Physical Rehabilitation Needs in the BRICS Nations from 1990 to 2017: Cross-National Analyses Using Data from the Global Burden of Disease Study

Factors influencing access to and participation in rehabilitation for people with lower limb amputation in East, South, and Southeast Asian developing countries: the perspective of rehabilitation professionals - a qualitative study

PURPOSE

To identify barriers and enablers for access to and participation in rehabilitation for people with LLA in East, South, and Southeast Asian developing countries from the perspective of rehabilitation professionals.

MATERIAL AND METHODS

A mixed-method study involving an anonymous cross-sectional screening survey followed by in-depth interviews of rehabilitation professionals in these regions following the COREQ guidelines. Participants were surveyed online using convenience and snowball sampling techniques to inform a purposive heterogenic sample for semi-structured online interviews, between September 2021 to February 2022. Interview transcripts were analysed and thematically coded using the modified Health Care Delivery System Approach (HCDSA) framework.

RESULTS

A total of 201 quantitative survey responses shaped the interview questions and participation of 28 participants from 13 countries for the qualitative investigation. Important factors at the patient level were sex, economics, health issues, language differences, and lack of awareness; at the care team level, peer and/or family support, referrals, and the gender of the professional; at the organizational level, service availability, resources, and quality; and at the environmental level, policies, supports, and physical and/or social accessibility.

CONCLUSIONS

Identified interlinked factors at multiple levels of the HCDSA underpin the need for a systems approach to develop and address regional rehabilitation service provision but requires contextually adapted policy.

Prostate cancer burden in major BRICS countries, 1990-2019: findings from the 2019 global burden of disease study

BACKGROUND

This study assessed prostate cancer burden and trends in major BRICS countries (Brazil, Russia, India, China, and South Africa) from 1990 to 2019.

METHODS

Utilizing Global Burden of Disease Study 2019 data, we calculated age-standardized rates for prostate cancer incidence, prevalence, mortality, and disability-adjusted life years (DALYs) with 95% uncertainty intervals (UIs). Joinpoint regression analysis determined the average annual percentage change (AAPC) for trend characterization.

RESULTS

Prostate cancer ranked highest in China for incidence, prevalence, mortality, and DALYs. In 2019, Brazil had the highest age-standardized incidence rate (ASIR) [55.029 (95% UI: 47.744-81.831)] and age-standardized prevalence rate (ASPR) [372.511 (95% UI: 327.549-549.128)], while South Africa recorded the highest age-standardized mortality rate (ASMR) [42.241 (95% UI: 32.146-47.933)], and age-standardized DALY rate (ASDR) [666.085 (95% UI: 522.626-764.612)]. ASIR and ASPR increased significantly over three decades (AAPC > 0), with varying ASMR and ASDR trends.

CONCLUSION

Prostate cancer poses a significant public health challenge. While incidence and prevalence rise, mortality declines in China, India, and Brazil. Tailored health policies are crucial to address diverse disease burden characteristics.

Trends and age-period-cohort effect on the incidence of falls from 1990 to 2019 in BRICS

Background

The increasing burden of falls in BRICS countries warrants a comprehensive investigation to understand the dynamics and trends. This study utilized data from the Global Burden of Disease Study (GBD) 2019 to assess fall incidence rates in Brazil, Russia, India, China, and South Africa (BRICS) to provide valuable insights for the development of targeted prevention and management strategies.

Methods

Data from the GBD 2019 were employed to estimate fall incidence rates. The study utilized age-period-cohort (APC) model analysis, implemented using R 4.3.0 software and the R package apc, to examine fall incidence trends from 1990 to 2019.

Results

In 2019, the BRICS nations collectively reported 32.32 million fall cases. The overall fall incidence rate increased from 2681.7 per 100,000 people in 1990-2896.3 per 100,000 people in 2019. China and India exhibited escalating trends, with China experiencing the highest growth rate at 21%, followed by India at 5.8%. South Africa displayed a comparatively lower overall incidence rate increase. Notably, the 90-94 age group in China exhibited the most significant deterioration, with men and women experiencing annual increases of 4.23% and 1.77%, respectively. Age effects indicated a higher susceptibility to falls among preschool children and the elderly. Period effects revealed no improvement in the fall state for India (2005-2019) and China (2015-2019). Cohort effects adversely impacted the incidence rate for individuals born earlier in South Africa.

