BACKGROUND: Musculoskeletal diseases consume a large amount of health and social resources and are a major cause of disability in both low- and high-income countries. In addition, patients frequently present with co-morbid chronic diseases of lifestyle. The area of musculoskeletal disease is restricted by a lack of epidemiological knowledge, particularly in low- and middle-income countries. OBJECTIVES: This pragmatic randomised controlled trial assessed the benefits of a 6-week physiotherapy intervention for middle-aged women with musculoskeletal conditions compared to usual care. METHOD: A weekly 2-h educational programme utilising a workbook, discussion group and exercise class was presented for the intervention group, while the control group received usual care. The primary outcome was health-related quality of life. Parametric and non-parametric data were used to determine the equivalence between the groups. RESULTS: Twenty-two participants were randomised to the intervention and 20 to the control group. The control group demonstrated no within-group improvement in health-related quality of life items, compared to significant improvements in two items in the intervention group. The change in median utility score within the intervention group was twice as large as the change in the control group. With regard to self-efficacy, the intervention group demonstrated significant within-group changes in perceived management of fatigue and discomfort. CONCLUSION: The positive impact of the intervention on the participants suggests that the programme should continue at the clinic in question, but should be presented at a more convenient time for participants who work, as recruitment to the study was less than anticipated. Primary health care systems in South Africa urgently need to put structures in place for effective management of the functional impact of chronic diseases of lifestyle and musculoskeletal conditions. It is time for physiotherapists and possibly other health care professionals to participate in the development of appropriate community level interventions to address the functioning and quality of life of individuals living with the diseases.

BACKGROUND: There is increasing interest in the collection of globally comparable disability data. Context may influence not only the rates but also the nature of disability, thus locally collected data may be of greater use in service delivery planning than national surveys OBJECTIVES: The objective of this article was to explore the extent to which two areas, both under-resourced but geographically and socially distinct, differed in terms of the prevalence and patterns of disability. METHOD: A cross-sectional descriptive survey design was utilised, using stratified cluster sampling in two under-resourced communities in the Western Cape, South Africa. Nyanga is an informal urban settlement in Cape Town and Oudtshoorn is a semi-rural town. The Washington Group Short Set of questions was used to identify persons with disabilities (PWD), and a self-developed questionnaire obtained socio-demographic information. RESULTS: The overall prevalence of disability was 9.7% (confidence intervals [CIs] 9.7-9.8) and the proportion of PWD was significantly different between the two sites (Chi-Sq = 129.5, p < 0.001). In the urban area, the prevalence rate of any disability was 13.1% (CIs 12.0-14.3) with 0.3% (CIs 0.1-0.6) reporting inability to perform any function at all. In contrast, the semi-rural community had a lower overall prevalence rate of 6.8% (CIs 6.0% - 7.8%) but a higher rate of those unable to perform any function: 1% (CIs 0.07-1.4). Disability was associated with gender, age, unemployment and lower income status in both areas. CONCLUSION: Deprived areas tend to show higher disability prevalence rates than the National Census estimates. However, the discrepancy in prevalence and patterns of disability between the two under-resourced areas indicates the need for locally specific data when planning health interventions.

BACKGROUND: Occupational therapy patient records are required for legal purposes, but may also be used to produce evidence for practice. Our aim was to establish how comprehensively occupational therapists documented patient records. METHODOLOGY: We conducted a descriptive cross-sectional study of occupational therapists at public health facilities in a South African province. Trained raters audited five randomly-drawn records per participant using a checklist developed for the study. The maximum possible score was nine and the lowest was zero. Audits were checked for consistency. RESULTS: Forty-nine occupational therapists participated and 240 records were audited. Records contained information on intervention (96%) and changes occurring at impairment (82%) and activity and participation levels (64%). Documentation of baseline assessment (impairment level: 20%; activity and participation level: 10.4%) and re-assessment (impairment level: 7%; activity and participation level: 0.0%) was limited. Audit scores were significantly better in the work practice area (H=16.10, p=0.003) and among therapists in urban areas (U=24.50, p<0.001).There was a significant negative correlation between audit score and number of clients seen per month (r s=-0.46, p<0.001). CONCLUSION: The low audit scores suggest that the records did not contain sufficient information to produce robust evidence. Manageable ways of documenting occupational therapy practice need to be devised.

