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Physiotherapy

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Browsing Physiotherapy by Author "Cobbing, Saul."

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    Home-based rehabilitation for people living with HIV in a resource-poor setting in KwaZulu-Natal, South Africa.
    (2016) Cobbing, Saul.; Hanass-Hancock, Jill.; Myezwa, Hellen.; Maharaj, Sonill.
    This PhD thesis centres on a home-based rehabilitation intervention (HBR) for people living with HIV (PLHIV) in a resource-poor setting in KwaZulu-Natal, South Africa. South Africa has the highest number of people infected with HIV worldwide, with 6.4 million PLHIV out of an estimated global total of 36.7 million. Antiretroviral therapy (ART) has ensured that PLHIV are living longer lives. However, there is a wide range of evidence that shows that PLHIV are prone to a broad range of physical and cognitive disabilities. It is crucial that PLHIV are able to attain a good health-related quality of life and optimal functioning, to support the success of the wide roll out of ART in countries like South Africa. Rehabilitation and exercise have been shown to improve the quality of life and function of PLHIV but there are numerous barriers facing patients who need to access rehabilitation. This PhD study aimed to determine the effect of an alternative approach of service delivery, namely a disability-inclusive HBR intervention, on PLHIVs’ perceived disability, quality of life, functional mobility and functional capacity. The study was situated in a resource-poor, semi-rural community in KwaZulu-Natal, the province with the highest HIV prevalence in South Africa. The design of the study intervention was informed by the synthesis of the evidence from a scoping review on HBR interventions for PLHIV, which revealed a paucity of evidence, and the practical experience of the lead author as a rehabilitation practitioner working with PLHIV. Embedded in a wider investigation related to an alternative model of care, this novel intervention, undertaken through a randomised control trial methodology, found that HBR is a safe strategy for treating the functional limitations experienced by PLHIV and may further improve their quality of life. While participants in the intervention group showed greater improvements across all outcome measures, between-group differences were nonsignificant. The community healthcare workers, who were trained via a task shifting approach to implement this HBR programme, reported feeling empowered by the knowledge and skills they attained through this study and gave valuable advice for improving future interventions. A synthesis of the overall PhD study results demonstrated that this intervention satisfied a number of the fundamental principles of a model of care for the rehabilitation of PLHIV, developed in the same study location. By building on the successes of this PhD study and addressing the limitations of its design and process, researchers can design and implement new rehabilitation interventions that involve multidisciplinary collaboration and the screening and treatment of people with a wide range of chronic conditions. This research should be combined with advocacy efforts to ensure that theoretical findings are translated into policies and practices that benefit all PLHIV, particularly those in resource-poor communities.
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    Physiotherapy rehabilitation in the context of HIV and disability in KwaZulu-Natal.
    (2012) Cobbing, Saul.; Rhode, Margaret.; Hanass-Hancock, Jill.
    Aim: The purpose of this study was to describe the experiences of people living with the human immunodeficiency virus who underwent a physiotherapy rehabilitation programme, with the aim of informing and improving future physiotherapy rehabilitation interventions. Methodology: Design: A qualitative research design was adopted, using the International Classification of Function, Disability and Health as a guiding framework. Population: All adult HIV positive patients who were referred for physiotherapy rehabilitation at a public-funded South African hospital during the course of a five week clinical block. Sample: Fourteen participants were eligible for the study. Eight of these participants, who were able to attend the post-rehabilitation interview, were considered for final analysis in the study. Study setting: A public-funded hospital within the eThekwini district of KwaZulu-Natal, South Africa. Research procedure: All eligible participants were requested to complete a questionnaire, the World Health Organisation Disability Assessment Schedule, prior to commencing a physiotherapy rehabilitation programme. After the period of rehabilitation, participants were interviewed using 14 open-ended questions designed to explore their experiences of this programme. Results: The questionnaire data described the participants’ demographics and illustrated the varying cognitive and physical challenges faced by these eight individuals. Content analysis of the eight interviews revealed the following themes: the participants’ knowledge of their health conditions and their prescribed medication, the impact of their illness on their impairments, activities and participation in their daily lives, the context in which these factors exist, the participants’ experience of physiotherapy rehabilitation and the barriers they faced in accessing continued rehabilitation. Conclusion: While participants reported mostly positive experiences related to physiotherapy rehabilitation, they face a number of barriers that limit their access to continued rehabilitation. It is hoped that the results of this study will assist in informing the development of future physiotherapy interventions, which are better designed to suit the needs of PLHIV in a South African public health context.