Forensic auditing safeguards patients' funds by investigating billing irregularities of claims submitted to medical schemes. However, billing irregularity audits can be misguided, as indicated in a study conducted in Australia, Canada and the United States. Negative consequences were reported, including attrition, and patients funding their treatments out of pocket. Medical professionals were penalised, without forensic auditors considering alternative explanations for the alleged irregular billing patterns. Small medical practitioners, unable to defend themselves financially, closed their practices, leaving patients without medical care. In South Africa, the experiences of physiotherapists who underwent forensic audits have not been examined. This study explored physiotherapists' experiences of forensic auditing by medical scheme administrators. An analytical qualitative study was conducted to interview 14 physiotherapists. Three focus group discussions and 11 individual interviews were conducted. A semi-structured open-ended interview guide was used, analysing the data via open and axial coding. The first five themes that emerged captured the adverse experiences of physiotherapists. These were (1) 'unfairly persecuted, judged and penalised'; (2) 'overpowered and oppressed'; (3) 'naively entrapped between a rock and a hard place'; (4) 'distressed with a knife over your head' and (5) 'detrimental and hurtful'. In the sixth theme, 'seeking remedies pre-emptively and preparedly', the participants made recommendations to prevent similar unwanted experiences. Physiotherapists experienced significant emotional, financial and professional detriment at the hands of South African medical scheme administrators. The quality of care provided by physiotherapists is adversely affected when forensic audit-related distress occurs.
Evidence-based practice (EBP) is a process that a clinician undertakes, implementing his or her clinical expertise while collaborating with the patient or client in the sociocultural context of care using the best available research evidence to inform practice. The approach has evolved over time in relation to its name, definition, scope and specific steps. In October 2001, member organisations of World Physiotherapy (then the World Confederation for Physical Therapy) gathered in London to discuss the status of EBP in the profession and to gain buy-in from regions to ensure that EBP would become a culture of practice in all regions. The purpose of this article is to describe the current state of EBP during physiotherapy as presented in the literature. Two decades have passed since this meeting, with noteworthy developments in clinical practice, education and research synthesis. Physiotherapists' opinions and attitudes towards EBP are favourable but do not always ensure good implementation and execution during clinical practice. Standardised outcome measures to evaluate the EBP of physiotherapists are available. Barriers remain, which are multifactorial, and facilitators such as time, support and education are integral to optimise implementation. The launch of the Physiotherapy Evidence Database is one strategy that facilitates EBP in physiotherapy. A culture of EBP exists upon reflection of published literature from different world regions. Consistent, quality implementation of EBP, including shared decision making with patients and evaluation of evidence implemented during clinical practice remain necessary.
Premature death in people with HIV in sub-Saharan Africa (SSA) is highly preventable. However, the lack of inclusive, cost-effective prognostic tools remains challenging. Most prognostic tools have been developed in high-income economies. The distinct cultural dynamics in HIV-related death epidemiology makes them unsuitable for the region. Additionally, the models lack systematic stratification of death determinants based on clinical relevance, and some included factors are too expensive for people with HIV in SSA. We aimed to create a tailored predictive model that considers the unique context of SSA, including cultural dynamics, cost-effectiveness, and clinical relevance. This is a 2-phase study. In the development phase, we will use a combination of evidence synthesis, namely meta-analysis, application epidemiology, biostatistical, and economic paradigms, to develop a prognostic model for people living with HIV in SSA. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol will be followed in the structuring of the meta-analysis. From their creation to the present, we will search African journals (Sabinet) and the PubMed, Scopus, MEDLINE, Academic Search Complete, Directory of Open Access Repository, Cochrane Library, Web of Science, EMBASE, and Cumulative Index for Nursing and Allied Health Literature databases. Only cohort studies with moderate to high quality will be included. The primary outcome variables include the predictors of HIV-related death and their corresponding effect sizes (adjusted relative risk). A random-effect meta-analysis model will be used to synthesize the unbiased estimate of risk (relative risk) per predictor. Epidemiological metrics such as risk responsiveness, geotemporal trend, risk weight (Rw), clinical minimum important difference (CMID), predictors interaction density (PID), critical risk points, and potential cost implication will be computed. A combination of Rw and CMID will be used for risk stratification. The model's constituent items will be selected based on the combination of Rw, CMID, PID and cost implication. In the validation phase, we will apply the emergent model to classify participants using a secondary data obtained from a cohort of people living with HIV in East and West Africa, with outcomes including sensitivity, specificity, calibration, and area under the receiver operating characteristic curve (AUC). The study is projected to commence in October 2025 and end in September 2026. The expected result will be published in November 2026. The result will be presented using narrative and quantitative synthesis. Indices of causality namely as strength of association, temporality, consistency, biological gradient, and specificity of the predictor-outcome association will be presented in a tabular format. TheAUC will be used to decide the optimal critical risk point for the emergent predictive algorithm. Effective prognostication coupled with intense monitoring and evaluation, and prioritizing of therapeutic targets could positively turn around the fate of millions of people living with HIV at risk of premature death in SSA. PROSPERO CRD42023430437; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023430437. PRR1-10.2196/63783.