Conclusion

The present study highlights a consistent upward trend in fall incidence rates across BRICS countries from 1990 to 2019. With an aging population, the burden of fall-related diseases is on the rise in these nations. Our results underscore the necessity of formulating evidence-based disease prevention and management approaches tailored to the distinctive demographic attributes of each nation. Addressing these trends is crucial for mitigating the growing impact of falls on public health in BRICS countries.

Global research publications on cardiovascular and pulmonary rehabilitation and their alignment with population rehabilitation needs: An ecological study

PURPOSE

Towards informing health research policy and planning, this article evaluates the relationship of the research publications in cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) with the rehabilitation needs arising from cardiovascular diseases (except stroke) and chronic respiratory diseases, over time (1990-2017).

METHODS

Ecological study using a secondary analysis and linear regressions of public domain data to associate two datasets of population-level data: (1) research publications for CR and PR (data from the PubMed database); and (2) global need for CR and PR (data from the Global Burden of Disease study).

RESULTS

The percentage of both CR and PR publications (among total rehabilitation research) significantly decreased from 1990 to 2017 (both: p < 0.01). PR needs and research publications were aligned: around 5% of total rehabilitation needs and rehabilitation research. For CR needs (around 2%, but significantly increasing since 1990), we found a greater portion of CR research publications (6.5% or over). Finally, we found an inverse association among the percentage of CR research publications and CR needs (b = -6.08; r2  = 0.37, p = 0.001).

CONCLUSION

The portion of CR and PR research (among total rehabilitation research) is declining over time. Yearly percentage of CR publications were greater than those of PR but for lower level of rehabilitation need, but the disparate trend was significantly decreasing over time. Population rehabilitation needs and their alignment with research volume must be one factor in the design of population-centred, equitable health research priorities.

Global estimates of rehabilitation needs and disease burden in tracheal, bronchus, and lung cancer from 1990 to 2019 and projections to 2045 based on the global burden of disease study 2019

Background

The global cancer burden is substantial and spiraling. Although rehabilitation specialists could offer assistance, oncologic rehabilitation is still underutilized and not a routine part of clinical oncology guidelines worldwide. Global investigations of disease prevalence and years lived with disability (YLDs) for tracheal, bronchus, and lung (TBL) cancer are valuable for facilitating clinical practice improvement and health resource management. The objective of this study is to report the global estimates of rehabilitation needs and disease burden of TBL cancers from 1990 to 2019 and provide predictions for 2045.

Methods

To estimate the need for rehabilitation, the data used from the Global Burden of Disease Study 2019 to calculate the prevalence, YLDs, and the attributable risk factors of TBL cancer. The Bayesian age-period-cohort model and Auto-Regressive Integrated Moving Average model were established to forecast the future health burden. All analyses were done at the global level and then some in the aggregation with the seven World Bank regions. All the data were analyzed by R software (x64 version 4.2.1) and Microsoft Excel (version 2019).

Results

Globally in 2019, 3,212,307 cases of TBL cancer (95% UI 2,937,037-3,488,346) could have benefitted from rehabilitation, contributing to 544,215 (95% UI 396,134-700,099) YLDs. Over the past 30 years, the age-standardized rate (ASR) of prevalence (EAPC = 0.51) and YLDs (EAPC = 0.03) increased. Throughout this period, the global prevalence and YLDs counts were greater in males than females. The ASR of prevalence and YLDs are projected to show a slight downward trend by 2045 on the global scale, the overall prevalence and YLDs due to TBL cancer are likely to increase further, but all indicators show a growing trend in females.

Conclusion

TBL cancer remains one of the major public health issues globally. According to the forecasted results, the burden of YLDs due to TBL cancer will continue to rise, and the increment is higher in females than males. A rising number of patients worldwide will benefit from rehabilitation services in the future to achieve precise control and management throughout the TBL cancer patient lifecycle.

