Rehabilitation In South Africa Research Articles

The Rehabilitation Landscape in a Low-to-Middle-Income Country: Stakeholder Perspectives and Policy Implications-A Qualitative Study.

The need for rehabilitation is increasing on a global level due to a rise in non-communicable diseases, aging and medical advances, and in South Africa (SA), due to the quadruple burden of disease. More information is required regarding rehabilitation scope and practices in SA to optimize the provision of rehabilitation interventions in the context of the transforming health care sector in SA, a low-to-middle-income country (LMIC). The purpose of this study is to explore the perspectives of South African rehabilitation stakeholders on the landscape of rehabilitation in SA. A descriptive qualitative study, with an interpretive approach, was used to explore stakeholder perspectives on rehabilitation practices in the public health care sector of SA. Semi-structured interviews were conducted with 12 rehabilitation stakeholders. Data were analyzed using a combination of deductive and inductive processes to generate themes and categories. We identified 5 main themes, with subsequent categories and sub-categories. The themes include a composite definition of rehabilitation, core elements of rehabilitation provision, challenges affecting rehabilitation practices, the importance of policy implementation, and the progress of rehabilitation in SA. Despite a common understanding of rehabilitation practices in SA amongst stakeholders, many persistent challenges hamper the delivery of effective rehabilitation services. We recommend that further research explore the rehabilitation needs of end-users, together with collaborative research for priority setting on the translation of policy to practice ensuring equitable and quality rehabilitation service delivery.

Understanding the value of rehabilitation: Perspectives from South African Stakeholders.

The need for rehabilitation in South Africa has doubled between 1990 and 2017 and is expected to increase in the coming years. However, the rehabilitation needs of South Africans (and globally) remain largely unmet. Establishing a common understanding of the value of rehabilitation can inform clinical practice and policymaking to achieve Universal Health Coverage (UHC). This study aims to explore the value of rehabilitation services in South Africa's public healthcare sector by gathering perspectives from stakeholders. The goal is to inform policy decisions related to the implementation of National Health Insurance (NHI) in South Africa. The study used a phenomenological approach and interpretivist paradigm. Semi-structured interviews were conducted face-to-face, online, or telephonically with 12 stakeholders from various rehabilitation sectors. The value of rehabilitation was analysed and categorised into five main categories: context, service delivery, patient outcomes, economic and financial components, and collaboration within and between sectors. The value of rehabilitation was found to be multifaceted, because of the varying health, economic, and social challenges faced by many South Africans. The study identified components of value-based rehabilitation that should be prioritised in the proposed NHI of South Africa. Future research should explore all stakeholder perspectives, including patients, and provide empirical evidence of rehabilitation's economic and societal value. We highlight priority areas that are central to the value of rehabilitation in South Africa and other low- and middle-income countries (LMICs). Tailoring rehabilitation services to patient and community needs is crucial for achieving value-based care. Given South Africa's commitment to the United Nations Convention on the Rights of Persons with Disabilities, prioritising rehabilitation remains essential.

Visitor and vagrant seabirds admitted for rehabilitation in South Africa, 1993–2017

Visitor and vagrant seabirds admitted for rehabilitation in South Africa, 1993–2017

Rehabilitation Capacity in South Africa-A Situational Analysis.

Rehabilitation in South Africa (SA) operates independently of major health services and reforms, despite the increasing rehabilitation need. With the introduction of National Health Insurance (NHI), SA is facing another major health reform. Evidence is needed on the current SA rehabilitation situation, regarding shortcomings, opportunities, and priority strategic strengthening actions. We aimed to describe the current rehabilitation capacity in the SA public health sector, which serves the majority and most vulnerable South Africans. A cross-sectional survey was conducted in five provinces, using the World Health Organisation's Template for Rehabilitation Information Collection (TRIC). Participants were purposively selected for their insights and experiences of rehabilitation in specific government departments, health sectors, organisations, and/or services. TRIC responses were analysed descriptively. Participants explained how timely and effective rehabilitation produced long-term health, social, and economic benefits. Positive initiatives were reported for rehabilitation data collection, service design, and innovation. Challenges included inadequacies in human resources, the integration of rehabilitation at primary care, guidelines, and specialised long-term care facilities. The continuity of care across levels of care was sub-optimal due to inefficient referral systems. Promoting and improving rehabilitation nationally requires concerted, innovative, collaborative, and integrated efforts from multiple stakeholders within, and outside, the health system.

