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Objectives To explore the perspectives of people with osteoarthritis (OA) on the use of digital technology into their rehabilitation program, including their awareness, views on accessibility, affordability and willingness to accept digital modalities for rehabilitation delivery. Methods A qualitative, descriptive design was conducted. Patients with OA who receive care at a public community rehabilitation centre in the Western Cape, South Africa were eligible to participants. Semi-structured interviewed were conducted and Atlas.ti 23 software was used for thematic analysis. Results The findings showed that the participants had limited awareness and exposure to telerehabilitation (TR), along with minimal digital literacy and skills. They were sceptical about the effectiveness of TR and concerned about the inherent lack of physical interactions with health professionals. However, some acknowledged TR's potential benefits for accessibility, convenience, family involvement and long-term community health improvement. Participants were willing to learn more about TR. Conclusion Considering the benefits of TR in lower resource settings such as South Africa, investment to increase awareness and patient education and training in TR may assist in enhancing access and quality of care. Resources dedicated to TR and management buy-in in low-and-middle income countries (LMICs) is necessary to facilitate the fit-for-context roll-out of TR.

Background: Implementing evidence-informed clinical practice recommendations is important for managing chronic musculoskeletal pain (CMSP) to address the multidimensional impact of the condition. Successful implementation of recommendations requires understanding the multiple context factors that influence CMSP management in different settings. Aim: This study aims to explore contextual factors that could influence the implementation of evidence-informed clinical practice recommendations for the primary health care of adults with CMSP. Setting: The study focused on the primary health care (PHC) sector in Cape Town, South Africa. Methods: A qualitative descriptive study was conducted. A multidisciplinary panel of 13 local health care professionals participated in focused group discussions. The participants considered multimodal clinical recommendations derived from published clinical practice guidelines. In four focus group discussions (three or four members per group), the panel generated and documented context factors that would influence implementing the recommendations in practice. Inductive content analysis was performed to identify categories and themes. Results: The five contextual themes generated indicated health care system organisation, human resource requirements, provider practice patterns, patient empowerment and integration into policy as imperative for the successful implementation of recommendations. Conclusion: There are diverse context factors that could influence the implementation of clinical recommendations for managing CMSP in PHC settings. Identifying these factors as barriers or facilitators is beneficial for developing effective knowledge translation strategies. Contribution: The study findings indicate that an integrated systems approach supported by health care policy and multisectoral collaboration is needed to successfully implement clinical recommendations to address the impact of CMSP.

Background: Knee replacement surgery can significantly improve the quality of life of patients with severe knee osteoarthritis. Equitable access to knee replacement surgery is important to ensure that everyone, regardless of their socioeconomic status or geographical location, have fair and timely access. Objectives: The aim of our study was to (1) describe the health equity profile and quality of life of patients awaiting knee replacement at a single academic hospital in South Africa and to (2) describe the association between these health equity factors and the waiting time. Method: A cross-sectional survey and retrospective record review of patients awaiting knee replacement was conducted using the PROGRESS-Plus health equity framework. Chi-square statistics were used to calculate association between health equity factors and the waiting time. Results: Three-hundred and two (N = 302) patients (77% female; mean age 67 years) participated, of whom one in three patients waited 5 years or longer for surgery. Elderly patients ( 70 years) and patients from lower socio-economic background were less likely to have equitable access to surgery. Conclusion: The current screening protocol for knee replacement surgery in the public health care sector does not provide equitable access to surgery. A more holistic screening approach alongside selective surgical prioritisation and rehabilitation could reduce the waiting list and facilitate equitable access to care. Clinical implications: Health equity factors such as socioeconomic status, age, and other patient characteristics such as life roles and employability should be taken into consideration when screening patients for elective knee replacement waiting lists.

