A study to investigate the functional rehabilitation outcomes of patients undergoing physical rehabilitation at Gugulethu Community Health Centre

[摘要] ENGLISH ABSTRACT: There has been a significant shift in the focus of evidence-based health care internationally and within government in South Africa, specifically the Western Cape (The Lancet, 2009:1793; Cieza, et al. 205-207: 2002; Western Cape Government, xv: 2014). A need for improved evidence based information for disability and rehabilitation services has been identified at international level (WHA, 1-2; 2005). There is hence an opportunity to strengthen the development of rehabilitation services and with that concurrently, an evidence approach to this part of the public sector health services.Aim: The aim of this study was to describe the functional rehabilitation outcomes of patients undergoing physical rehabilitation at the Gugulethu Community Health Centre.Methodology:This study employed a descriptive study design with pre-and post-rehabilitation test measuring changes in functional ability of clients. Quantitative methodology was followed. The study population included all patients who attended the Gugulethu Community Health Centre and who were referred to rehabilitation. The study sample included all patients who were admitted to the physiotherapy service at GCHC during the period February 2012 to September 2012. Patients with the five most prevalent conditions were included in the sample.Self-developed outcome measures that used the ICF and CBR guidelines as conceptual models were used to determine what the participants' socio-economic and environmental facilitators and barriers were. Six, standardised outcome measures were applied, namely the EQ5D for the whole cohort; and the Barthel Index, DASH, AIMS, Clinical Mobility Scale and the Oswestry respectively to do determine the level of functioning at the onset of rehabilitation and again either at discharge or three months post cessation of rehabilitation for each of the five most prevalent conditions. Results:By applying a t-test for dependent samples (Pre-VAS: N = 58; Post-VAS: N =52) to the whole cohort a statistically significant difference (p=0.03) in the participants' self-assessment of their health status (VAS) is noted. No statistical difference was reported in the activity related domains as well as the impairment related domains.Results for sub-sets of the cohort however indicated different results:Participants with Lower Limb Injuries (N=40) showed an overall significant improvement in pre- and post-testing in the activity domain; walking (p=0.02), Gait (p<0.3), Stair Climbing (p=0.01), Hand-held appliances (p=0.03). There was no improvement in the participation domain. Participants with Upper Limb Injuries (N=16) reported improvement in all three domains, namely impairment, activity limitations and participation restrictions. In terms of activity related elements, the following results indicated a significant improvement: Pushing a heavy door (p=0.04); Garden/yard work and making a bed (p=0.03) as well as pulling over a sweater (p=0.04). Impairment related element 'tingling of the arm, shoulder or hand showed a significant improvement (p=0.02). Participation related elements where participants indicated significant improvement includes recreational activities with 'little effort (p=0.01) and where the 'arm can move freely (p<0.01); 'managing transportation needs (p=0.01) and 'sexual activities (p=0.01).Participants with Lower Back Pain (N=11) reported a statistically significant difference in pre- and post-test results for the participation restriction domain: Socialising and Travel (p=0.04). No statistically significant difference was reported in the activity and impairment domains in this sub-set. Participants with Arthritis and Stokes reported no statistically significant difference between pre- and post-tests. This can be contributed to the low numbers of re-test that was present in these sub-sets.ConclusionThe results indicate significant changes in patients attending physical rehabilitation as far as mobility is concerned for people with lower leg injuries and lower back pain. Positive shifts were noted in the activity levels for patients with upper limb injuries as well as those with mobility problems. Significant improvements were noted in pain levels as well as patients' mental health. Participation in life roles were improved. More in-depth studies regarding the rehabilitation process would be beneficial to establish which interventions yield the most positive outcomes.RecommendationsThe mainstreaming of outcome measures at primary health-care level for rehabilitation services is strongly recommended. This will strengthen the development and delivery of rehabilitation services at primary health-care level. Furthermore, recommendations will be used to inform management and policy makers to move towards a firm outcome-based approach. Other recommendations include areas of strengthening further research, based on limitations identified in this study.KEY TERMS: Disability, Rehabilitation, functional outcomes, standardised outcome

[发布机构] Stellenbosch University