Development and evaluation of face and content validity of a survey to examine wound management by occupational therapists in hand therapy practice within the South African context

BACKGROUND: Wound management is internationally recognised as part of hand therapy practice. However, the role of occupational therapists in this area of upper limb rehabilitation in South Africa is unclear AIM: To develop and validate a survey to examine occupational therapists' wound management practices in hand therapy within the South African context METHODS: A sequential exploratory mixed methods study design was utilised to develop a survey. Thereafter, a panel of 11 occupational therapists with relevant experience in the field rated the relevance of survey items to produce item-content validity indices (I-CVIs RESULTS: An initial survey containing 27 questions containing 214 items was presented for review. Experts rated 171 items (69%) relevant with an I-CVI of 0.90-1.00. A further 32 items (13%) were rated relevant with an ICVI of >0.80 <0.90. A total of 45 items (18%) were irrelevant with I-CVIs <0.80. The final survey consisted of 19 questions containing 139 items, excluding those that obtained relevant demographic data CONCLUSIONS: The survey demonstrated good content and face validity but is limited to use with occupational therapists in South Africa. Validation for use with different populations in different settings is recommended Implications for practice This article offers researchers within the field of occupational therapy methodology for the development and validation of a survey. Suggestions for improving the overall validity of the survey are given. The survey may be used in future studies with occupational therapists providing hand injury care in South Africa. Use of the survey with different populations requires validation using the intended target population.

Knowledge and perception of occupational therapists and physiotherapists on the use of constraint-induced movement therapy for stroke rehabilitation in South Africa

BACKGROUND: Rehabilitation therapists are expected to manage upper extremities difficulties following stroke by using effective treatment approaches. Constraint-induced movement therapy (CIMT) facilitates upper extremity functional recovery in patients after stroke; however, in South Africa, its application is not well documented. AIM: To assess and compare the knowledge and perception of occupational therapists and physiotherapists on the use of CIMT for stroke rehabilitation in South Africa. METHODS: A descriptive cross-sectional design using a self-administered online questionnaire was distributed via the two national professional societies. Data were analysed descriptively and the Mann-Whitney U and Kruskal Wallis tests were used to make inferences RESULTS: Of 108 respondents, 49.1% (n=53) were occupational therapists, and 50.9% (n=55) physiotherapists. A higher level of education (p=0.037) and working specifically with stroke patients (p=0.050) are significantly associated with better CIMT knowledge and perception. The profession of the participants was not significantly associated with their knowledge and perception of CIMT. CONCLUSION: This study demonstrates gaps in the knowledge of CIMT as a treatment technique for upper extremity impairment following stroke. Although most respondents knew about CIMT, improved guidance and knowledge of CIMT are required to remediate knowledge gaps. This may assist in improving the feasibility of CIMT and thus promote its clinical application, given the prevalence of UE impairment in stroke patients managed by therapists.

