the experiences of persons with physical disabilities and service providers, regarding the multi-disciplinary rehabilitation services provided at a community-based out-patient rehabilitation centre. Methods: A qualitative, exploratory study design was used to collect the data. A focus group was conducted with conveniently selected persons with physical disabilities. Three in-depth interviews were conducted with purposively selected key informants. All ethical considerations were adhered to during the implementation of the study. Results: Patients and service providers had different experiences regarding accessibility to rehabilitation services, and similar experiences with patient education and intensity of rehabilitation. Although the patients experienced that the service providers had sufficient knowledge and skills to manage them, services providers expressed that they lacked certain skills. Conclusions: The experiences expressed highlighted the need to improve rehabilitation services in terms of increasing the capacity of service providers and providing transport services for persons with disabilities.http://www.ajod.org/index.php/ajod/article/view/164Publisher's versionAuthors retain copyrigh

Effectiveness of interventions by non-professional community-level workers or family caregivers to improve outcomes for physical impairments or disabilities in low resource settings: systematic review of task-sharing strategies

Abstract Background In low-resource settings, access to basic rehabilitation could be supplemented by community-level interventions provided by community health workers, health volunteers, or family caregivers. Yet, it is unclear whether basic physical rehabilitation interventions delivered to adults by non-professional alternative resources in the community, under task-shifting or task-sharing approaches, are effective as those delivered by skilled rehabilitation professionals. We aim to synthesize evidence on the effectiveness of community-level rehabilitation interventions delivered by non-professional community-level workers or informal caregivers to improve health outcomes for persons with physical impairments or disabilities. Methods We performed a systematic review with a PROSPERO registration. Eight databases were searched for (PubMed, CINAHL, Global Health, PDQ Evidence, Scopus, ProQuest, CENTRAL, and Web of Science), supplemented by snowballing and key-informant recommendations, with no time restrictions, applied. Controlled and non-controlled experiments were included if reporting the effects of interventions on mobility, activities of daily living (ADLs), quality of life, or social participation outcomes. Two independent investigators performed the eligibility decisions, data extraction, risk of bias, and assessed the quality of the evidence using the GRADE approach. Results Ten studies (five randomized controlled trials [RCTs]) involving 2149 participants were included. Most common targeted stroke survivors (n = 8); family caregivers were most frequently used to deliver the intervention (n = 4); and the intervention was usually provided in homes (n = 7), with training initiated in the hospital (n = 4). Of the four RCTs delivered by family caregivers, one demonstrated a statistically significant improvement in mobility (effect size: 0.3; confidence interval [CI] 121.81–122.19; [p = 0.04]) and another one in ADLs (effect size: 0.4; CI 25.92–35.08; [p = 0.03]). Of the five non-RCT studies by community health workers or volunteers, one demonstrated a statistically significant improvement in mobility (effect size: 0.3; CI 10.143–16.857; [p < 0.05]), while two demonstrated improved statistically significant improvement in ADLs (effect size: 0.2; CI 180.202–184.789 [p = 0.001]; 0.4; CI − 7.643–18.643; [p = 0.026]). However, the quality of evidence, based on GRADE criteria, was rated as low to very low. Conclusions While task-sharing is a possible strategy to meet basic rehabilitation needs in low-resource settings, the current evidence on the effectiveness of delivering rehabilitation interventions by non-professional community-level workers and informal caregivers is inconclusive. We can use the data and experiences from existing studies to better design studies and improve the implementation of interventions. Trial registration PROSPERO registration number: CRD4202231913