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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. 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. 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. [ABSTRACT FROM AUTHOR]

Rationale: Clinical practice guidelines (CPGs) should provide busy health care professionals with easy‐to‐use tools that support efficient uptake of current best evidence in daily clinical practice. However, CPG uptake rarely occurs at the speed of evidence production. The aim of this study was to explore the factors influencing CPG uptake among South African (SA) physiotherapists (PTs). Method: An exploratory, descriptive qualitative study design was used, within an interpretative research paradigm. A phenomenological approach was taken, as the study aimed to explore the phenomenon of CPG uptake by SA PTs and how the themes and subthemes related to each other within this phenomenon. Semistructured interviews were undertaken via telephone calls that were audiotaped and independently transcribed. An inductive and deductive thematic content analysis approach was taken where the transcript content was analysed by hand. Findings Thirty‐one PTs from the private, public, and education sectors participated in the interviews. The main themes identified were resources, training, and organizational factors. The SA PT workforce, particularly that in the public sector, is limited and patient load and need is high. Time to implement and stay up‐to‐date with current evidence were barriers for many interviewees. Participants also perceived CPG uptake as not being financially rewarding. Training in CPG uptake was mostly perceived as a facilitator, and the PTs felt that they would be more inclined to implement CPGs if they felt more confident in how to source and use CPGs, particularly if they were incentivized to undertake such training. Roles, responsibilities, and power in the health care team were perceived as being both organizational barriers and, conversely, facilitators, depending on work environments. Conclusions: The findings of this study generally concur with previous studies about PT barriers to CPG uptake; however, it provides novel information on barrier contexts in one LMIC with complex PT service delivery. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background & Objectives: Most medical complications following acute stroke are preventable (such as cardiac events, pneumonia, bed sores and venous thrombosis). This was a study on the frequency of medical complications and their association with key performance indicators. Methods: The study used a cross-sectional baseline audit of stroke care practices. The audit captured details on the nature of the stroke, patient demographics, characteristics of hospital care, and compliance with six key quality indicators in Philippine Academy of Rehabilitation Medicine Clinical Practice Guideline on Stroke Rehabilitation. Patient records were retrospectively consecutively sampled. Results: A total of 1,683 patients were included in the audit which came from 49 hospitals. Medical complications were seen in 182 patients (11.2%). Pneumonia contributed to half the medical complications (50%), followed by respiratory failure (7.7%) and gastrointestinal bleeding (3.8%). Presence of medical complications were associated with in-patient mortality (OR 3.3 (95% CI 2.1-5.3)) and prolonged hospital stay (16.1 ± 20.7 days vs 9.6 + 10.9 days). The best predictor model for pneumonia included variables of not having a swallow screen within the first 24 hours, having a nasogastric tube inserted, not achieving medical stability, not having a stroke unit in the admitting hospital, having suffered a previous stroke and being older. Conclusion: Non-adherence to evidence-based stroke care rehabilitation guidelines contributed significantly to medical complications in an audit of Filipino stroke patients. [ABSTRACT FROM AUTHOR]

Copyright of International Journal for Quality in Health Care is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Clinical practice guidelines need to be regularly updated with current literature in order to remain relevant. This paper reports on the approach taken by the Philippine Academy of Rehabilitation Medicine (PARM). This dovetails with its writing guide, which underpinned its foundational work in contextualizing guidelines for stroke and low back pain (LBP) in 2011. Methods: Working groups of Filipino rehabilitation physicians and allied health practitioners met to reconsider and modify, where indicated, the 'typical' Filipino patient care pathways established in the foundation guidelines. New clinical guidelines on stroke and low back pain which had been published internationally in the last 3 years were identified using a search of electronic databases. The methodological quality of each guideline was assessed using the iCAHE Guideline Quality Checklist, and only those guidelines which provided full text references, evidence hierarchy and quality appraisal of the included literature, were included in the PARM update. Each of the PARM-endorsed recommendations was then reviewed, in light of new literature presented in the included clinical guidelines. A novel standard updating approach was developed based on the criteria reported by Johnston et al. (Int J Technol Assess Health Care 19(4):646-655, 2003) and then modified to incorporate wording from the foundational PARM writing guide. The new updating tool was debated, pilot-tested and agreed upon by the PARM working groups, before being applied to the guideline updating process. Results: Ten new guidelines on stroke and eleven for low back pain were identified. Guideline quality scores were moderate to good, however not all guidelines comprehensively linked the evidence body underpinning recommendations with the literature. Consequently only five stroke and four low back pain guidelines were included. The modified PARM updating guide was applied by all working groups to ensure standardization of the wording of updated recommendations and the underpinning evidence bases. Conclusions: The updating tool provides a simple, standard and novel approach that incorporates evidence hierarchy and quality, and wordings of recommendations. It could be used efficiently by other guideline updaters particularly in developing countries, where resources for guideline development and updates are limited. When many people are involved in guideline writing, there is always the possibility of 'slippage' in use of wording and interpretation of evidence. The PARM updating tool provides a mechanism for maintaining a standard process for guideline updating processes that can be followed by clinicians with basic training in evidence-based practice principles. [ABSTRACT FROM AUTHOR]