The national cancer strategy includes guidelines for rehabilitation as part of a collaborative team for cancer care. Interprofessional engagement is a critical attribute of a rehabilitation team. Thus, exposing students to live case scenarios in physiotherapy (PT), occupational therapy (OT) and speech-language pathology (SLP) provides development of Interprofessional Education Collaborative (IPEC) core competencies. To evaluate students' acquisition of interprofessional competencies (Values and Ethics; Roles and Responsibilities; Interprofessional Communication; and Teams and Teamwork) in cancer rehabilitation and explore their qualitative experiences of interprofessional engagement. A cross-sectional survey design with open-ended questions was administered to final year rehabilitation students (PT, OT and SLP) post interprofessional education (IPE) session with a cancer survivor (CS). Of 140 enrolled final year students, 64 completed the IPEC survey on Redcap. Descriptive and qualitative data analysis were conducted. High levels of agreement across all IPEC domains were observed, with the highest seen in Teams and Teamwork. Three themes, (1) Scope of practice, (2) Teamwork, (3) Experience of the IPE activity, emerged from the open-ended questions. High agreement across IPEC domains indicates enhanced collaborative attitudes and role clarity, despite limited exposure to oncology in participants' undergraduate curricula. The presence of a CS added authenticity, fostering empathy and ethical practice. Students gained insight into professional boundaries, effective communication strategies and teamwork in complex care settings. Findings support integrating authentic, condition-specific IPE into curricula to strengthen collaboration and professional identity formation. Undergraduate Health Sciences students can gain exposure to national cancer policies through IPE sessions. Future research can explore if the skills learnt translate to clinical teamwork post-graduation.
Cancer is the main cause of morbidity and mortality worldwide, and its symptoms can affect an individual's life holistically. Our study aimed to determine the health-related quality of life (HRQoL) of individuals dealing with cancer in the Free State, South Africa. A descriptive, cross-sectional study design utilising the standardised Functional Assessment of Cancer Therapy - General (FACT-G) questionnaire as well as a self-developed sociodemographic and general health information questionnaire was used in this study. The study was conducted at the Universitas Annex Oncology Clinic. A total of 507 participants were conveniently sampled. The median age was 53 years with 73.8% being female. The FACT-G's overall score ranged from 11.7 to 108, with a median of 76.7 (interquartile range [IQR] 63-89.5). The Social or Family Well-Being subscale indicated the highest median of 22.2 and the Emotional Well-Being subscale the lowest of 18. The Physical Well-Being subscale found that 61.8% of individuals felt forced to spend time in bed and 53.4% experienced nausea. The Functional Well-Being subscale showed that 70.3% of individuals accepted their illness and 51.6% enjoyed their life. Our study highlights the importance of using a clinical assessment tool to determine the influence of cancer on the individual's HRQoL. Involvement of the individual's family and friends during management, as well as identifying the need for psychosocial support, is crucial for positively influencing HRQoL. The FACT-G is a valuable tool in guiding physiotherapists and other healthcare professionals with patients' cancer-related treatment experiences.