Prioritizing rehabilitation in low- and middle-income country national health systems: a qualitative thematic synthesis and development of a policy framework

BACKGROUND

There is a large and growing unmet need for rehabilitation - a diverse category of services that aim to improve functioning across the life course - particularly in low- and middle-income countries. Yet despite urgent calls to increase political commitment, many low- and middle-income country governments have dedicated little attention to expanding rehabilitation services. Existing policy scholarship explains how and why health issues reach the policy agenda and offers applicable evidence to advance access to physical, medical, psychosocial, and other types of rehabilitation services. Drawing from this scholarship and empirical data on rehabilitation, this paper proposes a policy framework to understand national-level prioritization of rehabilitation in low- and middle-income countries.

METHODS

We conducted key informant interviews with rehabilitation stakeholders in 47 countries, complemented by a purposeful review of peer-reviewed and gray literature to achieve thematic saturation. We analyzed the data abductively using a thematic synthesis methodology. Rehabilitation-specific findings were triangulated with policy theory and empirical case studies on the prioritization of other health issues to develop the framework.

RESULTS

The novel policy framework includes three components which shape the prioritization of rehabilitation on low- and middle-income countries' national government's health agendas. First, rehabilitation lacks a consistent problem definition, undermining the development of consensus-driven solutions which could advance the issue on policy agendas. Second, governance arrangements are fragmented within and across government ministries, between the government and its citizens, and across national and transnational actors engaged in rehabilitation service provision. Third, national legacies - particularly from civil conflict - and weaknesses in the existing health system influences both rehabilitation needs and implementation feasibility.

CONCLUSIONS

This framework can support stakeholders in identifying the key components impeding prioritization for rehabilitation across different national contexts. This is a crucial step for ultimately better advancing the issue on national policy agendas and improving equity in access to rehabilitation services.

Evaluation of the feasibility and acceptability of ReWin-A digital therapeutic rehabilitation innovation for people with stroke-related disabilities in India

Background

Developing culturally appropriate, scalable interventions to meet the growing needs for stroke rehabilitation is a significant problem of public health concern. Therefore, systematic development and evaluation of a scalable, inclusive, technology-driven solution for community-based stroke care are of immense public health importance in India. ReWin is a digital therapeutics platform that was developed systematically. This study aimed to evaluate its feasibility and acceptability in an Indian context.

Objectives

Phase-1: To pilot the intervention for identifying operational issues and finalize the intervention. Phase-2: To assess the feasibility and acceptability of ReWin intervention in an Indian context.

Methods

Design: Mixed-methods research design. Setting: Participant's home and rehabilitation centers. Participants were selected from rehabilitation centers in South India. Participants: Ten stroke survivors and their caregivers, as well as four rehabilitation service providers were recruited for phase 1. Thirty stroke survivors who were treated and discharged from the hospital, and their caregivers as well as 10 rehabilitation service providers were recruited for Phase 2. Intervention: ReWin a digital therapeutic platform with the provider and patient app for the rehabilitation of physical disabilities following stroke was piloted. Process: Evaluation of the intervention was completed in two phases. In the first phase, the preliminary intervention was field-tested with 10 stroke survivors and four rehabilitation service providers for 2 weeks. In the second phase, the finalized intervention was provided to a further 30 stroke survivors to be used in their homes with support from their carers as well as to 10 rehabilitation service providers for 4 weeks. Outcome measures: Primary outcomes: (1) operational difficulties in using the ReWin intervention; (2) feasibility and acceptability of the ReWin intervention in an Indian setting.

Results

Field-testing identified operational difficulties related to 1. Therapeutic content; 2. Format; 3. Navigation; 4. Connectivity, 5. Video-streaming, 6. Language; and 7. Comprehensibility of the animated content. The intervention was reviewed, revised and finalized before pilot testing. Findings from the pilot testing showed that the ReWin intervention was feasible and acceptable. About 76% of the participants had used ReWin for more than half of the intervention period of 4 weeks. Ninety percentage of the stroke care providers and about 60% of the stroke survivors and caregivers felt that the content of ReWin was very relevant to the needs of the stroke survivors. Forty percentage of the stroke survivors and caregivers rated ReWin intervention as excellent. Another 45% of the stroke survivors and caregivers as well as 90% of the stroke care providers rated ReWin intervention as very good based on its overall credibility, usability, and user-friendliness.