Background: Understanding health-related quality of life (HRQOL) among people with HIV (PWH) can inform strategies to maintain or improve health and functioning. Most HRQOL research has focused on resource-rich settings, underrepresenting younger cohorts in low-resource settings. Objectives: To assess HRQOL and associated factors in PWH visiting two primary healthcare clinics in the Western Cape, South Africa. Method: A cross-sectional study included 48 PWH (58.3% women; mean age: 39.2 [10.3]). Health-related QOL was assessed using EQ-5D-5L descriptive domains, visual analogue scale (EQ-VAS), and index score (EQ-index). Mobility was assessed using clinical tests. Tobit regression determined associations. Results: Mean and median EQ-VAS scores were 88.14 (16.35) and 95.00. Mean and median EQ-index scores were 0.84 (0.10) and 0.90. PWH reported problems as pain/discomfort (35.4%), depression/anxiety (25.0%), mobility (22.9%), usual activities (18.7%) and self-care (12.5%) domains. Slow chair rise (p = 0.012), low income (p = 0.030), longer HIV duration (p = 0.009) and polypharmacy (p = 0.034) were associated with lower HRQOL. Antiretroviral therapy (ART) adherence was associated with higher HRQOL (p = 0.020). Conclusion: Despite high overall HRQOL, specific domains presented challenges to PWH. Health-related QOL was associated with chair rise repetitions, income, HIV duration, polypharmacy, and treatment adherence. Comprehensive care and contextualised interventions to address these through rehabilitation, including health promotion, are proposed strategies for future investigation. Clinical implications: Clinicians should be cognisant of potential physical and mental functioning problems, and factors related to drug therapy, socio-economic status and disease duration that may affect HRQOL even in seemingly unimpaired PWH.

Background: Chronic musculoskeletal pain (CMSP) is prevalent globally and places a significant burden on individuals, healthcare systems and economies. Contextually appropriate clinical practice guidelines (CPGs) on CMSP are advocated to translate evidence into practice. Aim: This study aimed to investigate the applicability and feasibility of evidence-based CPG recommendations for adults with CMSP in the primary health care (PHC) sector of South Africa (SA). Setting: The PHC sector in South Africa (SA). Methods: Consensus methodology was used, comprising two online Delphi rounds and a consensus meeting. A multidisciplinary panel of local healthcare professionals involved in CMSP management was purposefully sampled and invited to participate. The first Delphi survey considered 43 recommendations. In the consensus meeting, the results of the first Delphi round were discussed. The second Delphi round reconsidered the recommendations with no consensus. Results: Seventeen experts participated in the first Delphi round, 13 in the consensus meeting and 14 in the second Delphi round. In Delphi round two, 40 recommendations were endorsed, three were not endorsed and an additional recommendation was added. Conclusion: A multidisciplinary panel endorsed 41 multimodal clinical recommendations as applicable and feasible for the PHC of adults with CMSP, in SA. Although certain recommendations were endorsed, they may not be readily implementable in SA because of context factors. Contribution: The study forms the basis of a model of care for contextually relevant PHC of CMSP. Future research should explore factors that could influence the uptake of the recommendations into practice to optimise chronic pain care in SA.

Background: Medical professionals working in an elite sport environment have the challenging task to balance the athlete’s readiness to return to the playing field after severe injury with other stakeholders’ (coaches, sponsors, teammates) opinions and objectives. Objectives: Our study aimed to evaluate differences in the physical profiles of elite rugby players at return to play (RTP) after a severe knee injury, compared with their pre-injury profiles and matched controls. Method: Before the injury, participants performed four performance tests during their preseason screening. These tests were repeated and compared to baseline once a player was declared fit to play. Results: Significant differences (p ≤ 0.05) were found in the injured players’ group who were slower over 10 m speed, in their decision-making time and the total time of the reactive agility tests at RTP, whilst controls were significantly faster over 10 m and 30 m speed tests. The countermovement jump outcomes showed significant improvement in the uninjured participants (p ≤ 0.05). Conclusion: Our study highlights that injured players’ running speeds and decision-making times are slower after injury. The uninjured players have a positive outcome to training and match stimulus by improving their running speed and lower body explosive power during the season. Clinical implications: Our study provides insight into the RTP profile of elite rugby players, and a novel finding was the decision-making time deficit. This highlights the importance of cognitive training during injury rehabilitation as athletes make numerous decisions in a pressured and uncontrolled environment during a match. Speed training development is recommended as the athletes were slower after severe knee injury.