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of morbidity and mortality in South Africa. Physiotherapy practice and factors that influence management of patients with AECOPD are unknown. To explore physiotherapy practice in the management of patients with AECOPD in South African private healthcare settings and to identify and describe factors that influence physiotherapy patient management. The study adopted a qualitative descriptive design using semi-structured interviews. Purposive and snowball sampling was used to identify physiotherapists working in private healthcare in three South African provinces. Individual interviews were conducted face-to-face or via telephone and transcribed verbatim. Content analysis was done using an inductive approach. Participants (n = 9) working in private hospitals reported that their management is based on patient-specific needs assessment. Treatment interventions included various respiratory physiotherapy techniques and exercise rehabilitation strategies. Patient education on self-management of disease symptoms featured prominently. Enablers of physiotherapy management included supportive workplace relations, conducive work environment, physiotherapists' competence, familial support and patient cooperation. Barriers identified included limited communication, nurses' attitudes, work environment, disease burden, mental health challenges and limited professional development opportunities. Physiotherapists provide individual needs-based care to patients with AECOPD. Various enablers and barriers to physiotherapy patient management have been identified. Advocacy for physiotherapy, better communication between multidisciplinary team members and recognition of the need for psychological support are important factors to address to enhance the care provided to patients with AECOPD.
The prevalence of polytrauma is increasing globally and in South Africa, contributing to the reported rates of disability. Early physiotherapy intervention in the acute care setting reduces the risk of complications and facilitates functional recovery of patients who sustained polytrauma injuries. There is minimal evidence exploring patients' perceptions of their recovery of physical function following polytrauma injury in an acute setting and after hospital discharge. To explore patients' perceptions of their recovery of physical function after polytrauma. A qualitative single-case study was carried out at a private trauma facility in Johannesburg, drawing on eight semi-structured interviews gathered through purposive sampling. The interview transcripts were examined using an inductive analytical approach, with MAXQDA assisting in generating the codes and themes. Six central themes emerged, capturing patients' views on the factors that hindered or supported their recovery of physical function following polytrauma. These broad themes included satisfaction with the care received, experiences with rehabilitation after discharge, mental health and resilience, degree of disability, pain and physical functioning, and the influence of support systems. Multiple factors shape how patients perceive their physical recovery after experiencing polytrauma. Notably, the quality of interpersonal interactions played a prominent role in shaping their views of the care they received. Our study may inform practice in the clinical setting in the management of patients recovering from polytrauma injuries to address barriers and promote facilitators identified.
Physical activity (PA) promotion and exercise prescription (EP) are crucial core competencies in addressing the growing burden of non-communicable diseases. However, the extent to which these competencies are taught and implemented in clinical education for physiotherapy remains unclear within the South African context. To explore clinical educators' perceptions regarding PA and EP in clinical education for physiotherapy at a local university in the Western Cape, South Africa. A qualitative exploratory descriptive design was employed. Eleven clinical educators participated in two focus group discussions. Participants had an average of 15 years of clinical experience. More women (73%, n = 8/11) participated. Thematic analysis revealed three principal themes: (1) Professional identity and patient empowerment, (2) knowledge translation challenges: bridging theory and practice and (3) time and resource constraints - identifying practical constraints that impact teaching and implementation. Participants expressed their profession's responsibility in promoting PA and prescribing exercises across all clinical settings. They identified challenges in clinical practice, knowledge translation gaps and the need for strengthened professional development. The complex interplay between educational theory, clinical practice constraints and the evolving role of physiotherapists in public health are highlighted. A multi-faceted approach that considers educational reform and healthcare system constraints, while maintaining a focus on improving patient outcomes through promoting PA and exercise, is recommended. Emphasis on preparing physiotherapy students to effectively educate and empower patients for independent health management is recommended and could impact population health outcomes in resource-limited settings in which the ongoing professional supervision of exercise programmes is often not feasible.
