Current stroke rehabilitation services and physiotherapy research in South Africa

Background: Stroke is one of the most common causes of morbidity and disability in South Africa, with the burden of stroke particularly high in rural South Africa. Objectives: The aim of this study was to collate South African (SA) physiotherapy stroke rehabilitation research. Method: A narrative review of physiotherapy stroke rehabilitation research conducted within the last 10 years in South Africa. Results: Stroke survivors in South Africa have poor functional ability at discharge from the hospital and have poor access to transport, work and education. Their caregivers experience strain and have a poor quality of life. Inpatient rehabilitation services focus on the medical model approach and patients are discharged into family care because of limited rehabilitation facilities. Physiotherapy interventions found to be effective in SA studies: longitudinal shoulder strapping, balance exercises in the community, task-orientated circuit gait training, saccadic eye movement training with visual scanning exercises for unilateral spatial neglect and workplace intervention programmes to increase return to work after stroke. Caregiver education alone and use of pictorial exercise programmes does not improve patients' functional ability and adherence to home exercise programmes, respectively. Conclusion: There is a need to focus physiotherapy stroke rehabilitation on barriers that hinder full social integration of the patient, including return to work and improving carer support. Most research reviewed focused on description of the problems experienced; however, more intervention studies are now underway to develop context-specific interventions with feasible treatment intensity, frequencies and equipment requirements. Future research should explore new ways of improving post-discharge rehabilitation services. Examples of intervention research that may be beneficial in a SA context are mirror therapy, mental practice and patient-directed activities in rehabilitation. Clinical implications: Knowledge of interventions that were found to be effective in this context will encourage clinicians to translate these findings into practice. Noting that outcome measures that are core for stroke rehabilitation are not included in some projects may remind researchers to consider them to make comparisons between different research projects.