Home-based rehabilitation for people living with HIV in a resource-poor setting in KwaZulu-Natal, South Africa.

Doctoral degree. University of KwaZulu-Natal, Durban.This PhD thesis centres on a home-based rehabilitation intervention (HBR) for people living with HIV (PLHIV) in a resource-poor setting in KwaZulu-Natal, South Africa. South Africa has the highest number of people infected with HIV worldwide, with 6.4 million PLHIV out of an estimated global total of 36.7 million. Antiretroviral therapy (ART) has ensured that PLHIV are living longer lives. However, there is a wide range of evidence that shows that PLHIV are prone to a broad range of physical and cognitive disabilities. It is crucial that PLHIV are able to attain a good health-related quality of life and optimal functioning, to support the success of the wide roll out of ART in countries like South Africa. Rehabilitation and exercise have been shown to improve the quality of life and function of PLHIV but there are numerous barriers facing patients who need to access rehabilitation. This PhD study aimed to determine the effect of an alternative approach of service delivery, namely a disability-inclusive HBR intervention, on PLHIVs’ perceived disability, quality of life, functional mobility and functional capacity. The study was situated in a resource-poor, semi-rural community in KwaZulu-Natal, the province with the highest HIV prevalence in South Africa. The design of the study intervention was informed by the synthesis of the evidence from a scoping review on HBR interventions for PLHIV, which revealed a paucity of evidence, and the practical experience of the lead author as a rehabilitation practitioner working with PLHIV. Embedded in a wider investigation related to an alternative model of care, this novel intervention, undertaken through a randomised control trial methodology, found that HBR is a safe strategy for treating the functional limitations experienced by PLHIV and may further improve their quality of life. While participants in the intervention group showed greater improvements across all outcome measures, between-group differences were nonsignificant. The community healthcare workers, who were trained via a task shifting approach to implement this HBR programme, reported feeling empowered by the knowledge and skills they attained through this study and gave valuable advice for improving future interventions. A synthesis of the overall PhD study results demonstrated that this intervention satisfied a number of the fundamental principles of a model of care for the rehabilitation of PLHIV, developed in the same study location. By building on the successes of this PhD study and addressing the limitations of its design and process, researchers can design and implement new rehabilitation interventions that involve multidisciplinary collaboration and the screening and treatment of people with a wide range of chronic conditions. This research should be combined with advocacy efforts to ensure that theoretical findings are translated into policies and practices that benefit all PLHIV, particularly those in resource-poor communities

Challenging power and unearned privilege in physiotherapy: lessons from Africa

Power and unearned privilege in the profession of physiotherapy (PT) reside in the white, Western, English-speaking world. Globally, rehabilitation curricula and practices are derived primarily from European epistemologies. African philosophies, thinkers, writers and ways of healing are not practiced widely in healthcare throughout the globe. In this invited perspectives paper, we discuss the philosophies of Ubuntu and Seriti, and describe how these ways of thinking, knowing, and being challenge Western biomedical approaches to healthcare. We believe implementing these philosophies in the West will assist patients in attaining the health outcomes they seek. Further we call for Western professionals and researchers to stand in solidarity with their African counterparts in order to move towards a diversity of practitioners and practices that help to ensure better outcomes for all

Physical conditioning strategies for the prevention of concussion in sport : a scoping review