Background: Osteoarthritis (OA) is a heterogenous degenerative disorder often causing destructive joint changes with severe pain and functional disability. Modifiable and non-modifiable risk factors, social context and psychological factors influence the development and progression of the disease. Total knee replacement (TKR) aims at reducing pain and improving function and is more successful with pre-operative and post-operative rehabilitation. However, most international research on rehabilitation interventions is conducted in high income contexts. Objective: The aim of our systematic review is to gain an overview of the demographic and social profiles of adults undergoing TKR for primary knee OA in lower, middle- and high-income countries through a health equity lens to inform the translation of intervention research in local contexts. Methods: A systematic review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Eligibility criteria include observational studies and grey literature (theses) since the beginning of the databases reporting on demographic data of adults awaiting or undergoing TKR surgery. The PROGRESS-Plus framework will be used to describe equity elements. Results: A narrative summary and description of the global profile of individuals undergoing total knee replacement for osteoarthritis. Conclusion: A snapshot of the global demographic and social profile of individuals receiving TKR for primary knee OA through an equity lens will shed light on the similarities and differences between individuals from different contexts. Global demographic profile information may inform or assist in the development of translational strategies for evidence-based rehabilitation. Clinical implications: Translation of existing rehabilitation interventions to local contexts could improve pre-operative and post-operative outcomes for individuals on our surgical waiting lists.

Background: Anterior knee pain (AKP) commonly affects both physically active and sedentary individuals and the aetiology is unknown. Altered joint position sense (JPS) impacts accurate motor action and knee joint stability. It is unclear whether people with AKP have altered JPS. Objective: The aim of our study was to investigate JPS in the knees of individuals with AKP. Method: A descriptive cross-sectional study measured JPS in 25 participants with unilateral or bilateral AKP. JPS was measured using active JPS testing during single leg squat (SLS) and active knee extension (AKE) in sitting. Target angles (TA) were self-determined based on each participant’s capabilities. The absolute error (AE) was the main outcome measure. Impaired JPS was classified as an AE equal to or greater than five degrees. Results: There were no significant differences in JPS when comparing the affected and unaffected knees in participants with AKP (p 0.05). However, a subgroup of participants with altered knee JPS was identified. There was a tendency towards greater knee flexion in the TAs of knees without AKP. Conclusion: Our results showed that JPS is not significantly more impaired in knees with AKP compared with knees without AKP in a group of individuals with AKP. A subgroup with altered JPS in knees with and without AKP was identified. This finding could be because of compensatory gait patterns and the precision of the Vicon 3D motion analysis system. Clinical implications: Joint position sense should be assessed bilaterally in individuals with AKP.

Background: Idiopathic scoliosis (IS) is a common musculoskeletal condition with a multi-factorial aetiology characterised by a three-dimensional torsional deformity of the spine. Objectives: To ascertain the current level of knowledge on IS among registered practising physiotherapists who expressed an interest in orthopaedic, muscular, manual and manipulative therapy in South Africa (SA). Method: An online survey was used to collect the data. The questions were based on an existing questionnaire, validated by a South African panel of experts in the field of musculoskeletal physiotherapy and updated based on the 2016 Society of Scoliosis Orthopaedic Rehabilitation Treatment (SOSORT) guidelines for the assessment and management of IS. Results: Two hundred and twenty-three physiotherapists spread across the nine provinces of SA met the inclusion criteria and were included in our study. Our findings showed that about one-third (33.6%) of the physiotherapists could answer more than 50% of these questions correctly, and 16.5% could answer 70% of the questions correctly in relation to the widely accepted guidelines on IS management. Conclusion: The participants had a poor understanding of the diagnosis and treatment involved in managing patients with IS and a lack of knowledge regarding the methods of conservative treatment for scoliosis. Future studies should be aimed at assessing intervention strategies to improve the knowledge of IS in physiotherapists in SA, especially regarding diagnosis and identifying appropriate management strategies. Clinical implications: Physiotherapists are often the first contact practitioners for patients presenting with scoliosis and therefore need to have the necessary clinical knowledge on the assessment and management of IS. Our study can improve the awareness among the South African physiotherapists regarding IS and its complex presentation and management.