Speech-language pathology (SLP) students in South Africa often face persistent challenges in transferring theoretical learning to authentic clinical contexts. This theory-practice divide is compounded by limited placement opportunities, multilingual classrooms, and broader structural inequities, all of which contribute to a significant theory-practice divide. Addressing these contextual realities requires innovative pedagogical approaches that extend beyond traditional teaching methods. This article presents the conceptual and theoretical foundations of a low-cost, online escape room aimed at enhancing clinical reasoning skills in third-year SLP students, grounded in the contextual realities of South African higher education. The design was informed by social constructivism, self-determination theory, and simulation-based learning. Implemented via the Genial.ly platform, the escape room integrated authentic case-based tasks, facilitator-mediated feedback, progress-dependent sequencing, and multimedia layering. These features created an interactive, psychologically safe space where students could apply theoretical knowledge to contextually relevant clinical challenges. The design foregrounds social learning, motivation, and contextual responsiveness - core dimensions of capability building in resource-limited systems. It demonstrates how theoretically informed, technology-enhanced learning can promote autonomy, competence, and relatedness, supporting the development of confident and reflective practitioners in multilingual and under-resourced environments. This article proposes a scalable and contextually responsive model for developing clinical reasoning in the Global South healthcare education contexts. By foregrounding theoretical grounding and contextual adaptability, it contributes to the broader conversation on how technology-enhanced learning can support capability development in resource-limited settings. The online escape room illustrates the potential of low-fidelity, technology-enhanced simulations to improve clinical reasoning, learner engagement, and confidence in diverse, resource-constrained training contexts, providing an equitable, scalable means to bridge theory and practice.
Idiopathic scoliosis is a three-dimensional spinal curvature treated during adolescence with physiotherapy, braces or surgery. This can be stressful for patients. Few studies compare the quality of life of adolescents with and without scoliosis. Our study aims to investigate the quality of life of adolescents with and without scoliosis using the KIDSCREEN-27 questionnaire. The aim of this study was to investigate the quality of life of adolescents with scoliosis in comparison to adolescents without scoliosis. This comparative cross-sectional study included 60 participants who answered KIDSCREEN-27 accompanied by questions about age, sport intensity and their school category. Girls between the ages of 12 and 17 were included in the study. For each category of KIDSCREEN-27, the values were compared between participants with and without scoliosis. Statistical analysis was done using R Version 4.3.3. In none of the categories were the mean T-scores of adolescents with scoliosis significantly lower than those of the comparison group. In the scoliosis group, 33% (n = 10) showed values rated as 'low' quality of life in the category 'physical well-being'. In the category 'psychological well-being', 36% (n = 11) showed 'low' values. A general statement about the quality of life in adolescents with scoliosis cannot be made, but monitoring during treatment appears to be important. It is a complex construct that varies for each patient. KIDSCREEN-27 can quickly and easily identify low quality of life in patients with scoliosis. Physiotherapists play an important role in the scoliosis treatment team as they usually see the patients most often. Thus, early recognition of impaired quality of life is crucial to offer a targeted therapy plan.
The rehabilitation experience can influence the transition back to home and community life. With impending National Health Insurance reform and limited rehabilitation guidelines in South Africa, there is a need to understand the current state of rehabilitation services. To the authors' knowledge, no other South African study has explored inpatient rehabilitation experiences and their influence on the readiness to transition home in spinal cord injury (SCI). To explore the experiences of inpatient rehabilitation among people with SCI, to examine how the experience influenced their transition out of inpatient rehabilitation, and to identify the needs of people with SCI when transitioning out of inpatient rehabilitation. A phenomenological, qualitative design was used. Semi-structured interviews were conducted with 11 patients with SCI in their final week of inpatient rehabilitation from October 2023 to February 2024. The interview guide was developed from similar studies in New Zealand. Interviews were transcribed verbatim and inductively analysed to identify themes. Three themes emerged: overall rehabilitation experience, factors influencing the experience and transition readiness, and needs impacting the transition to home. Participants reported a positive experience overall, although some negative elements were noted. Key needs for a smoother transition included bridging the gaps in the approach to care, more realistic home environment simulations and individualised psychological support. Rehabilitation experiences highlight the need for a specialised, patient-centred approach to SCI care. Addressing unmet needs can enhance preparedness for reintegration, especially in contexts without a structured SCI model of care. Ongoing professional development, improved rehabilitation environments and structured psychological support during rehabilitation are needed.