Barriers and facilitators of using outcome measures in stroke rehabilitation in South Africa

Background/AimsDespite outcome measures being found to be useful in stroke rehabilitation, surveys have indicated that therapists do not use them regularly. The aim of this study was to identify outcome measures commonly used in the rehabilitation of patients with stroke in South Africa and the barriers and facilitators to their use.MethodsA mixed-methods study was used. A cross-sectional study using a self-administered questionnaire to establish the outcome measures used by physiotherapists was undertaken first, and then qualitative interviews of physiotherapists were carried out to establish the barriers and facilitators to the use of outcome measures used in stroke rehabilitation.ResultsThe most commonly used impairment level outcome measure was the Modified Ashworth Scale (84%), while for activity limitation and participation restriction the Berg Balance Scale (96%) and the Stroke Impact Scale (32%) were used. The factors found to have an influence on the choice of outcome measure included time taken to complete the outcome measure, ability to integrate the outcome measure into daily practice, funds to buy the outcome measure, and the physiotherapist's knowledge of the outcome measure.ConclusionsThe most commonly used outcome measures are the Modified Ashworth Scale, the Berg Balance Scale and the Stroke Impact Scale. Physiotherapists mainly use outcome measures that are freely available, easy to understand, not time consuming, require less space to administer and are meaningful to patients.

Community-based rehabilitation implementation for people with disabilities in South Africa: a protocol for a scoping review

BackgroundPeople with disabilities (PWDs) remain among the poorest and least empowered population. They experience limited access to basic services, especially in low- and middle-income countries (LMIC). The infringement of their human rights remains at an alarming level, despite the availability of the community-based rehabilitation (CBR) strategy and the United Nations Convention on the Rights of People with Disabilities (UNCRPD). CBR, as a strategy for poverty alleviation, social inclusion and equalisation of opportunity, has broadened its scope from a mere strategy for access to health and rehabilitation services to include education, livelihood, social inclusivity and empowerment. CBR is implemented across the world in the majority of LMIC signatories to the UNCRPD. South Africa is among the countries that are implementing CBR. However, the extent and the nature of implementation is not known. This study, therefore, aims to map out the empirical evidence of the implementation of CBR in South Africa.MethodThe study is a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Review (PRISMA-ScR) methodology. The information will be extracted and captured on a data charting template that will be used through each phase of the study. The review will be guided by the following research question validated by the amended population-concept-context framework according to the Joanna Briggs Institute methodology for scoping reviews: ‘An investigation into CBR implementation in South Africa.’ The search will be conducted in the following electronic databases Google Scholar, PubMed, Medline, and Cochrane, etc, using Boolean logic. Restrictions will be set for years (Jan. 2009–Dec. 2019), English language peer-reviewed studies based on South Africa. The search output will be screened for primary studies on Community based rehabilitation in South Africa. Two independent reviewers will conduct title and abstract screening to identify potential eligible studies. After which full-text screening on the potential eligible studies and assessed for inclusion by the two independent reviewers. The Mixed Method Appraisal Tool will be applied to assess the quality of the studies included in the review.DiscussionThe gathered evidence from the selected studies will be discussed in relation to the research questions using a narrative to identify and explore emergent themes. The review will provide a baseline of evidence on the implementation of CBR and will highlight gaps regarding the implementation of CBR in a South African Context. The gaps identified will be used to develop a framework that will guide implementation of CBR in South Africa.

Knowledge exchange enhances engagement in ecological restoration and rehabilitation initiatives

Effective knowledge sharing and community engagement can be major enablers in the pursuit of socially relevant benefits from ecological restoration and rehabilitation. Focusing on two ecological restoration and rehabilitation practitioner organizations and their workers, this paper evaluates perceptions of the extent to which short‐term knowledge exchange contributes to social goals in ecological restoration and rehabilitation in South Africa through (1) stakeholder engagement and awareness of community well‐being, and (2) knowledge enrichment. Data collected through impact questionnaires, participatory site visits, practical work exchange, focus group discussions, and a workshop are analyzed using thematic analysis framed by the International Principles and Standards for the Practice of Ecological Restoration #1 and #2. We explore participants' perceptions of knowledge exchange benefits and discuss implications for future collaboration in establishing long‐term knowledge exchange. Findings show that knowledge exchange is perceived to result in enhanced teamwork engagement, and strengthened knowledge on restoration techniques through mutual learning, inspiration, and a strengthened sense of community. Findings suggest that sustained knowledge exchange and engagement activities between different practitioner organizations is key to realize and transform short‐term perceived benefits into long‐term applied socioecological impacts across landscapes in dryland Africa. There is a need to progress from short‐term, horizontal learning, to long‐term (horizontal and vertical) knowledge exchange, to inform restoration project design and implementation.