Background: Patellofemoral pain (PFP) is a common and complex condition. The diagnosis and causal mechanisms are not well understood and therefore the long-term prognosis tends to be poor. Exercise is currently the only evidence-based treatment strategy suggested to improve pain and function in the long term. However, no qualitative studies have been conducted to establish patients’ perceptions of recovery in the long term following an exercise intervention. Objectives: To measure self-reported recovery on a 7-point Likert scale in 31 participants with PFP 6 months after a 6-week physiotherapy intervention. To explore the subjective accounts of patients who received a physiotherapy intervention for PFP, regarding their expectations and perceptions of recovery. Method: Semi-structured exit interviews were conducted electronically 6 months after intervention to ascertain the patients’ perspectives on whether expectations of treatment were met, and factors that influenced their recovery experience. Results: Quantitative analysis of self-reported recovery on a 7-point Likert scale showed that 48.4% of participants felt that they were ‘recovered’. Qualitative analysis showed three main categories: expectations of treatment, perceptions of recovery and changes in functional abilities. Conclusion: Clinicians should address patients’ expectations of treatment and include the patients in decision-making regarding their treatment. Long-term follow-up is essential to ensure that treatment effects have been maintained, and this should include information about patients’ self-reported recovery. Clinical implications: This study suggests that patients’ expectations of treatment and perceptions of recovery from PFP may influence prognosis. Clinicians need to collaborate with patients and involve them in decision-making to achieve their goals. An individualised treatment approach is essential to adequately address patients’ experiences, priorities and beliefs.

Abstract Background Professional South African ballet dancers face a higher risk of overuse injuries and overtraining syndrome as compared to dancers from other countries; especially towards the end of a ballet season. Fatigue is a major factor leading to overtraining syndrome and injuries in professional ballet dancers. The study aimed to explore the fatigue and recovery experiences of South African ballet dancers, highlighting how they navigate these aspects and the strategies they employ for recovery. Methods Snowball sampling was employed to recruit ten professional South African ballet dancers. Between March and June 2023, individual semi-structured interviews were conducted online using Microsoft Teams. The interview schedule, informed by previous research, delved into the dancers’ fatigue and recovery experiences. Interviews were recorded, transcribed, and analysed using inductive thematic analysis. Results Seven main themes were developed from the data. Participants distinguished between mental and physical fatigue, highlighting the impact of mental fatigue on their well-being. They identified factors contributing to fatigue, including high external pressure, motivated behaviours, and expectations from audiences and management. These contributors often resulted in injuries, mandatory breaks, and sub-optimal performance. Participants accepted fatigue as inherent to their profession, emphasising mental resilience. Recovery practices included psychological, nutritional, and active strategies. The COVID-19 lockdown provided a respite from external pressures, allowing for improved recovery, but participants faced challenges upon returning to work. Gradually increasing practice time and exposure to external pressures assisted ballet dancers in effectively managing fatigue and enhancing their recovery as they returned to work. Conclusion This study offers a perspective of fatigue and recovery in a sample of professional ballet dancers in South Africa. It emphasises the ongoing significance of fatigue and recovery and the necessity for effective strategies by arts organisations, mental health professionals, and academic researchers to support artists. The insights gained from this research could be crucial in redesigning training programs for dancers, adjusting training intensity and volume to enhance performance, and promoting recovery. Furthermore, this information serves as a strong rationale for adopting a holistic approach to fatigue and recovery, emphasising the importance of a collaborative effort to address these aspects effectively.

Background: Approximately two out of three people with stroke experience gait problems. Trunk movement control and symmetry is an important prerequisite for functional walking gait. Movement control, measured objectively as kinematics during walking gait, is rarely investigated. Objective: To describe the three-dimensional (3D) kinematics of the trunk during gait in people with stroke, including key spatiotemporal characteristics. Methodology: A total of 17 adults with stroke who met the inclusion criteria were selected to participate in this cross-sectional pilot study. An eight-camera T-10 Vicon system with Nexus 1.8 software (Vicon Motion System Limited, Oxford, UK) was used to analyse the 3D kinematics of the trunk during self-selected walking speed. Trunk kinematics throughout the gait cycle and spatiotemporal parameters were extracted using custom-built scripts in MATLAB used at the Stellenbosch University Movement Analysis Laboratory. Stata Version 12.1 software was used to assess differences in trunk kinematics between the affected and unaffected sides during gait using the Sign test (statistical significance level p < 0.05). Results: Participants achieved functional gait speeds although they presented with asymmetrical trunk kinematics. During the full gait cycle, there were statistically significant differences of trunk motion between the affected and unaffected sides in the coronal plane (p < 0.001). There were statistically significant differences in the trunk kinematics between the affected side and unaffected sides at initial contact (p < 0.001) and foot off (p < 0.049) in the coronal plane as well as at initial contact (p < 0.000) and foot off (p < 0.013) in the transverse plane. Conclusion: This pilot study found significant asymmetry in trunk motion between the affected and unaffected sides that varied across the gait cycle. This suggests the trunk may need to be targeted in clinical gait retraining post-stroke.