Background: Pulmonary rehabilitation (PR) is recommended in the management of people with chronic obstructive pulmonary disease (COPD), but referral to this service is low. Aims: To identify barriers to, and facilitators for, referral to PR programmes from the perspective of Australian general practitioners. Methods: Semi-structured interviews were conducted with general practitioners involved in the care of people with COPD. Interview questions were informed by a validated behavioural framework and asked about participants' experience of referring people with COPD for PR, and barriers to, or facilitators of, this behaviour. Interviews were audiotaped, transcribed verbatim, and analysed using content analysis. Results: Twelve general practitioners participated in this study, 10 of whom had never referred a patient to a PR programme. Four major categories relating to barriers to referral were identified: low knowledge of PR for COPD; low knowledge of how to refer; actual or anticipated access difficulties for patients; and questioning the need to do more to promote exercise behaviour change. Awareness of benefit was the only current facilitator. Three major categories of potential facilitators were identified: making PR part of standard COPD care through financial incentive; improving information flow with regard to referrals and services; and informing patients and public. Conclusions: Significant barriers to referral exist, but opportunities to change the organisation of practice and information management were identified. Behaviour change strategies which directly target these barriers and incorporate facilitators should make up the key components of interventions to improve referral to PR by general practitioners who care for people with COPD. [ABSTRACT FROM AUTHOR]

Background: Screening for risk of functional decline in the elderly is increasingly important in ambulatory health care settings, to ensure that appropriate services are provided to reduce the risk of downstream decline. These screening tools should have sound psychometric properties and clinical utility. Design: An updated systematic literature review for (1) new screening tools published since the last review, conducted in 2007 and published in 2008, and (2) recent research into psychometric properties of the five tools identified in the previous review. Methods: A comprehensive review of multiple databases using the search terms from the Sutton et al review was conducted. The reference lists of included articles were hand-searched for additional articles, and the literature was evaluated with the appropriate critical appraisal tool. Included screening tools should be designed for, or applicable to, hospital emergency departments. Results: Two relevant new tools were identified (the Simplified PROFUNCTION index and Brief Risk Identification for Geriatric Health Tool). Six additional papers testing psychometric properties of four of the five previously reported screening tools were also found. Conclusion: Seven relevant screening tools are available with similar validity and reliability estimates. They consider similar constructs and have convincing evidence of applicability to a range of older populations, or different cultures. Identification of Seniors at Risk, is the most frequently reported screening tool. The wider unanswered question is how, why, and where these functional decline screening tools are used; how valid the findings are on ill, stressed, older people in emergency departments; and how the findings are acted upon in terms of community intervention to slow functional decline. [ABSTRACT FROM AUTHOR]

Background: Stress urinary incontinence (SUI) is a prevalent and costly condition which may be treated surgically or by physical therapy. The aim of this review was to systematically assess the literature and present the best available evidence for the efficacy and effectiveness of pelvic floor muscle training (PFMT) performed alone and together with adjunctive therapies (eg biofeedback, electrical stimulation, vaginal cones) for the treatment of female SUI. Methods: All major electronic sources of relevant information were systematically searched to identify peer-reviewed English language abstracts or papers published between 1995 and 2005. Randomised controlled trials (RCTs) and other study designs eg non-randomised trials, cohort studies, case series, were considered for this review in order to source all the available evidence relevant to clinical practice. Studies of adult women with a urodynamic or clinical diagnosis of SUI were eligible for inclusion. Excluded were studies of women who were pregnant, immediately post-partum or with a diagnosis of mixed or urge incontinence. Studies with a PFMT protocol alone and in combination with adjunctive physical therapies were considered. Two independent reviewers assessed the eligibility of each study, its level of evidence and the methodological quality. Due to the heterogeneity of study designs, the results are presented in narrative format. Results: Twenty four studies, including 17 RCTs and seven non-RCTs, met the inclusion criteria. The methodological quality of the studies varied but lower quality scores did not necessarily indicate studies from lower levels of evidence. This review found consistent evidence from a number of high quality RCTs that PFMT alone and in combination with adjunctive therapies is effective treatment for women with SUI with rates of 'cure' and 'cure/improvement' up to 73% and 97% respectively. The contribution of adjunctive therapies is unclear and there is limited evidence about treatment outcomes in primary care settings. Conclusion: There is strong evidence for the efficacy of physical therapy for the treatment for SUI in women but further high quality studies are needed to evaluate the optimal treatment programs and training protocols in subgroups of women and their effectiveness in clinical practice. [ABSTRACT FROM AUTHOR]

This paper compares patient and episode characteristics in allied health services delivered in country and metropolitan hospitals. Eight public hospitals (46 allied health services) participated in the study (three country and five metropolitan sites, situated in South Australia, Queensland and Tasmania). Standardised rates of patient throughput were similar for country and metropolitan allied health services, despite smaller numbers of country staff providing services to larger geographical areas. Although the differences were not significant, country patients were generally older and had more chronic conditions than metropolitan patients. Fewer country patients than metropolitan patients were eligible for rebates in the private sector. In addition, fewer alternative services were available in country communities, which heightened the role of the public hospital outpatients services within the community. This paper provides an argument for similar funding arrangements for country and metropolitan ambulatory allied health services. [ABSTRACT FROM AUTHOR]