Healthcare professionals’ perceptions of community-based rehabilitation in KwaZulu-Natal, South Africa

BackgroundPeople with disabilities (PWDs) continue to experience challenges with access to healthcare. Community-based rehabilitation (CBR) is an approach that advocates for equal opportunities and social inclusion of PWDs to enhance their quality of daily life. Healthcare professionals are crucial in the implementation of CBR. However, little is known about the perception of healthcare professionals on this approach to rehabilitation in South Africa.AimThis study sought to explore perceptions of healthcare professionals on CBR in the province of KwaZulu-Natal, South Africa.SettingThis study was located across four public healthcare facilities spanning districts to tertiary levels care in KwaZulu-Natal, situated in rural and peri-urban areas.MethodsAn explorative qualitative approach using focus group discussions was used to collect data from healthcare professionals employed at these public hospitals in the province. Twenty-five healthcare workers participated in four focus group discussions, with four to eight participants per group. Data were transcribed and analysed using thematic analysis.ResultsThe findings revealed four dominant themes, namely, the CBR conundrum, CBR enablers, perceived impediments to CBR implementation and a proposal for the implementation of CBR.ConclusionContinual promotion of, as well as education and training on, CBR for healthcare professionals, was understood as an imperative for the development and roll-out of CBR programmes in South African communities. Excellent communication about CBR programmes was described as key to ensuring social inclusion, quality of life and access to services for PWDs.

Estimating the costs and benefits of stroke rehabilitation in South Africa.

This paper explores the economic value of rehabilitation to South Africa, using a costed example of cerebrovascular accident (CVA) (stroke) rehabilitation. We report an economic modelling approach using a worked cost-effectiveness to validate the argument for the cost-saving benefits of stroke rehabilitation. South African health care, employing analysis of available secondary data from South African research and government reports. In line with international trends in stroke epidemiology, we focused on people who were employed prior to having their stroke, with return-to-work as the desired rehabilitation outcome. Not applicable. We used information on stroke rehabilitation and secondary data derived from grey and published literature, to determine if early stroke rehabilitation represents value for money from the government perspective. For our worked example, we used return-to-work rates, intervention costs, and the cost of rehabilitation services to estimate cost-savings as a result of an individualized workplace intervention. The cost of delivering the individualized intervention was estimated at R5633/patient. Combining survivor rates, return-to-work rate, and costs of the programme, a work intervention programme could result in a net saving of R133.1 million over 5 years (or about R26.6 per year (discount 3%). The value of rehabilitation should not be considered in terms of cost-effectiveness alone, but also as an investment for the country. A staged, prioritized approach should be considered in future South African national health budget.

Health system challenges affecting rehabilitation services in South Africa

Background The World Health Organization (WHO) recommends that access to rehabilitation is a human right. To date, however, rehabilitation in South Africa has not been a health priority. The focus has rather been on saving lives from communicable diseases such as HIV/AIDs and TB, which has been increasingly successful. Whilst more South Africans are now living with pharmacologically managed chronic, communicable diseases, they often suffer significant challenges to their physical and mental health. Moreover, there are many health conditions in South Africa that have not attracted as much attention, and which also compromise individuals’ capacity to contribute effectively to their own wellbeing, that of their families and communities, and to the general economy. These include birth trauma, degenerative neurological conditions, acquired injuries such as spinal cord damage, limb amputation or head trauma, and chronic noncommunicable diseases (heart or kidney disease, stroke). In the absence of robust prevalence studies, it is estimated that one-in-three adults suffer from at least one chronic health challenge. For South Africa not to invest in rehabilitation is counter-productive, as it means that a significant percentage of its population cannot contribute to its economy. In the face of scant health resources to underpin equitable rehabilitation services, evidence needs to be provided to demonstrate that for increased expenditure on rehabilitation, there will be increased return at individual, family, society, and country levels. Purpose This article presents challenges and solutions to ensure that South Africa can meet WHO 2030 Rehabilitation Goals for equitable provision of effective public rehabilitation services using the WHO’s health system building block framework. IMPLICATIONS FOR REHABILITATION To meet the challenge of providing rehabilitation for those in need requires country-specific, strategic, evidence-informed, and planned decisions in terms of best investment for highest return. Whilst there is sound international evidence for best-practice rehabilitation care, country-specific strategies are required to identify and address local barriers to evidence implementation. In South Africa, where rehabilitation has not been a priority to date, it is important that a planned and well-costed approach is taken to ensure provision of equitable, accessible, affordable, and evidence-based rehabilitation. Measuring social, economic, and educational return on investment from rehabilitation should be part of the South African service-delivery planning process. National data could be obtained through adding additional questions on disability to the national census and through local surveys and reports at various public health care facilities.