OBJECTIVES: To determine activity limitations, participation restrictions, health-related quality of life and caregiver strain in community-dwelling stroke survivors discharged from an intensive inpatient rehabilitation programme at 6 months post stroke. METHODS: Fifty-one consecutive stroke patients admitted to a Western Cape rehabilitation centre were included. Community-dwelling participants (N=46) at 6 months post stroke were assessed using the Modified Rankin Scale (MRS), Barthel index (BI), Nottingham extended activities of daily living (NEADL) scale, Euroqol (EQ-5D) instrument and caregiver strain index (CSI). RESULTS: Most participants (73.9%) were independent in activities of daily living or had minimal disability (BI 75 - 100). However, according to the NEADL, many participants were not independent in housework (60.9%), food preparation (52.2%), shopping (80.4%) and public transport use (65.2%), implying the need for caregiver assistance. According to the MRS, 29% of participants were severely disabled, requiring caregiver assistance for basic needs, and 20% could not be left alone. Feelings of anxiety or depression were felt in 50% of participants and 59% reported pain or discomfort, according to the EQ-5D. High levels of caregiver strain were reported in 56% of caregivers (CSI). Follow-up after discharge was reported in few participants. CONCLUSIONS: Consideration should be given to support for stroke survivors and caregivers after discharge and whether targeted programmes can improve specific aspects of functioning, such as community mobility.

OBJECTIVE: To determine factors predictive of the score on the visual analogue scale (VAS) of the EQ-5D questionnaire. METHODS: The responses of 1159 residents of a socially and ethnically diverse suburb of Cape Town, South Africa, to the EQ-5D questionnaire were analysed using forward stepwise multiple regression. The variables entered included ethnic group, religious affiliation (Christian or Muslim), income level, unemployment, recent illness or disability and each level of the five EQ-5D domains. FINDINGS: The model developed accounted for an adjusted r² of 0.234 and included 11 variables. In addition to the EQ-5D domains, the presence of a disability, an income of less than US$ 420 per month, unemployment and age in years were significant predictors of VAS score. CONCLUSION: The substantial contribution of health state to the VAS indicates that it is a valid measure of health-related quality of life (HRQoL) across population groups. However, the subjects with lower social status reported a worse HRQoL than their health state alone warranted and this variable might need to be taken into account if the VAS is to be used to compare health states across populations. This paper provides empirical evidence of how HRQoL is perceived by different socioeconomic, cultural, ethnic and religious communities within a developing country.

OBJETIVO: Determinar los factores predictivos de la puntuación obtenida en la escala visual análogica (EVA) del EQ-5d. MÉTODOS: Se analizaron las respuestas al cuestionario EQ-5d por parte de 1159 habitantes de un barrio residencial social y étnicamente diverso de Ciudad del Cabo, Sudáfrica, usando la técnica de regresión múltiple anterógrada por etapas. Las variables analizadas incluyeron el grupo étnico, la religión (cristiano o musulmán), el nivel de ingresos, la posesión o no de un empleo, la existencia de enfermedad o discapacidad reciente, y cada uno de los niveles de los cinco dominios del EQ-5d. RESULTADOS: El modelo desarrollado se ajustó hasta obtener un r² = 0,234 e incluyó 11 variables. Además de los dominios del EQ-5d, fueron factores predictivos significativos de la puntuación de la EVA la presencia de discapacidad, unos ingresos inferiores a US$ 420 por mes, la condición de desempleado y la edad (años). CONCLUSIÓN: La sustancial contribución del estado de salud a la puntuación de la EVA indica que ésta es una medida válida de la calidad de vida relacionada con la salud (CVRS) en todos los grupos de población. Sin embargo, las personas con menor estatus social refirieron una CVRS inferior a la que cabía inferir considerando sólo su estado de salud, y es posible que haya que tener en cuenta esta variable si se decide usar la EVA para comparar los estados de salud entre poblaciones. Este artículo aporta datos empíricos acerca de la percepción de la CVRS por parte de diferentes comunidades socioeconómicas, culturales, étnicas y religiosas dentro de un país en desarrollo.

OBJECTIF: Déterminer les facteurs prédictifs du score obtenu sur l'échelle visuelle analogue (EVA) du questionnaire EQ-5D. MÉTHODES: Les réponses au questionnaire EQ-5D données par 1159 habitants d'une banlieue socialement et ethniquement hétérogène du Cap (Afrique du Sud) ont été analysées à l'aide de la régression multiple par étapes. Les variables retenues étaient l'origine ethnique, l'appartenance religieuse (chrétienne ou musulmane), le niveau de revenu, le chômage éventuel, une maladie ou une incapacité récente et chaque niveau des cinq domaines EQ-5D. RÉSULTATS: Le modèle mis au point comportait un r² ajusté de 0,234 et incluait 11 variables. Outre les domaines EQ-5D, la présence d'une incapacité, un revenu inférieur à US $420 par mois, le chômage et l'âge en années étaient d'importants éléments prédictifs du score EVA. CONCLUSION: Le rôle important de l'état de santé dans l'EVA montre qu'il s'agit là d'une mesure valable de la qualité de vie liée à la santé dans différents groupes de population. Toutefois, les personnes socialement défavorisées signalaient une qualité de vie liée à la santé moins bonne que ne le justifiait leur état de santé et il faudrait peut-être prendre en compte cette variable si l'EVA doit être utilisée pour comparer l'état de santé dans différents groupes de population. Le présent article montre de façon empirique comment la qualité de vie liée à la santé est perçue par différentes communautés socio-économiques, culturelles, ethniques et religieuses dans un pays en développement.