BACKGROUND : Concussion in sports has received a great deal of media attention and may result in short and longer-lasting symptoms, especially in adolescents. Although significant strides have been made in the identification and management of concussion, less is known about the primary prevention of this condition. The aims of this scoping review are to (1) summarize the current research of physical conditioning strategies to reduce or prevent concussion incidence in individuals participating in sport, especially adolescents, and (2) to identify gaps in the knowledge base. Our research question was what is known from the existing literature about physical preparation strategies to reduce or prevent concussion in adult and adolescent sports? METHODS: Three literature searches were conducted by information officers at two universities at six-month intervals, using five electronic databases (PubMed; WorldCat.org; Mendeley; EBSCOHost and Ovid MEDLINE). To increase the search range, subject experts were consulted and articles and reference lists were hand searched. A scoping review methodology identified eligible studies that analyzed physical preparation techniques on modifiable physical risk factors in athletes to reduce the incidence of concussion. The PRISMA-ScR checklist guided the reporting of the findings. RESULTS : A total of 1414 possible articles were identified, after duplicates removed, and articles analyzed against the inclusion and exclusion criteria, only 9 articles qualified for analysis. Two articles were found from studying reference lists. Thus, a total of 11 articles were included in the final evaluation for the purposes of this study. Data are reported from mostly adolescent subjects participating in nine different sports from three countries. Findings are presented with specific reference to previously recognized modifiable risk factors of concussion which include neck strength, neck size, cervical stiffness, type of sport, and pre-activity exercises. CONCLUSION : There is limited research examining the physical preparation of athletes, especially in adolescents, to reduce or prevent concussion, and conflicting evidence in the few small sample studies that were identified. This scoping review identifies the research gap for a potentially vital modifiable risk factor, notably in the physical preparation of children and adolescents to reduce or prevent sports-related concussion.https://sportsmedicine-open.springeropen.com/dm2022Physiotherap

Managers’ perceptions on the implementation of community-based rehabilitation in KwaZulu-Natal

Background: Community-based rehabilitation (CBR) is a World Health Organization (WHO) strategy for social inclusion, equalisation of opportunities and provision of essential services for people with disabilities (PWDs). Community-based rehabilitation is a multi-sectoral strategy that requires all stakeholders to participate equally in its implementation. KwaZulu-Natal has implemented CBR for over two decades, with various stakeholders at the forefront of implementation. However, the status of stakeholder engagement, collaboration and coordination is unknown. Objective: The objective of our study was to understand how CBR is implemented in KwaZulu-Natal and the roles of each stakeholder in its implementation, with a focus, on managers from government and non-governmental organisations. Method: A descriptive explorative approach using semi-structured interviews was used to collect data from 20 managers from various stakeholders involved in implementing CBR in KwaZulu-Natal. Data were transcribed and analysed using thematic analysis. Results: The findings revealed five dominant themes: (1) the understanding of concepts, (2) missed opportunities for implementing CBR, (3) barriers to implementing CBR, (4) benefits to implementing CBR and (5) recommendations for future implementation. Conclusion: A formal management structure with clear roles and responsibilities was fundamental for implementation. Collaboration, coordination and planning were believed to be the critical roles of managers in the implementation of CBR. Training, awareness and sharing of resources among stakeholders were also identified as important factors in implementing CBR in KwaZulu-Natal. Clinical implications: Our study will assist managers and clinicians to improve their planning and implementation of CBR

The epidemiology of injury and illness amongst athletes at the Indian Ocean Island Games, Mauritius 2019

Background: The Indian Ocean Island Games is a multi-sport event that occurs every four years and includes athletes from seven islands of the Indian Ocean. Objective: This study aims to describe the injury and illness epidemiology of the athletes participating during the 2019 Indian Ocean Islands Games. Material and Methods: This prospective cohort study recorded injury and illness cases from athletes who competed in these Games. All medical physicians received detailed instructions and training on data collection using an injury report form. All athletes (minor and adults) who provided consent, or consent given from the minors’ guardians, were included in this study. Athletes who did not provide consent for this study were excluded. Results: 1 521 athletes (531 women and 990 men) reported 12 injuries per 100 athletes (n=160) and 6 illnesses per 100 athletes (n=85). The percentage of distribution of injuries were highest in football and basketball. Most injuries occurred during competition compared with training Joint sprains were the most common type of injury (28%), followed by muscle strains (19%). Men suffered the majority of injuries (79% vs. 21%). Similarly, men sustained more illness than women (57% vs. 43%). Most illnesses affected the respiratory system (67%), and infection was the most common cause of illness (84%) in participating athletes. Discussion: These findings are similar to previous events in other parts of the world. However, unique ailments, not previously reported on, were discovered. Conclusion: Epidemiological data from this study can be inferred to athletes who compete in similar multi-sport events and/or Olympic Games in the Indian Ocean region

The perceptions of older people living with hiv/aids towards physical activity and exercise