Background: The environment of older adults plays an important role in their well-being. It influences their quality of life and physical activity level. In South Africa, there is a dearth of literature concerning this issue. Methods: An analytic cross-sectional sample of 80 older adults living in old age homes and the community was compared in terms of level of physical activity and quality of life. The study was conducted in Soweto, Johannesburg. A computer-generated random sample of older adults aged 60 years and above participated. The Physical Activity Scale for the Elderly (PASE) and RAND 36 questionnaires were used for data collection. Descriptive statistics were used to describe the sample. Unpaired t-tests, Pearson’s correlation coefficient and chi-squared test explored the differences and associations between institutionalised and community living older adults. Results: Quality of life in old age home dwellers (M = 68.53 ± 19.55) was significantly lower (p = 0.025) than in community dwellers (M = 77.74 ± 16.25). The mean physical activity score was also significantly (p = 0.000) lower in old age home dwellers (M = 20.18 ± 24.52) compared with community dwellers (M = 190.31 ± 82.81). Conclusion: Older adults who live in the community have a higher quality of life and physical activity levels compared with those who live in institutions (old age homes).

Objectives To map the scope of available evidence on relationships between multimorbidity patterns and functioning among adults in low- and middle-income countries (LMICs), and describe methods used.Design Scoping review guided by a five-step methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines.Data sources PubMed/MEDLINE, Scopus, EBSCOhost (CINAHL) and Cochrane databases were searched from January 1976 to March 2023, plus reference lists of included studies.Eligibility criteria for selecting studies Peer-reviewed full-text articles or conference proceedings of any design, published in English or Afrikaans, involving adults (>18 years) with multimorbidity living in LMICs. Studies had to refer to associations between multimorbid patterns of co-occurrence and functioning. Multimorbidity was defined as the coexistence of ≥2 diseases, including any combination of non-communicable, infectious and mental health conditions.Data extraction and synthesis Data were extracted independently by two reviewers using a piloted form. Findings were synthesised according to methodological approaches, multimorbidity-pattern epidemiology, evidence gaps/limitations and recommendations for future research. The International Classification of Functioning, Disability and Health framework was used to classify functional problems.Results Nine studies (total sample size: 62 003) were included, mainly from upper-middle-income Asian countries. Key methodological inconsistencies were identified in defining and operationalising multimorbidity, conditions included in determining patterns, statistical methods for pattern determination and functioning outcome measures. Five main multimorbidity pattern domains emerged: Cardio-Metabolic and Coronary Atherosclerotic, Musculoskeletal, Respiratory and Digestive/Visceral, Degenerative, and Mental Health-Related. Mobility limitations, instrumental activities of daily living, self-care and bowel/bladder problems were consistently linked to all pattern domains.Conclusions The limited and geographically skewed body of literature, along with methodological inconsistencies, hampers a comprehensive understanding of multimorbidity patterns and associations with functioning in LMICs. Future research should explore context-specific multimorbidity definitions, employ transparent methodologies, use standardised measures and incorporate diverse samples to inform tailored interventions and policies.

Conclusions: Participants had a developing concept of pain that was partially aligned with contemporary pain science. Participants had pain knowledge strengths and gaps that can be used to develop a tailored school-based pain education intervention for them. There were indications that contextual factors may have influenced the participants’ concept of pain. Further studies to explore socioenvironmental factors that influence pain knowledge in children are recommended.

Background: Consideration of the patient’s perspective in healthcare is important because it may inform holistic and contextually relevant management strategies. Objectives: The purpose of this study was to explore patients’ experiences and perspectives about their chronic musculoskeletal (CMSK) pain and its management in the private healthcare sector in South Africa. This work was done as a pilot study to test, adapt and finalize an interview schedule. Methods: A descriptive, qualitative study was conducted. The sampling was purposive. Three patients with CMSK pain were recruited to participate in in-depth individual interviews. The interviews were recorded and transcribed ensuring confidentiality. Inductive, thematic content analyses of the transcripts were undertaken. Initial codes were assigned and a code book developed, which was applied to the transcripts to develop categories and themes. Results: Four themes emerged from the data: (1) the participants sought understanding about the pain’s origin and the reason for pain persistence; (2) pain impacted their lives in multiple ways; (3) the participants depended on healthcare providers (HCP) for guidance and support; and (4) they had the option of acceptance of chronic pain. Conclusion: The participants’ knowledge about their health condition had important implications as it influenced their perspectives on pain and its management. The pain presented the participants with several challenges, which included developing an understanding about pain and coping with the impact of pain in their lives. HCPs were perceived to play an important role in empowering or disempowering the participants.