Conclusions

ReWin has all the essential components to connect care providers and consumers not just for stroke rehabilitation but for several other health conditions with the use of several other technological features that support rehabilitation of persons with disabilities and strengthen rehabilitation in health systems worldwide. It is critical to amalgamate ReWin and other evidence-based interventions for rehabilitation to innovate scalable solutions and promote universal health coverage for stroke care worldwide.

Rehabilitation professionals' perspectives of factors influencing return to occupation for people with lower limb amputation in East, South, and Southeast Asian developing countries: A qualitative study

Objective

To identify barriers and enablers for return to occupation (RTO) for people with lower limb amputation (LLA) in East, South, and Southeast Asian developing countries from the perspective of rehabilitation professionals.

Methods

A convenience sample of rehabilitation professionals working in Asian developing countries participated in online in-depth interviews between September 2021 and February 2022. Interview transcripts were analyzed and thematically coded to the modified Health Care Delivery System Approach (HCDSA) framework. COREQ guidelines were followed.

Results

Twenty-eight interviewees from 13 countries shared their experiences of factors related to RTO for people with LLA. Identified factors described barriers and facilitators for RTO at all four HCDSA framework levels. The "environmental" level had the most identified factors (n = 56) and the "care team" level the least (n = 31). Common environmental RTO challenges included cultural attitudes to women; lack of rural/remote services; inadequate numbers and regulation of rehabilitation professionals; inappropriate prosthesis; limited government support for rehabilitation, and reliance on charitable models.

Conclusions

Despite varied cultural, religious, and geographical characteristics, consistent factors impacting RTO were identified within these thirteen countries. Identified barriers to RTO underline the need for improvements throughout service systems from the acute-care focus on saving life without consideration of RTO, the rehabilitation focused primarily on mobility, to the lack of occupational rehabilitation services and supporting policy in these countries. These interlinked factors at different levels of healthcare service systems reinforce the importance of systems approaches to best utilize limited resources toward improving RTO in this region.

Influential factors for access to and participation in rehabilitation for people with lower limb amputation in East, South, and Southeast Asian developing countries: a scoping review

PURPOSE

To explore factors impacting access to and participation in rehabilitation for people with lower limb amputation (LLA) in East, South, and Southeast Asian developing countries.

MATERIALS AND METHODS

A scoping review was undertaken following the PRISMA-ScR guidelines. Five electronic databases (PsycINFO (Ovid), Medline (Ovid), CINAHL (EBSCO), AMED, and Proquest Social Sciences) were searched for articles from January 1980 till March 2020. Two authors independently assessed articles for inclusion. Included articles were classified according to the Health Care Delivery System Approach (HCDSA) framework levels.

RESULTS

Twenty-four studies from 14 countries were identified. At patient level, age, gender, limited rehabilitation awareness, and economic status; at the rehabilitation level, gaps in referrals, family support, and professional skills; at the environmental level, services availability, and location; and, at government level, service costs, income loss, and lack of supporting policies were identified as important influencing factors.

CONCLUSIONS

Rehabilitation access and participation factors were identified at multiple levels of the HCDSA. Contextually appropriate and accessible services considering individual characteristics and socio-economic status of individuals with LLA are needed, with timely referral to rehabilitation by trained professionals. Improving rehabilitation services for people with LLA in Asian developing countries requires supportive environments, accessible transport, social and financial security, and increased awareness, underpinned by appropriate policy.Implications for rehabilitationProvision of timely referral to rehabilitation by primary/acute health care settings with involvement of family/peer supports.Improved government support systems to facilitate individual access to and participation in rehabilitation with consideration of contextual socio-demographic and economic factors.Prioritisation of adequately resourced and well-designed rehabilitation centres by health care organisations in accessible locations.Implementation by local government of strategies to support development and implementation of well resourced, accessible, equitable, and contextually responsive rehabilitation services.

Secular trends in chronic respiratory diseases mortality in Brazil, Russia, China, and South Africa: a comparative study across main BRICS countries from 1990 to 2019

Background

As the emerging economies, the BRICS (Brazil, Russia, India, China, and South Africa) shared 61.58% of the global chronic respiratory diseases (CRD) deaths in 2017. This study aimed to assess the secular trends in CRD mortality and explore the effects of age, period, and cohort across main BRICS countries.