Outcomes after acute traumatic spinal cord injury in Botswana: from admission to discharge.

Prospective follow-up study. To increase the knowledge regarding clinical and functional outcomes after traumatic spinal cord injuries (TSCI) in a resource-constrained setting. A special focus was placed on secondary complications such as pressure ulcers. The national referral hospital in Gaborone, Botswana. The study included all patients admitted with an acute TSCI during a 2-year period (n=39). Data collection was conducted at the time of discharge, and clinical characteristics, length of stay and pressure ulcers were analysed using descriptive and inferential statistics. Completeness of injury and presence of pressure ulcers were the factors found to significantly prolong hospitalization, which was 5 months (median). One patient died before discharge and one was discharged to rehabilitation in South Africa; all other patients were living with close or distant family members after discharge. Patients were supplied with electrical or manual active wheelchairs. Self-catheterization or suprapubic catheters were the main methods for bladder management, and ano-rectal stimulation to manage the bowel. Pressure ulcers, urinary tract infections and pain were the most frequent complications during in-patient care. Rehabilitation of patients with TSCI in Botswana has been going through big changes, and new rehabilitation objectives, such as techniques used for the management of bladder and bowel dysfunctions and the provision of technical aids, have been implemented, which likely can contribute to an overall improvement in the outcomes. However, basic care at the general wards is still lagging behind, causing high rates of pressure ulcers that significantly extend hospitalization periods.

Bridging the gap: investigating challenges and way forward for intersectoral provision of psychosocial rehabilitation in South Africa.

BackgroundIntersectoral collaboration between government sectors such as Health and Social Development and non-governmental organisations (NGOs) in communities is crucial for provision of psychosocial rehabilitation (PSR) for those with severe mental illness. This study aims to provide recommendations for strengthening such intersectoral collaboration in South Africa and with relevance to other low and middle income countries (LMIC), particularly African countries.MethodsTwenty-four in-depth semi-structured interviews were conducted with 16 key informants from the South African Department of Health, two key informants from the Department of Social Development, four key informants from the NGO sector and one key informant from a service user organisation at national level. Framework analysis was conducted with NVivo 10 software.ResultsChallenges to intersectoral work identified were lack of communication between sectors, problems delineating roles, and each sector’s perception of lack of support from other sectors. Participant-identified strategies for addressing these challenges included improving communication between sectors, promoting leadership from all levels and formalising intersectoral relationships through appropriate written agreements; as well as ensuring that the available resources for PSR are effectively re-directed to district level.ConclusionsThis study has outlined several directions for progress to address challenges for intersectoral working for PSR in South Africa. These may be of relevance to other LMIC, particularly those in Africa. Political will and a long-term view will be necessary to realise these strategies.