Objectives: The anterior cruciate ligament is the most commonly injured ligament in the knee, with an average of only 64% of affected athletes returning to their pre-injury level of sport. Intrinsic factors associated with an increased likelihood of return to sport may be addressed during rehabilitation to improve the outcome of the reconstruction. The objectives of this review were to systematically appraise publications from six electronic databases describing intrinsic factors that may be associated with return to sport after anterior cruciate ligament reconstruction. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Methodological quality appraisal was performed according to the Critical Appraisal Skills Programme for cohort studies. We performed a descriptive synthesis of the findings that associated intrinsic factors with return to sport. Results: Ten studies were included in the review. The findings show that fear of re-injury is a common reason for not returning to participation in sport. Younger patients may be more likely to return to sport, but findings regarding gender were equivocal, with male competitive athletes appearing to be more likely to return to sport than their female counterparts. Good knee function is not always associated with a higher likelihood to return to sport. Conclusion: Fear of re-injury and age should be considered in the management of sports participants after anterior cruciate ligament reconstruction.

Background: A notable rise in health-related disability for which evidence-based rehabilitation is beneficial is evident in low-to-middle income countries. This scoping review aims to summarize and synthesize the status of peer-reviewed literature regarding the most common functioning problems associated with health conditions that contribute most to disability in South Africa and Zimbabwe. Methods: The scoping review will be conducted according to the framework developed by Arksey and O’Malley and corresponding guidance contained in the Joanna Briggs Institute Reviewers’ Manual. Peer-reviewed studies of all designs published from January 2006 onwards will be systematically searched from five databases. Studies reporting on functioning problems (impairments, activity limitations, and participation restrictions) in South African and Zimbabwean adults (>18 years) related to the top 10 health conditions contributing most to years lived with disability in South Africa and Zimbabwe according to the Global Burden of Disease Study 2019 will be included. Two reviewers will screen titles, abstracts, and full texts and chart data. The International Classification of Functioning, Disability and Health (ICF) framework will be used to map identified functioning problems. A narrative approach will be used to synthesize results. Discussion: This scoping review will provide a comprehensive mapping of functioning problems affecting adults in South Africa and Zimbabwe. Understanding the local rehabilitation needs may be a first step in strengthening primary care rehabilitation in low-resource settings. Registration: This scoping review protocol was registered with the Open Science Framework (doi: 10.17605/OSF.IO/FJM7W) on 31/12/2020.

Objectives Recent research has indicated seemingly increased propensity for falls and accelerated bone demineralisation in people living with HIV (PLWH). We aim to map out the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH.Methods A scoping review was done following Arksey & O’Malley’s methodological framework and recommendations from Joanna Briggs Institute. Four databases were searched until October 2019 for peer-reviewed studies available in English reporting on the definition, prevalence, assessment, risk factors and interventions for falls in PLWH as well as information on bone demineralisation linked to falls in PLWH. Narrative reviews were excluded. Two reviewers independently performed the extraction using a predesigned Excel sheet. A descriptive analysis of extracted information was done.Results Fourteen studies on falls in older PLWH were identified, with all but one study conducted in high-income countries. Prevalence of falls in PLWH ranged from 12% to 41%. Variable assessment tools/tests were used to assess potential risk factors, but it remains to be determined which are more predictive and appropriate for use among PLWH. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age-matched and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH.Conclusion More research is needed on falls in younger cohorts of PLWH and in sub-Saharan Africa where HIV is most prevalent and more robust clades exist. More studies need to report on data in seronegative controls to determine risk factors unique to PLWH. More intervention studies targeted at falls prevention and promotion of bone health are required. Quality clinical practice guidelines highlighting validated assessment tools and outcome measures need to be developed.