Methods

Data were obtained from the Global Burden of Disease Study (GBD) 2019 and analyzed using the age-period-cohort (APC) model to estimate period and cohort effects between 1990 and 2019. The net drifts, local drifts, longitudinal age curves, period/cohort rate ratios (RRs) were obtained through the APC model.

Results

In 2019, the CRD deaths across the BRICS were 2.39 (95%UI 1.95 to 2.84) million, accounting for 60.07% of global CRD deaths. Chronic obstructive pulmonary disease (COPD) and asthma remained the leading causes of CRD deaths. The age-standardized mortality rates (ASMR) have declined across the BRICS since 1990, with the most apparent decline in China. Meanwhile, the downward trends in CRD death counts were observed in China and Russia. The overall net drifts per year were obvious in China (-5.89%; -6.06% to -5.71%), and the local drift values were all below zero in all age groups for both sexes. The age effect of CRD presented increase with age, and the period and cohort RRs were following downward trends over time across countries. Similar trends were observed in COPD and asthma. The improvement of CRD mortality was the most obvious in China, especially in period and cohort effects. While South Africa showed the most rapid increase with age across all CRD categories, and the period and cohort effects were flat.

Conclusions

BRICS accounted for a large proportion of CRD deaths, with China and India alone contributing more than half of the global CRD deaths. However, the declines in ASMR and improvements of period and cohort effects have been observed in both sexes and all age groups across main BRICS countries. China stands out for its remarkable reduction in CRD mortality and its experience may help reduce the burden of CRD in developing countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12484-z.

Experiences and needs of the caregivers of stroke survivors in Malaysia-A phenomenological exploration

Introduction

Informal caregivers play a crucial role in supporting the activities of daily living, rehabilitation, and the road to recovery for stroke survivors. However, these informal caregivers are often reported as experiencing neglect and lack of recognition despite their primary contribution to stroke recovery. This study investigated the experiences of the caregivers of stroke survivors and access to stroke care in Malaysia.

Method

This qualitative study with a phenomenological approach utilized in-depth interviews, including ten primary caregivers, one formal caregiver, and stroke healthcare providers as the participants. The interviews were done until the data saturation was achieved, and the data was analyzed using thematic analysis.

Result

Three primary themes and 14 subthemes were identified from the interviews. The role of primary caregivers of stroke survivors had tremendous physical, mental and social impact on the caregivers. Caregivers had two primary needs. The need for information about comprehensive stroke care at home and the need for psychological support to themselves. The key internal driver for providing care was identified to be the motivation level of the stroke survivor and the external driver was identified to be the societal support with access to comprehensive stroke care.

Conclusion

The role of informal caregivers becomes critical for continuum of stroke care. As caregivers take up the roles and responsibilities of those who contribute to stroke rehabilitation single-handedly soon after hospital discharge. Results of this study highlights the needs for providing systematic support to caregivers for engaging them in effective stroke care, particularly in the community. Stroke service providers, policy makers and program planners must be sensitized to empower caregivers of stroke survivors in effectively supporting stroke survivor in their family on the road of recovery.

Occupational Therapy for Reducing Disabilities in Persons with Disabilities in India: A Systematic Review

Background

The current evidence for occupational therapy practice, teaching, and research is replicated and implemented significantly from high-income countries in India. Therefore, a systematic review and an evaluation of existing evidence for occupational therapy (OT) to reduce disabilities including impairments, activity limitations, and participation restriction in persons with disabilities (PWD) in India are warranted.

Objectives

The objective of this review was to evaluate the effectiveness of OT interventions for reducing disabilities in PWD in India.

Study Design

Systematic review.

Methods

We searched the Cochrane CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, AMED, and Web of Science. A hand search was also carried out in selected Indian journals, OT-specific databases, and repositories, such as Indian Journal of Occupational Therapy, Indian Journal of Physiotherapy and Occupational Therapy, OT Seekers, World Federation of Occupational Therapy Bulletin, Asia Pacific Occupational Therapists Regional Group, and clinical trials registers. The search was restricted to published studies conducted in India during 2000–2021. We included randomized controlled trials (RCTs) of an occupational therapy intervention delivered by OTs for PWD, where the effects of the intervention were evaluated using any relevant disability outcome measure. Studies without access to full text were excluded. Two review authors independently completed screening, and one author reviewed the full text of the screened studies. Another pair of authors extracted data from included studies for prespecified disability outcomes, and two authors assessed the risk of bias in the included studies.