OBJECTIVE: To determine the age-weighting preferences of urban Zimbabweans in relation to health care priorities. METHOD: A total of 67 randomly selected residents of a high-density area of Harare participated in the study. Participants were asked "person trade-off" questions to determine their preferences in terms of the numbers of people of various ages who would be saved from death and from suffering a year of ill-health relative to the number of 30-year-olds who would be saved from these eventualities. FINDINGS: The responses indicate that the value of averting a year of ill-health was judged greatest for 15-year-olds and was equal for people aged 1, 30, and 45 years. The value of averting a death primarily reflected the expected years of life lost, but the influence of age-weighting was evident in that 15 years was the most highly valued age. CONCLUSION: Although the age-weighting curves did not correspond exactly with the Global Burden of Disease (GBD) age-weights, Zimbabweans showed a preference for saving the lives of young adults. The GBD age-weights should be used to determine the disability-adjusted life years lost in the Zimbabwean population.

OBJETIVO: Determinar las preferencias ponderadas por la edad de los zimbabwenses en relación con las prioridades asistenciales. MÉTODOS: Participaron en el estudio 67 residentes de una zona de alta densidad de Harare elegidos al azar. Se les hicieron preguntas de "equivalencias de personas" para determinar sus preferencias en cuanto al número de individuos de diversas edades a los que salvarían de la muerte o de un año de mala salud en comparación con el número de individuos de 30 años a los que salvarían de esas mismas contingencias. RESULTADOS: Las respuestas muestran que el valor de evitar un año de mala salud es máximo para los jóvenes de 15 años, y similar para las personas de 1, 30 y 45 años. El valor de evitar una muerte se correspondía sobre todo con los años de esperanza de vida perdidos, pero la influencia de la ponderación por la edad se advierte claramente en el dato de que la edad de 15 años fue la más valorada. CONCLUSIÓN: Aunque las curvas de ponderación por la edad no coincidían exactamente con los pesos atribuidos a las edades en la Carga Mundial de Morbilidad (GBD), los zimbabwenses demostraron un interés preferente por salvar la vida de adultos jóvenes. Se deberían usar los pesos de la GBD para determinar los AVAD (años de vida ajustados en función de la discapacidad) perdidos en la población de Zimbabwe.

OBJECTIF: Déterminer chez des Zimbabwéens vivant en zone urbaine les préférences pondérées en fonction de l'âge au regard des priorités de santé publique. MÉTHODES: L'étude a été réalisée sur un échantillon de 67 résidents d'un quartier fortement peuplé de Harare choisis par tirage au sort. Il leur a été posé des questions sur la valeur accordée à la vie ou à la santé d'une personne afin de déterminer leurs préférences, exprimées en nombre de personnes de différents âges qui devraient être sauvées de la mort ou d'une année de vie en mauvaise santé par rapport au nombre de personnes de 30 ans qui devraient être préservées des mêmes risques. RÉSULTATS: Les réponses indiquent que le fait d'éviter une année de vie en mauvaise santé a la valeur jugée la plus élevée lorsqu'il s'agit de personnes de 15 ans et une valeur égale pour les personnes de 1 an, 30 ans et 45 ans. La valeur accordée au fait d'éviter un décès reflétait principalement le nombre d'années de vie prévues qui seraient perdues, mais l'influence de la pondération en fonction de l'âge ressortait clairement du fait que l'âge de 15 ans était celui pour lequel cette valeur était jugée la plus élevée. CONCLUSION: Bien que les courbes de pondération en fonction de l'âge ne correspondent pas exactement aux pondérations de la charge mondiale de morbidité, les Zimbabwéens ont montré qu'ils préféraient sauver la vie des jeunes adultes. Les pondérations de la charge mondiale de morbidité en fonction de l'âge devront être utilisées pour déterminer les années de vie ajustées sur l'incapacité (DALY) perdues dans la population du Zimbabwe.