Abstract Background Older people living with HIV (OPLWH) require significant levels of support, including healthcare and rehabilitation interventions. People living with HIV are living longer, but still experience health-related impairments that affect functional activity, participation in day-to-day interactions, livelihoods and overall quality of life. Physical activity and exercise should be included as part of the comprehensive medical management for OPLWH but the investigation of prior studies reveal a gap in understanding and prescription. Our study aimed to explore the perceptions of OPLWH about physical activity and exercise. Methods The study adopted a phenomenological, qualitative design, using in-depth interviews, to understand OPLWH perceptions of physical activity and exercise, and their need for, and access to, physical activity and exercise programmes in a community in South Africa. Nine [9] males and seven [7] females participated in the study. Results Sixteen individuals voluntarily participated in face-to-face, semi-structured interviews which took place at the healthcare facility where they received regular treatment. All participants were 50 years and older. Personal gratification and the ability to perform activities of daily living as well as participate in community activities were believed to be strong motivators for exercise participation, while barriers to exercise were attributed to physical health issues; lack of proper instruction as well as stigma associated with HIV status within their communities. Participants also favored a combination of aerobic, flexibility and strength activities, as well as proper supervision and instruction within a group exercise setting. Conclusion The qualitative nature of our study provided an in-depth understanding of the perceptions of OPLWH towards physical activity and exercise. Our study highlighted the factors that hinder adherence to physical activity and exercise in this population. Many indicated that they would love to engage in structured physical activity programmes, but did not know where, when or how to begin. Creating a suitable environment with proper supervision and instruction by suitably qualified health professionals are essential when developing a community-based exercise programme for OPLWH

Assessing home-based rehabilitation within the development of an integrated model of care for people living with HIV in a resource-poor community

Background: People living with HIV (PLHIV) are living longer lives but are at a greater risk of developing disability. South Africa has the largest antiretroviral therapy (ART) programme in the world, shifting HIV from a deadly to a chronic disease. The integration of rehabilitation into chronic care is therefore now crucial to ensure the highest quality of life of PLHIV. Aim: To describe how a home-based rehabilitation (HBR) programme adhered to the fundamental principles of a theoretical model of integrated care developed for the study setting in KwaZulu-Natal, South Africa. Method: The process and results from the HBR programme were assessed in relation to the model of care to ascertain which principles of the model were addressed with the HBR programme and which elements require further investigation. Results: The HBR programme was able to apply a number of principles such as evidence-based practice, task shifting to lay personnel, enabling patient-centred care and maximising function and independence of PLHIV. Other elements such as the adoption of a multidisciplinary approach, training on the use of disability screening tools and the use of evidence to influence policy development were more difficult to implement. Conclusion: It is possible to implement elements of the integrated model of care. Further research is needed to understand how principles that require further training and collaboration with other stakeholders can be implemented. The results of this study provide additional evidence towards understanding the feasibility of the theoretical model and what is required to adjust and test the full model

Physiotherapy postgraduate studies in South Africa: Facilitators and barriers

Aim: To investigate the facilitators and barriers to attaining a postgraduate physiotherapy degree in South Africa. Methods: A quantitative, cross-sectional design using an internet-based survey was employed. The population of the study included all qualified physiotherapists who had completed community service and who were on the South African Society of Physiotherapy e-mailing list at the time of the study. Results: In all, 425 valid responses were received. The study participants were predominantly white women with a mean age of 36.9 and the majority were working in private practice. A total of 20.5% of respondents had completed a master’s or doctoral degree in physiotherapy, while a further 13% of respondents were registered for a postgraduate degree in physiotherapy at the time of the study. Study participants who had obtained a postgraduate degree identified the same main barriers (namely cost/lack of financial support, family commitments and lack of time) and the same main facilitators (namely gaining of expertise, fulfilment of a personal goal and improvement of patient care) as participants who had not obtained a postgraduate degree. Participants who had not obtained a postgraduate degree were significantly more likely (p < 0.05) to report concerns regarding their own ability and a lack of motivation as barriers to further study. Conclusion: South African physiotherapists with and without a postgraduate degree reported common facilitators and barriers to pursuing postgraduate studies. In order to ensure that a greater number and diversity of physiotherapists see postgraduate studies as a worthwhile career option, stakeholders in health and education in both the South African public and private sectors need to be engaged to limit the barriers to postgraduate study and seek novel methods of making postgraduate study a more attractive option from a personal development and career perspective