Results

We identified seven RCTs of occupational therapy interventions for PWD in India with 305 participants in total. All seven studies were very different in terms of their objective, participants, comparison, and outcomes. Allocation concealment and blinding and risk of bias were high in five trials. All the trials reported impairment outcomes with a statistically significant difference between the experimental arm and the control arm in terms of their primary outcomes except one. Given the sample size and the risk of bias in each of the included trials, the effect size has to be understood and interpreted with utmost caution.

Conclusion

Overall, this review establishes the paucity of evidence for occupational therapy for PWD in India. Building the capacity for rigorous and relevant scientific research in occupational therapy would enable bridging the gaps in evidence for occupational therapy in India.

Growing physical rehabilitation needs in resource-poor world regions: secondary, cross-regional analysis with data from the global burden of disease 2017

PURPOSE

This paper aims to analyze the levels and trajectories of physical rehabilitation needs across five resource-poor world regions, against global and key country-specific benchmarks.

MATERIALS AND METHODS

This comparative, secondary cross-region analysis uses data from the Global Burden of Diseases study 2017 [1990-2017], specifically varied metrics of the Years Lived with Disability (YLD) measure from the health conditions likely benefiting from physical rehabilitation.

RESULTS

All the resource-poor world regions had significant increases (p < 0.01) in the absolute, relative, and percentage of physical rehabilitation needs [1990-2017]. Nonetheless, The Asia-Pacific region stood out with the greatest YLD Rates (i.e., per population size) in 2017, the greatest growth in YLD Rates since 1990 (38%), and an exponential growth in the rehabilitation-sensitive YLD Rates. The Asia-Pacific region also had the greatest portion of their YLDs coming from rehabilitation-sensitive conditions (72% in 2017), closely followed by the Latin America & Caribbean (67%). Nonetheless, in South Asia and Sub-Saharan Africa, we observed the greatest percent increases in the portion of physical rehabilitation needs among all YLDs, out of lower initial values.

CONCLUSIONS

An overall growth but differential patterns were observed in the evolution of physical rehabilitation needs across the resource-poor world regions.IMPLICATIONS FOR REHABILITATIONAsia-Pacific and Latin America & Caribbean regions had over than two-thirds of their non-fatal health loss arising from conditions sensitive to physical rehabilitation, and important growths in rehabilitation need indicators have been observed also for South Asia and Sub-Saharan Africa.The scale-up and strengthening of rehabilitation services and resources should be informed by needs-based data.The needs-based data from this study can inform trans-national developments and the planning of rehabilitation resources, inclusively at the world-region level.

Towards a needs-based design of the physical rehabilitation workforce in South Africa: trend analysis [1990-2017] and a 5-year forecasting for the most impactful health conditions based on global burden of disease estimates

BACKGROUND

Rehabilitation can improve function in many people with chronic health conditions. It is important to consider priority conditions requiring rehabilitation, so it can be realistically positioned and costed in national health financing systems like South Africa (SA)'s proposed National Health Insurance (NHI). This paper describes temporal trends of top-ranked conditions on years lived with disability (YLDs) rates in SA, for which physical rehabilitation can ameliorate associated disability.

METHODS

This study is a systematic synthesis of publicly available Global Burden of Disease (GBD) 2017 estimates. The top 11 conditions contributing most to YLDs and for which evidence-based rehabilitation interventions exist were identified. Age-standardized rates per 100,000 and YLDs counts were extracted from 1990 to 2017. Significance of changes in temporal trends was determined using Mann-Kendall trend tests. Best-fit rates of yearly changes were calculated per condition, using GBD estimates (2012-2017), and extrapolated (by imposing the best-fit regression line onto results for each subsequent predicted year) as forecasts (2018-2022).