Vulture rescue and rehabilitation in South Africa: An urban perspective

South Africa is home to 9 vulture species, of which 7 are endangered. While the cause of the population declines remains largely speculative, a vast amount of effort has been dedicated towards the protection of populations by ensuring sustainable and safe food sources for the various colonies. Limited focus was placed in the past on efforts related to the rescue and/or rehabilitation (R&R) of injured birds and the release of these birds back into the wild. This paper provides an overview of the causes, the impact and success of 3 organisations involved in R&R efforts of vultures in the Magaliesberg mountain range and surrounding areas over a period of 10 years. Study material included 162 Cape griffon (CGV) and 38 African white-backed (AWBV) vultures. Datasets include the number, sex and age of birds received, the reason the vultures were brought in for R&R, surgical interventions performed and outcomes of rescue efforts. The CGV dominated the rehabilitation attempts. Results further show that a large number of apparently healthy birds were presented for veterinary treatment. The R&R data clearly indicate that the major cause of injuries was birds colliding with overhead pylons, as a high number of soft tissue and skeletal injuries were observed. The study also shows that successful releases of rescued birds are possible. It is concluded that urbanisation has had a major negative impact on vultures around the Magaliesberg mountain range.

Hierarchical spatial organization and prioritization of wetlands: a conceptual model for wetland rehabilitation in South Africa

Wetland rehabilitation planning needs to take into account many different aspects of the wetland and its context. In South Africa, much emphasis is placed on the delivery of ecosystem services, poverty relief and skills development for those involved in labour-intensive rehabilitation measures. A framework is presented that facilitates decision-making with regards to wetland rehabilitation planning. This starts with prioritizing which wetlands need attention within a catchment. This is followed by decisions regarding which rehabilitation measures would be effective in improving certain ecosystem services based upon the aims of rehabilitation and the social context of the surrounding catchment. The functional unit that is most suitable to work with for rehabilitation is the Hydrogeomorphic (HGM) Unit, defined as a section of a wetland with more or less uniform hydrological and geomorphological characteristics. An individual wetland may comprise several HGM units, and a HGM Unit itself can be sub-divided into several smaller habitat or vegetation units. Different rehabilitation measures have been identified which are appropriate for the different scales in this spatial framework. Two case studies are presented as examples of how this spatial framework impacts upon the decisions made by the rehabilitation practitioner.

A survey of wildlife rehabilitation in South Africa: is there a need for improved management?

AbstractThe focus of wildlife rehabilitation is the survival of the individual animal, often leading to rehabilitators being in conflict with government wildlife officials, who regulate the industry and whose focus is on the security of entire wildlife communities. In South Africa, wildlife rehabilitation has been the focus of recent attention from the general public, government and academics, due mostly to the development and adoption of norms and standards for the management of primates. Our study was initiated to provide the first survey of rehabilitation centres in South Africa. Questionnaires were returned by 65% known rehabilitation centres in South Africa, including all nine Provinces, through which several thousand injured, diseased and orphaned animals pass each year. It is clear there is a need for rehabilitation centres in South Africa. However, due to a lack of scientific research on the efficacy of rehabilitation methods for care and release, and minimal post-release monitoring, wildlife rehabilitation techniques and protocols have been based on work experience and subjective intuition. In conjunction with a lack of funds, there may be negative impacts on individual animal welfare and survival, as well as on conservation efforts for wildlife communities. Similar issues have been documented in other regions of the world. In the authors’ opinion, centralisation of wildlife rehabilitation to national or provincial government is a necessity. Furthermore, it is suggested that guidelines of minimum standards should be developed in consultation with experienced rehabilitators, veterinarians and conservation scientists; to be enforced by trained and dedicated conservation officials.

