Verusia Chetty

Background: Children and adolescents undergoing cancer treatment often experience physical and psychosocial challenges, such as weakness, fatigue, anxiety, and social isolation, which significantly impact quality of life (QoL) and daily activities, including school. Physiotherapy addresses physical limitations, while music therapy supports emotional well-being and social engagement. Although both therapies are used in paediatric oncology, evidence on multimodal rehabilitation approaches combining these interventions is limited, particularly in low- and middle-income countries (LMICs) with scarce rehabilitation resources. Mapping available literature may help inform more holistic care in these contexts. Aim: To map and describe evidence on multimodal rehabilitation interventions incorporating physiotherapy and music therapy for children and adolescents with cancer, focusing on intervention characteristics, outcomes, implementation, and contextual factors, especially in LMICs. Methods: This scoping review will use the PCC (Population, Concept, Context) framework following JBI guidance. Studies from 2016 to 2026 will be identified through searches in PubMed, PsycINFO, Web of Science, Scopus, EMBASE, CINAHL, and grey literature, with the search strategy peer-reviewed using PRESS guidelines. Eligible studies will include children and adolescents (6 years – 17 years) with cancer who received multimodal rehabilitation involving physiotherapy and/or music therapy, or combined exercise and music-based approaches, during inpatient or hospital care. Results: Studies will report on any outcomes related to physical function, psychosocial well-being, QoL, feasibility, acceptability, implementation, or barriers and facilitators. Two reviewers will independently screen and extract data, which will be synthesised both descriptively and thematically. Studies from LMICs will be analysed separately where sufficient data exist, with contextual factors thematically analysed. Conclusion: This review will support the development of effective, culturally relevant rehabilitation for paediatric oncology in resource-limited settings. Contribution: The review will highlight current evidence and gaps, supporting the development of culturally appropriate, multimodal interventions.

Cerebral palsy (CP) classified as Gross Motor Function Classification System (GMFCS) Level V results in severe postural impairment and complete dependence on external support for upright sitting. In low- and middle-income countries such as South Africa, access to specialised adaptive seating devices within the public healthcare system is severely limited. Frugal innovation the adaptation of readily available, affordable resources to meet complex rehabilitation needs represents a promising strategy to address this gap. We report the case of a 12-year-old male (pseudonym: Jessie) with a confirmed diagnosis of CP GMFCS Level V, born at 28 weeks gestation following antepartum haemorrhage. He presented with profound generalised hypotonia, absent independent trunk stability, poor head control, postural asymmetry in sitting, complete dependence on caregivers for all activities of daily living, and bilateral visual impairment. He had outgrown his transporter buggy (a caregiver-propelled basic pram-style mobility device) and was unable to maintain a safe upright sitting position in a standard basic folding frame wheelchair due to postural collapse. Baseline assessment using the validated Posture and Postural Ability Scale (PPAS) yielded a total score of 3/12 (frontal: 1/6; sagittal: 2/6). A commercially available car seat was selected based on systematic individual anthropometric and postural assessment. Low-cost modifications were applied using repurposed materials: a trunk control harness (repurposed buggy fabric), a seat belt extension, an abduction wedge (sponge foam), a polystyrene footrest, and a wheelchair attachment system (Velcro straps). A built-in four-position tilt-in-space feature was used to optimise hip flexion angle. The total material cost was negligible. Following the intervention, PPAS scores improved to 12/12 (frontal: 6/6; sagittal: 6/6), representing improved postural alignment as measured by PPAS across both planes. A commercially available car seat, systematically modified using low-cost repurposed materials through a structured, physiotherapy-guided fitting process, achieved improved postural alignment as measured by PPAS in a child with GMFCS Level V CP. This case provides proof-of-concept that structured, physiotherapy-led modification of commercially available car seats can achieve significant postural correction in children with GMFCS Level V cerebral palsy in low-resource settings.

Background: Variations in external examination processes across South African universities may challenge the validity of physiotherapy assessments. Our study explores external examiners’ understanding of moderation and academic standards. Objectives: This study aimed to describe the examination processes and external examiners’ perceptions of academic standards in South African physiotherapy programmes. Method: A descriptive cross-sectional survey using a self-administered questionnaire sent to all eight universities that offer a physiotherapy degree in South Africa. The total population size was 103. Results: Practices include appointing the same external examiner for up to 2 years (n = 4), using the same examiner for reassessments (n = 3), and assigning examiners across all modules regardless of expertise (n = 2). Five institutions allocate clinical blocks specifically, and four expose students to all clinical areas. External examiners assess all third- and fourth-year students at five institutions and receive procedural orientation via written guidelines (n = 5). Feedback is typically shared orally (n = 5) or in a university-formatted written report (n = 3). A 10% mark difference is acceptable at two institutions; others lack clear criteria. Internal and external marks carry equal weight, and two universities apply sub minima for clinical safety and effectiveness. Moderation samples span high to low scoring scripts (n = 4). Contingency plans for examiner cancellations are in place at all institutions. Indicators of good performance include evidence-based practice (88%), alignment with departmental outcomes (71%), and meeting examiners’ assessment expectations (50%). Conclusion: Clarification of the external examiner’s role is needed in the absence of formal guidelines from governing bodies. Clinical implications: Findings can guide consistent competency standards and also support the Health Professions Council in evaluating physiotherapy training institutions.