A large part of physiotherapy clinical training is situated in the workplace. Learning in an authentic environment is supported by facilitators. This study focussed on the perceptions and understanding of physiotherapy students and facilitators while learning on the clinical platform. A qualitative methodology within an interpretivist paradigm was followed using convenience sampling. Physiotherapy students (n = 45) in their fourth and final year of study and clinical facilitators of this student group (n = 13) were invited to participate in a focus group discussion (FGD) for the students (n = 7) and semi-structured interviews for the facilitators (n = 7). An inductive data analysis approach was followed. Three themes were generated: Learning as a Shared, Active Process; Relationships, Role Modelling and Power Dynamics in Clinical Learning; and the Clinical Environment as Both Constraint and Catalyst. Across themes, learning was shaped by how students and facilitators understood and enacted their roles, the degree to which student agency was recognised and supported, and how relational safety and environmental constraints mediated engagement. Implicit and sometimes misaligned expectations between students and facilitators influenced whether learning opportunities were taken up or constrained. Clinical learning emerged as a co-constructed, relational process rather than a unidirectional transfer of knowledge. Supporting meaningful learning in the clinical environment requires greater attention to implicit expectations, relational dynamics and the conditions under which student agency can be enacted.
Understanding the physical activity behaviours of adults at risk of poor health is important to inform targeted interventions. We profiled the frequency, intensity, duration and domain (work or non-work) of self-reported physical activities of rural South African adults living with hypertension. The aim of this study was to provide a profile of the frequency, intensity, duration and domain of self-reported physical activities over a 7-day period in adults with hypertension from a rural sub-district in South Africa. A total of 429 adults diagnosed with hypertension aged 40 years and above completed the International Physical Activity Questionnaire Long-Form via telephone interview. Data were summarised using means and standard deviations or medians and interquartile ranges. The Mann-Whitney U test and Krustal-Wallis rank test were used to assess physical activity differences by sex and work status. Statistical significance was set at p < 0.05. The mean age of the participants was 65.1 (standard deviation [s.d.] ± 10.9 years), 58% were women and 52% had paid or unpaid work. Men reported greater (duration and frequency) vigorous physical activity at work compared to women (p = 0.003 and p = 0.002). Walking frequency as a mode of transport was higher for working men and women (p < 0.001). Women reported higher frequency of moderate-intensity physical activity inside the house (p < 0.001) and outside the house (p < 0.001) compared to men. Non-working men and women spent more time sitting during the week compared to their working counterparts (p = 0.009). The physical activity profile of hypertensive adults varied by sex and work status. Contextual factors such as gender roles are also related to the physical activity profile of hypertensive adults living in rural South Africa and should be considered when designing specific interventions targeted at improving hypertension control for this population.
Worldwide, musculoskeletal disorders represent a global threat, and primary replacement arthroplasty is the preferred surgical treatment for late-stage arthritis. In South Africa, the waiting lists for arthroplasty are extensive and physiotherapists can have an impact on this situation by implementing prehabilitation; hence, the need to conduct research on the efficacy of such a programme. Develop a prehabilitation programme for a resource-scarce community in South Africa. Our study consisted of three phases wherein the first step entailed conducting a scoping review. The second phase was a consultation of stakeholders through semi-structured interviews and self-administered questionnaire, and the final stage was an evaluation of the effects of the prehabilitation programme by a pilot, single-blinded study on a convenient sample of patients. The scoping review identified several gaps in existing programmes such as duration, mode and content of the prehabilitation programmes. Stakeholder surveys revealed a lack of knowledge and understanding of physiotherapy and prehabilitation. This highlighted the need to investigate the efficacy of a hybrid model of prehabilitation. Our study is novel within the South African public healthcare system, as it envisages a hybrid approach; and to construct a programme that is contextually relevant. Our study aims to deliver the services in a hybrid way using telerehabilitation and face-to-face therapy which will improve access and reduce waiting times.