Abstract Background The chasm between rehabilitation needs and available rehabilitation services is widening. In most low-resource contexts, there are inadequate rehabilitation professionals at primary health care (PHC), leaving nonrehabilitation primary care providers’ (PCPs) and district rehabilitation professionals and managers to address patients’ rehabilitation needs. This study explored rehabilitation and non-rehabilitation PCPs’ and managers’ perspectives on the situation of rehabilitation service provision in PHC settings and the challenges experienced in providing rehabilitation care. Methods In this descriptive, exploratory qualitative study, individual semi-structured interviews and focus group discussions were conducted with purposefully sampled PCPs in Manicaland, Zimbabwe and Eastern Cape, South Africa. The transcripts were analysed thematically using Atlas.ti. version 22.2®. Results Thirty-six PCPs (29 nonrehabilitation and 7 rehabilitation) and one district manager participated in the study. The current PHC rehabilitation services in the two low-resource contexts were described as inadequate, if not nonexistent. District rehabilitation professionals attempted to fill the gap through outreach and home visits, but resource limitations, particularly in Zimbabwe, often hampered this strategy. The nonrehabilitation PCPs took on task-shifting roles in the identification, referral, and education of patients with rehabilitation needs in the absence of rehabilitation professionals at PHC. Challenges encountered in providing rehabilitation care at PHC included unsupportive leadership, human resource shortages, lack of comprehensive PHC rehabilitation guidelines, no or delayed rehabilitation referral, lack of clear communication strategies, and users’ low demand for PHC rehabilitation. Conclusion Tailored approaches, including context-specific rehabilitation guidance for existing task-shifting models, increased investment in rehabilitation and increased rehabilitation awareness, are needed to establish basic rehabilitation services in the described contexts because they are mostly absent. Importantly, the PHC systems in which rehabilitation is to be nested need to be strengthened.

Abstract Background The need for rehabilitation in low-to-middle income countries (LMICs) is rapidly increasing as more people are living longer with chronic diseases. Primary health care (PHC) is ideally placed to provide the spectrum of care required to meet most of the complex and evolving population's health needs locally. This study aimed to describe the patient journeys of adults attending primary care in the Eastern Cape province of South Africa to understand the factors that affected their access to primary care rehabilitation services (or the lack thereof) and obtain suggestions on how rehabilitation may be enhanced at primary care. Methods A maximum variation sampling approach was used to purposefully select persons with varied chronic health conditions and demographic characteristics to gain diverse perspectives regarding their rehabilitation needs and ways in which the current rehabilitation services at primary care may be enhanced. Data were collected via face-to-face semi-structured interviews between March and June 2022 which were electronically recorded. Inductive thematic analysis of transcribed data was done and coded in Atlas.ti.22®. Results Twenty-five adult patients participated in the study. The patients had different experiences at their local PHC facilities that affected their access to rehabilitation at primary care. The study found that most patients were not able to access rehabilitation at primary care. There were several personal and contextual factors that resulted in the patients having a low perceived need to receive rehabilitation that potentially lowered patients' demand for and utilization of rehabilitation at primary care. Patients suggested increasing rehabilitation workforce at primary care, improving availability of assistive devices, increasing their knowledge regarding rehabilitation, and facilitating socio-economic integration into their communities. Conclusions Patients attending primary care are not guaranteed access to rehabilitation by virtue of having entered the PHC system. It is important to consider the patient perspectives regarding their health needs and suggestions for enhancing care.

Objective To assess the readiness of healthcare institutions that serve as clinical platforms for Stellenbosch University’ rehabilitation students, and to explore the opinions of rehabilitation professionals regarding the integration of telerehabilitation (TR) into service delivery and students clinical training. Methods This study employed a qualitative research design and involved the participation of fourteen rehabilitation managers. Semi-structured interviews were conducted using both face-to-face and online platforms. Thematic analysis was employed to analyse the collected data. Results The readiness for implementing TR services varies across different dimensions. Facilities faced challenges related to funding for TR equipment and the absence of policies and guidelines, indicating a lack of financial and governance readiness. Rehabilitation professionals demonstrated high attitudinal readiness but low technical readiness due to a lack of knowledge and skills. Rehabilitation students particularly lacked practical experience, confidence, clinical reasoning and decision-making skills further contributing to low technical readiness. Conclusion Health care institutions are generally not ready for a successful implementation of TR. To improve the readiness, senior management should actively participate and provide financial support, develop policies, guidelines and training programs for rehabilitation professionals. Educational institutions should incorporate TR program into curricula to prepare students to gain practical experience and familiarity with the use of TR technology for their future clinical practice.