Background: Hip and knee joint arthroplasty in many low- and middle-income countries has lengthy waiting lists as trauma-related procedures are prioritised. A comprehensive care pathway that includes prehabilitation can enhance patient outcomes. Prior to designing an impactful service, a contextually grounded study with an understanding of current knowledge, relationship between felt and expressed needs in the specific socio-cultural setup is critical. Objectives: This study aimed to investigate patients’ knowledge and perceptions of physiotherapy and prehabilitation before undergoing total hip or knee replacement operations in a South African public healthcare setting. Method: A mixed-methods approach utilising semi-structured, face-to-face interviews and questionnaires was employed. Patients in the orthopaedic outpatient queue who consented to participate were recruited. Forty-nine participants answered the questionnaires, and seven patients were interviewed. Questionnaire data were analysed descriptively, including estimates of means and percentages and qualitative data by content analysis. Results: A significant (p < 0.001) 77.6% (38) of patients indicated that they were unsure of the role of a physiotherapist, and 67.3% (33) of respondents were unsure of the necessity for pre-operative exercises (p < 0.001). Three main themes emerged from the interviews, which were patients’ preconceptions of physiotherapy, the perceived value of prehabilitation and patients’ recommendations regarding physiotherapy and prehabilitation. Conclusion: This study identified a lack of knowledge and understanding regarding physiotherapy and prehabilitation among these patients. Contribution: The findings of this study may inform the design of a prehabilitation programme tailored to this context and highlighted a need for the education of medical personnel.

Background: Despite the existence of South African frameworks guiding the inclusion and accessibility of persons with disabilities in the workplace, there is no tool available to guide how healthcare facilities meet the inclusion and accessibility standards set out in the Convention of the Rights of Persons with Disabilities (CRPD) and national frameworks. Objectives: This study sought to achieve consensus among experts regarding the tool that can be utilised to guide the implementation of the CRPD-aligned standards of universal design and reasonable accommodation in the public healthcare sector. Method: A panel of experts (27) in the field of disability across South Africa participated in a two-round modified Delphi technique. The 80% agreement threshold was set to determine the level of agreement among experts. Results: Consensus was reached on all seven domains (with various disability indicators) as outlined by the CRPD to be included in the development of a tool. These domains are, namely, the prohibition of discrimination, protecting and promoting the rights of persons with disabilities, labour and trade union participation, access to technical and vocational training, employment opportunities and career advancement, reasonable accommodation and professional and vocational rehabilitation training programmes for persons with disabilities. Conclusion: The panellists agreed that the developed tool can be utilised to evaluate and guide the implementation of universal design and reasonable accommodation in the public healthcare sector. Contribution: This study provides a consensus-based, CRPD-aligned assessment tool that enables healthcare facilities to systematically evaluate and improve disability inclusion and accessibility in the workplace.

Background: People living with long-COVID (PLWLC) experience a broad range of persistent coronavirus disease 2019 (COVID-19) symptoms extending beyond 4 weeks. Long-term, multi-organ damage in the body negatively impacts physical activity, which is vital to improving mental well-being and quality of life. People living with long-COVID experiment with self-management strategies, and this can have damaging outcomes. Objectives: Our study explored the influence of the 2019 coronavirus on physical activity, through the lived experiences of PLWLC, to inform future rehabilitation initiatives for this population. Method: A qualitative research study design involving semi-structured interviews was utilised to gather the experiences of 17 purposively selected participants who have long-COVID at a private facility in KwaZulu-Natal, South Africa. Data collected from the interviews were transcribed verbatim and thematically analysed. Results: Four main themes emerged, namely, perceptions of pre-COVID and post-COVID physical activities in daily life, approaches to coping strategies with physical activity limitations, perceptions of physical activity’s influence in recovery and progressive informal exercise therapy. Conclusion: Our study reveals long-COVID’s complex and multifactorial nature, which imposes challenges on PLWLC’s individual functioning and daily activities, community participation and societal roles. Individuals perceived poor, mixed or beneficial effects with the uptake of physical activity and resorted to self-taught management strategies. Further research on safe, tailored and contextualised rehabilitation advice and interventions for the common debilitating symptoms of long-COVID is needed. Clinical implications: Inform future rehabilitation considerations for healthcare professionals and provide insight for further interventional explorative studies for long-COVID rehabilitation.

Well-established, regular exercise interventions for older people living with HIV (OPLWH) are beneficial. However, the fundamental principles of exercise prescription for this population have not been sufficiently explored. An expert panel of health care professionals engaged in a modified Delphi technique to explore their perceptions of, and gain their consensus on, an exercise prescription framework for OPLWH in a resource-poor South African setting. A high level of agreement among participants was determined using a priori threshold of 80% agreement and an interquartile range of ≤ 1. Expert consensus was reached on a structured, multifaceted exercise prescription and also fundamental principles, such as multidisciplinary engagement and team collaboration, pre-exercise health screening, and exercise supervision. These were viewed as necessary components of a framework to improve the integration of exercise rehabilitation in the treatment, care, and support for OPLWH.

Background: 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. Objectives: Develop a prehabilitation programme for a resource-scarce community in South Africa. Method: 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. Results: 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. Conclusion: 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. Clinical implications: 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. Keywords: prehabilitation; arthroplasty; exercise; rehabilitation; hybrid.

"Blending Bytes and Bench Presses: The Future of Online Exercise and Artificial Intelligence-Enhanced Rehabilitation" published on 27 Nov 2024 by Human Kinetics.

The South African Journal of Physiotherapy is the official scholarly refereed journal of the South African Society of Physiotherapy. It aims to publish original research and facilitate continuing professional development for physiotherapists and other health professions both nationally and internationally.