Physiotherapy management is a necessary core aspect in spinal cord injury (SCI) rehabilitation, and undergraduate preparation for adequate application is imperative. To determine physiotherapy students' self-perceived competence and readiness in treating patients with SCI. This study included 48 fourth-year students enrolled in a Bachelor of Physiotherapy degree in South Africa. Students completed a QualtricsXM online survey consisting of 32 questions self-compiled from the Assessment of Physiotherapy Practice (APP) tool and the Dundee Ready Education Environment Measure (DREEM) questionnaire to determine self-perceived competence and readiness to treat SCI patients. Descriptive (frequencies and means) and inferential data (independent t-test and Fisher's exact test) were analysed using SPSS v26 at a 0.05 level of significance. Students reported 70% self-perceived competence and 73% readiness to treat SCI patients. Theoretical knowledge was perceived as adequate (p < 0.01), and students who completed their SCI clinical block perceived themselves as more competent in treating patients with SCI (p < 0.01). They were able to clinically reason and adequately differentiate between diagnoses (p < 0.01) and safely perform treatment techniques (p < 0.01). Students who completed their SCI clinical block had higher self-perception of competence to differentially diagnose SCI and to treat SCI patients safely, compared to those who had not. Hands-on experience of SCI patient care is encouraged before SCI clinical block rotation. In cases where there are limited clinical placements, universities are recommended to augment written case scenarios with finite supervised patient exposure.
Clinical reasoning in the intensive care unit (ICU), a complex, high-acuity and stressful environment, may require a different set of critical thinking and decision-making approaches to undergraduate physiotherapy student training in this setting that needs to be explored. To explore clinical reasoning processes of undergraduate physiotherapy students (novices) and clinicians (experts) in ICU settings in the Western Cape. A qualitative exploratory study using semi-structured interviews with purposively sampled participants: seven final-year physiotherapy novices and four physiotherapy clinicians with over 5 years of ICU experience. Data were analysed using Braun and Clarke's six-phase thematic content analysis. Both novice and expert physiotherapists described using information gathering, assessment planning, and hypothesis formulation from medical folder reviews and objective assessments to guide critical thinking and decision-making in ICU care. Experienced clinicians relied on the International Classification of Function framework and extensive ICU exposure to strengthen their reasoning. Novice physiotherapists reported that theory and its application supported their clinical reasoning, but their effectiveness was limited by the complex, high-pressure ICU environment, emotional burden of critically ill and end-of-life care, and feelings of overwhelm, fear, stress, anxiety and limited experience. The study highlights shared foundations but clear differences in the depth of clinical reasoning between novice and expert physiotherapists, with clinicians' greater experience and situational familiarity enabling more advanced reasoning in ICU care. Structured ICU exposure, emotional support and guided reasoning frameworks are needed to help novice physiotherapists apply theory effectively in high-pressure ICU settings.
The Participation Measurement Scale (PM-Scale) is an International Classification of Functioning, Disability and Health-based and Rasch-built scale developed specifically to assess participation in people with stroke. Our study aimed to estimate the minimal clinically important difference (MCID) for the PM-Scale. We performed a secondary analysis of data from the 'Circuit walking, balance, cycling and strength training' trial. Participants underwent mixed and collective physical activities or sociocultural activities for 12 weeks, and participation data were collected before and after the interventions. The activity limitations (ACTIVLIM)-Stroke scale was used as the anchor of importance. The MCID for the PM-Scale was estimated using receiver operating characteristic (ROC) curves and the Youden index. Data were collected from 46 people with chronic stroke, of which 22% were female, with median (Percentile 25, Percentile 75) age of 54 (44; 60) years, and time since stroke is 24 (11; 37) months. For all participants, the PM-Scale measures range from -2.98 logits to 5.02 logits. The area under the curve (AUC) for the receiver operating characteristic (ROC)-analysis was 0.74 yielding an estimated MCID of 1.98 logit for the PM-Scale. Our study estimated the MCID of the PM-Scale at 1.98 logit, enabling a more precise interpretation of the outcome in the clinical and research settings. An improvement of at least 1.98 logit on the PM-Scale is required to induce a clinical change in the independence in activities of daily living in people with chronic stroke.
