Rehabilitation needs in individuals with knee OA in rural Western Cape, South Africa: an exploratory qualitative study

Abstract

Background: Current clinical practice guidelines have suggested that each individual with knee osteoarthritis (OA) should receive three core treatments from their health care provider. These core treatments comprise of exercise, education and weight loss. Identification of the health care and rehabilitation needs of individuals with knee OA in rural areas are imperative for focusing service delivery in a specific context in order to empower the individual. The aim of this study was to explore the rehabilitation needs of individuals with knee OA living in rural Western Cape in order to identify the gaps in services offered and inform rehabilitation programmes in these settings. Methods: Semi-structured in-depth individual interviews were performed on 16 individuals with knee OA living in rural settings of the Western Cape, South Africa. A deductive data analysis approach was used and the needs of the individuals were identified and categorised for interpretation and comparison with the reported services received. Findings: The three major themes identified were ‘I would like to know more’, ‘There’s not much support from the clinic’ and ‘I don’t feel myself anymore’. These themes relate to the lack of disease-specific education, barriers in the health systems and service delivery resulting in individuals lack of self-worth and poor mental wellbeing. The results revealed the integral relationship between health care systems, service delivery and the effect on patient wellbeing. Conclusion: The rehabilitation needs of individuals with knee OA in rural areas advocates for addressing barriers in rural primary health care system such as adequate human resources, referral systems and continuity of care. This will allow for a comprehensive, person-centred and context-specific multidisciplinary approach focused on empowering individuals with knee OA through disease-specific education, improving functional participation and symptom management strategies. This could improve the social inclusion and mental wellbeing of individuals living with knee OA.

Implementation of Best-Evidence Osteoarthritis Care: Perspectives on Challenges for, and Opportunities From, Low and Middle-Income Countries

“…In South Africa, access to healthcare is more limited in rural areas where health personnel are often limited to students, new graduates, and medical aides ( 22 ). A qualitative study of people with knee osteoarthritis in rural Western Cape revealed three themes: lack of osteoarthritis education, barriers to osteoarthritis-related healthcare, and physical restrictions, such as reduction in mobility and inability to do household chores, that lowered quality-of-life ( 12 ). Further, South African provinces are governed by different political parties, which impacts the care available in each region, and results in fragmentation of health services ( 17 ).…”

“…Although much of the osteoarthritis care provided in South Africa is in the public primary health clinics, due to poor resourcing there are long waiting times and little support to assist people to self-manage their osteoarthritis ( 12 ). People in Brazil often pay for their own osteoarthritis treatment ( 24 ), as SUS services are limited and the waiting times are also long ( 25 ).…”

“…Many people with osteoarthritis in high-income countries are still not receiving these first-line treatments, and are missing out on the care they need to fully live their lives (9). This situation is amplified in LMICs as both health system-level and individual-level factors influence access to care (10)(11)(12). While many challenges to implementing osteoarthritis care are similar globally, it is recognized that LMICs face challenges and needs specific to their local contexts.…”

“…While many challenges to implementing osteoarthritis care are similar globally, it is recognized that LMICs face challenges and needs specific to their local contexts. Little is known about these challenges and needs, although several issues have been highlighted: inequity of care; costs of delivering and receiving treatment; and lack of training for health professionals ( 10 , 12 ).…”

Rehabilitation and primary care treatment guidelines, South Africa

“…Several publications have reported that the primary health care rehabilitation service and workforce are inadequate in South Africa. 12 – 16 For example, the estimated number of occupational therapists in the country is less than one for every 10 000 people who depend on public health care. 17 Furthermore, therapists are mainly available only in tertiary hospitals and less than a quarter of primary health-care facilities provide rehabilitation on a daily basis.…”