Background Telerehabilitation is an emerging segment of telehealth and telemedicine that has a potential to deliver quality, accessible, cost-effective and efficient rehabilitation services where geographical distance is a critical factor. The objectives of this review are: to describe the feasibility and cost-effectiveness of telerehabilitation, to scope to what extent telerehabilitation has the potential impact on access to quality of rehabilitation services with specific references to low to middle income countries, and to understand key process factors including barriers and facilitators relevant to the implementation of telerehabilitation. Methods A scoping review of the literature will be conducted. An electronic search literature will be conducted in PubMed, Scopus, Cochrane library, Africa-wide information, CINAHL, MEDLINE, ProQuest, Web of science and reference lists. The review team will develop a data charting form and pilot it on four randomly-selected studies. The form will be refined based on the results of the piloted articles. Studies identified will be screened at the title and abstract levels by the first reviewer, followed by an independent verification for the accuracy and eligibility by two more reviewers prior to obtaining the full texts. Studies to be included must report on feasibility, cost-effectiveness, access to rehabilitation services, implementation process factors including barriers and facilitators of telerehabilitation. The analysis will include both descriptive summary and inductive thematic analysis. Conclusion Telerehabilitation has ability to change the current standard of care and allow for improved access and health outcomes in cost-effective ways, while addressing the scarce and unequal distribution of limited number of healthcare providers especially in low to middle income country settings. Thus, the research findings could be used by different stakeholders including: researchers, clinicians, policy makers, and implementation teams as they determine the appropriate setup for new telerehabilitation programs.

Objectives To explore the opportunities and challenges within the health system to facilitate the achievement of universal health coverage (UHC) for people with stroke (PWS) in South Africa (SA).Setting SA.Design Scoping review.Search methods We conducted a scoping review of opportunities and challenges to achieve UHC for PWS in SA. Global and Africa-specific databases and grey literature were searched in July 2020. We included studies of all designs that described the healthcare system for PWS. Two frameworks, the Health Systems Dynamics Framework and WHO Framework, were used to map data on governance and regulation, resources, service delivery, context, reorientation of care and community engagement. A narrative approach was used to synthesise results.Results Fifty-nine articles were included in the review. Over half (n=31, 52.5%) were conducted in Western Cape province and most (n=41, 69.4%) were conducted in urban areas. Studies evaluated a diverse range of health system categories and various outcomes. The most common reported component was service delivery (n=46, 77.9%), and only four studies (6.7%) evaluated governance and regulation. Service delivery factors for stroke care were frequently reported as poor and compounded by context-related limiting factors. Governance and regulations for stroke care in terms of government support, investment in policy, treatment guidelines, resource distribution and commitment to evidence-based solutions were limited. Promising supporting factors included adequately equipped and staffed urban tertiary facilities, the emergence of Stroke units, prompt assessment by health professionals, positive staff attitudes and care, two clinical care guidelines and educational and information resources being available.Conclusion This review fills a gap in the literature by providing the range of opportunities and challenges to achieve health for all PWS in SA. It highlights some health system areas that show encouraging trends to improve service delivery including comprehensiveness, quality and perceptions of care.

Abstract Background Low back pain (LBP) remains a common health problem and one of the most prevalent musculoskeletal conditions found among developed and developing nations. The following paper reports on an updated search of the current literature into the prevalence of LBP among African nations and highlights the specific challenges faced in retrieving epidemiological information in Africa. Methods A comprehensive search of all accessible bibliographic databases was conducted. Population-based studies into the prevalence of LBP among children/adolescents and adults living in Africa were included. Methodological quality of included studies was appraised using an adapted tool. Meta-analyses, subgroup analyses, sensitivity analyses and publication bias were also conducted. Results Sixty-five studies were included in this review. The majority of the studies were conducted in Nigeria (n = 31;47%) and South Africa (n = 16;25%). Forty-three included studies (66.2%) were found to be of higher methodological quality. The pooled lifetime, annual and point prevalence of LBP in Africa was 47% (95% CI 37;58); 57% (95% CI 51;63) and 39% (95% CI 30;47), respectively. Conclusion This review found that the lifetime, annual and point prevalence of LBP among African nations was considerably higher than or comparable to global LBP prevalence estimates reported. Due to the poor methodological quality found among many of the included studies, the over-representation of affluent countries and the difficulty in sourcing and retrieving potential African studies, it is recommended that future African LBP researchers conduct methodologically robust studies and report their findings in accessible resources. Trial registration The original protocol of this systematic review was initially registered on PROSPERO with registration number CRD42014010417 on 09 July 2014.