Health professions education is undergoing a paradigm shift from a predominantly curative focus towards prevention and health promotion, in line with global health priorities such as Sustainable Development Goal 3 (SDG3). Physiotherapy curricula, however, often still devote limited attention to preventative competencies. The objectives of this study are to identify risk factors for shoulder pain in amateur fast bowlers and illustrate how such evidence can inform the integration of preventative competencies into undergraduate physiotherapy curricula. A prospective, longitudinal cohort study was conducted during the 2018-2019 amateur cricket season. Thirty-nine male fast bowlers completed baseline musculoskeletal screening and weekly online questionnaires documenting injury incidence. Physical assessments included shoulder range of motion, scapular control, muscle strength, endurance and stability tests. Data were analysed using t-tests, Mann-Whitney U tests, chi-square and/or Fisher's exact tests. Nine participants (23%) sustained shoulder pain during the season. Risk factors associated with injury included scapular dyskinesia, decreased internal rotation, increased external rotation, glenohumeral internal rotation deficit, poor endurance and reduced isometric muscle strength. These factors demonstrated moderate-to-large effect sizes. The identification of modifiable risk factors for shoulder pain demonstrates the value of embedding screening skills into undergraduate physiotherapy curricula. Teaching students to assess and address risk factors fosters a preventative orientation that extends beyond sports injuries to broader health contexts. Incorporating risk factor screening into training equips physiotherapy graduates with practical skills for early detection and prevention, thereby reducing the burden of preventable conditions and aligning education with the objectives of SDG3.
The global rise in the older population, especially in sub-Saharan Africa, has heightened the impact of non-communicable diseases (NCDs), responsible for 74% of global deaths and the leading cause for years lived with disability. Physical activity (PA) has proven to manage NCDs; however, 80% of older adults in sub-Saharan Africa engage in low-to-moderate PA levels. This literature review explores current evidence on the effects of PA on ageing and NCDs in older people in sub-Saharan Africa. Insights gained will enable physiotherapists to refine their PA prescriptions, aligning short-term rehabilitative goals with the broader scope NCD management while fostering principles of healthy ageing. Electronic searches were conducted in: PubMed, EBSCOhost (Academic Search Premier - Africa-Wide Information, CINAHL, Health Sources Premier), Scopus and Google-Scholar to identify peer-reviewed studies published after 2010 related to PA, ageing, NCDs and older people (OP) in sub-Saharan Africa. A structured PA protocol, comprising aerobic activity at 60% - 79% of maximal heart rate and resistance training at 50% - 60% of one-repetition maximum (3 weekly sessions each), proved effective in reducing NCDs. Integrating lifestyle behaviour changes further enhanced outcomes, notably improving blood sugar management and cardiac health. Structured aerobic and resistance PA, combined with lifestyle education, significantly reduces NCD risk factors in older adults, supporting healthy ageing. The current research base in the field of ageing in SSA is limited, indicating the need for non-pharmacological interventions to manage the prevalence of NCDs, including in mental/cognitive health, where PA has a direct influence.
Critical care units require an interprofessional management approach to optimise patients' health. Clinical education and training delivered in remote healthcare settings are vital for fostering interprofessional collaboration (IPC) among health science students for future team functioning. Our study explored the IPC among clinicians in the intensive care unit (ICU) setting at two South African decentralised clinical training facilities to understand the existing collaborative practices that students are exposed to during their clinical training. A qualitative study design, utilising semi-structured interviews, was used to gather information on the experiences of 40 purposively selected participants working in the ICU settings at the two clinical sites. Data collected from the interviews were transcribed verbatim and thematically analysed. Four major themes were identified from the data, namely, scope-of-practice dispute, teamwork disruption, organisational obstacles and future aspirations. Participants believed that a lack of professional regard by medical doctors and an inadequate understanding of the role of other professionals impeded appropriate referral practice and collaborative team functioning. Under-exposure to interprofessional education (IPE) at an undergraduate level and the pervasive medical hierarchy were perceived as a primary attributable cause of this phenomenon. Moreover, the coronavirus disease 2019 (COVID-19) pandemic and persistent staff shortages purportedly obstructed potential opportunities to collaborate in multidisciplinary meetings. Participants believed that improving undergraduate IPE and compulsory multidisciplinary meetings to promote communication would improve team functioning in these clinical settings. Undergraduate IPE is a feasible approach to improve collaborative care in ICUs to achieve better patient outcomes.