RESULTS

Trends for YLDs counts per condition year (1990-2017) and forecasted values (2018-2022) showed an overall steady increase for all conditions, except HIV and respiratory conditions. YLDs counts almost doubled from 1990 to 2017, with a 17% predicted increase from 2017 to 2022. The proportionate contribution to YLDs counts reduced over time for all conditions, except HIV. Although age-standardized YLDs rates appear relatively stable over the analyzed periods for all conditions (except HIV, respiratory conditions and type 2 diabetes), trend changes in YLDs rates over 28 years were significant for all conditions, except neonatal (p = 0.855), hearing loss (p = 0.100) and musculoskeletal conditions (p = 0.300). Significant trend decreases were apparent for 4/9 conditions, implying that another 5/9 conditions showed trend increases over 28 years. Predicted all-age prevalence in 2022 suggests relatively large increases for cardiovascular disease and heart failure, and burns, while relative decreases are predicted for fractures and dislocations, stroke, and musculoskeletal conditions.

CONCLUSION

Rehabilitation needs in SA are potentially massive and unmet, highlighting the need for innovative and context-specific rehabilitation that considers current local needs and projected changes. These findings should be considered when designing the NHI and other schemes in SA to ensure human and financial resources are deployed efficiently.

Examining the Availability and Accessibility of Rehabilitation Services in a Rural District of South Africa: A Mixed-Methods Study

Introduction: Rehabilitation services aim to optimise individuals’ functioning and reduce disability. However, people with disabilities, who represent a key population of users of rehabilitation services, continue to have unmet needs for rehabilitation services that include the provision of assistive devices. This paper examines the availability and accessibility of rehabilitation services in a rural district of South Africa in order to explore why unmet needs for rehabilitation services persist. Methods: All nine district hospitals in a rural district of South Africa were included in the study. Rehabilitation services capacity was assessed by examining the available assistive devices, consumables and human resources at the level of the health facility. Data collection was conducted using the Global Co-operative Assistive Technology [GATE] Assistive Products List, AT2030’s ATScale priority list and the South African National Catalogue of Commodities for Primary Health Care Facilities. Descriptive statistics were then used for the analysis. For the qualitative component, semi-structured interviews were conducted with adults with physical disabilities at household level to explore barriers to accessing assistive device inclusive rehabilitation services and the consequences thereof in the same rural district. An interview guide based on the WHO health system building blocks was used. Thematic content analysis guided the analysis of the interview transcripts. Findings: The findings of the research demonstrate that rehabilitation service capacity in the district was constrained as a result of low availability of assistive devices [2–22%] and consumables [2–47%], as well as, possibly, a shortage of rehabilitation providers [n = 30] with an unequal distribution across health facilities [n = 9]. In addition, people with physical disabilities reported poor referral pathways, financial constraints, transport and road consideration and equipment unavailability as barriers to accessing rehabilitation services. Moreover, these barriers to access predisposed individuals to finance-, health- and person-related harm. Conclusion: Rehabilitation service availability is constrained by a lack of service capacity in rural South Africa. In addition, the rehabilitation services in district hospitals are not adequately accessible because of existing barriers to enable key populations to achieve optimised functioning.

Application of Nanosystems Synergized by Optics and Chemotherapy in the Treatment of Sports Rehabilitation Diseases

With the rapid development of sports in my country, many athletes will have mild or severe diseases. Physical rehabilitation can improve their physical pain, and some more serious diseases require optical and chemotherapy treatments. This article mainly studies the application of nanosystems that cooperate with optical and chemotherapy in the treatment of sports rehabilitation diseases. In the experiment, the bacteria-infected mice in the wound were divided into 5 groups (n = 4), and the mouse wound model was made. After that, the number of bacteria remaining in the wound was determined by the plate count method. At the same time, a cytotoxicity test was performed, and a control experiment was performed on the cell culture of the polymer at a concentration below the VCR and CMC values. The final sections were used for tissue analysis of serine and epoxy staining. It was found from the experimental data that the cumulative release of free CLB molecules within 3 hours almost reached 100%, and its rapid release was attributed to its small molecular size. In contrast, the release of CLB-HDH micelles in 3 h is 62%, which has a certain relaxation effect. The results showed that CLB-HDH micelles significantly inhibited tumor growth, had good safety in vivo, and had low systemic toxicity. CLB-HDH micelles provide new ideas for efficient CLB tumor treatment.