Developing a Curriculum Module to Prepare Students for Community-Based Physiotherapy Rehabilitation in South Africa

Background and purpose With the rapid turnover and consequent demand for hospital beds and the inadequate number of physiotherapists, increasing numbers will need to work in community settings in South Africa in the future. Education of students at the University of Cape Town was required to move away from a disease-centred, hospital-based curriculum to a community-based programme in order to meet the rehabilitation needs of the majority of the disabled population in the country. The aim of this study was to identify the gaps in the undergraduate curriculum and to make the required curricular changes to ensure that, on graduation, the students would be competent and confident to work in community settings. Methods A module on community physiotherapy preceded a four-week placement in an historically disadvantaged community with no access to rehabilitation facilities. Seventy-five students provided severely disabled persons and their caregivers with rehabilitation and education programmes in their homes. The students were provided with two sessions of clinical supervision weekly. At the end of the placement they were examined on their ability to treat patients in a home environment and were also scored on their block performance over the month. Students evaluated the placement as a learning experience and the clinical supervisors kept records throughout the two years on gaps in the content of the community physiotherapy module. Findings The majority of students found the placement a valuable learning experience and suggested that it should be developed into a multi-disciplinary student rotation. The clinical supervisors identified several topics that were essential to include in the community physiotherapy module to help the students in moving from a medical model to a bio-psychosocial model in the management of their clients. Conclusion The study achieved its aim of identifying the gaps in the existing undergraduate programme that needed to be addressed in order to prepare students to be competent and confident to practise in community settings on graduation. Changes to the curriculum were done incrementally during the year and also at the beginning of each of two years. These have been in operation for the past five years. With the rapid turnover and consequent demand for hospital beds and the inadequate number of physiotherapists, increasing numbers will need to work in community settings in South Africa in the future. Education of students at the University of Cape Town was required to move away from a disease-centred, hospital-based curriculum to a community-based programme in order to meet the rehabilitation needs of the majority of the disabled population in the country. The aim of this study was to identify the gaps in the undergraduate curriculum and to make the required curricular changes to ensure that, on graduation, the students would be competent and confident to work in community settings. A module on community physiotherapy preceded a four-week placement in an historically disadvantaged community with no access to rehabilitation facilities. Seventy-five students provided severely disabled persons and their caregivers with rehabilitation and education programmes in their homes. The students were provided with two sessions of clinical supervision weekly. At the end of the placement they were examined on their ability to treat patients in a home environment and were also scored on their block performance over the month. Students evaluated the placement as a learning experience and the clinical supervisors kept records throughout the two years on gaps in the content of the community physiotherapy module. The majority of students found the placement a valuable learning experience and suggested that it should be developed into a multi-disciplinary student rotation. The clinical supervisors identified several topics that were essential to include in the community physiotherapy module to help the students in moving from a medical model to a bio-psychosocial model in the management of their clients. The study achieved its aim of identifying the gaps in the existing undergraduate programme that needed to be addressed in order to prepare students to be competent and confident to practise in community settings on graduation. Changes to the curriculum were done incrementally during the year and also at the beginning of each of two years. These have been in operation for the past five years.

Consulting the South African experts in physiotherapeutic stroke rehabilitation

This paper presents the opinions of expert physiotherapists on what constitutes optimal stroke rehabilitation in South Africa. Data were collected by the use of the Delphi technique. Consensus was reached after two rounds, and the respondents’ views are summarised and discussed within the framework of South African health care. Results showed that physiotherapy was felt to be very important after stroke, and the survey created a profile of the skills that physiotherapists may require in order to work in this field. However, no new or innovative methods by which appropriate rehabilitation services could be delivered in South Africa were generated by the survey.The Delphi technique is described and its use in this survey considered.

The Challenge of Service Provision in South Africa for Patients with Hemiplegia

Hemiplegia is a major cause of disability, requiring extensive long-term rehabilitation. In South Africa this has traditionally taken the form of intensive individual treatment in secondary and tertiary government hospitals. The country’s new democratic government has prioritised primary health care as a solution to addressing the present inadequate health services, resulting in the need for a more community-oriented approach to rehabilitation. This article explores various approaches and constraints to improving the accessibility of comprehensive rehabilitation in South Africa. It concludes that an analysis of the needs of the local hemiplegic patient population is necessary in order to plan a relevant rehabilitation programme. This may require modification of undergraduate physiotherapy education.