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Background: Historically, the profession of physiotherapy in South Africa has closely aligned itself with our former colonial master, the United Kingdom. Whilst efforts have been made in recent years to transform our profession, numerous challenges remain. An improved understanding of the topic of decoloniality is a useful and necessary way of beginning to address these challenges.Objectives: The aim of this opinion piece is to encourage further dialogue amongst South African physiotherapists working in all sectors – a dialogue that must focus on genuinely transforming our profession to be better suited to serving the majority of South Africans.Method: Global and local literature related to decoloniality is summarised for readers, followed by a closer scrutiny of how this topic relates to some of the challenges faced by the profession of physiotherapy in South Africa.Results: The evidence presented demonstrates that whilst some efforts have been made to transform South African physiotherapy, significant work and dialogue is required to bring about a true transformation of the profession.Conclusion: An honest and transparent conversation about decoloniality and transformation can assist in realising the potential of our profession, thereby improving the health and well-being of all South Africans.Clinical implications: Real engagement with this topic can assist in transforming who enters our profession, what we teach, where and why we conduct research and how we can ensure that physiotherapy practice contributes to real social justice by benefitting the majority of our population.

Background Older people living with HIV (OPLWH) require significant levels of support, including healthcare and rehabilitation interventions. People living with HIV are living longer, but still experience health-related impairments that affect functional activity, participation in day-to-day interactions, livelihoods and overall quality of life. Physical activity and exercise should be included as part of the comprehensive medical management for OPLWH but the investigation of prior studies reveal a gap in understanding and prescription. Our study aimed to explore the perceptions of OPLWH about physical activity and exercise. Methods The study adopted a phenomenological, qualitative design, using in-depth interviews, to understand OPLWH perceptions of physical activity and exercise, and their need for, and access to, physical activity and exercise programmes in a community in South Africa. Nine [9] males and seven [7] females participated in the study. Results Sixteen individuals voluntarily participated in face-to-face, semi-structured interviews which took place at the healthcare facility where they received regular treatment. All participants were 50 years and older. Personal gratification and the ability to perform activities of daily living as well as participate in community activities were believed to be strong motivators for exercise participation, while barriers to exercise were attributed to physical health issues; lack of proper instruction as well as stigma associated with HIV status within their communities. Participants also favored a combination of aerobic, flexibility and strength activities, as well as proper supervision and instruction within a group exercise setting. Conclusion The qualitative nature of our study provided an in-depth understanding of the perceptions of OPLWH towards physical activity and exercise. Our study highlighted the factors that hinder adherence to physical activity and exercise in this population. Many indicated that they would love to engage in structured physical activity programmes, but did not know where, when or how to begin. Creating a suitable environment with proper supervision and instruction by suitably qualified health professionals are essential when developing a community-based exercise programme for OPLWH.

As people age with HIV, the prescription of physical activity should be included as part of their comprehensive medical management. The higher prevalence of comorbidities, polypharmacy, drug interactions and end-stage complications in this specific population requires a multidisciplinary health care approach. This study adopted a phenomenological, qualitative design, using a process of in-depth focus group interviews in order to understand the perceptions of healthcare workers regarding physical activity and exercise for older people living with HIV (OPLWH). Fifteen healthcare professionals who are actively involved in the daily treatment and care of OPLWH at a primary health care facility in KwaZulu-Natal, South Africa voluntarily participated in the study. Three overarching themes emerged from the discussions, namely factors influencing exercise adherence; general considerations for exercise programmes for OPLWH; and recommendations for exercise prescription for OPLWH. This research highlights the importance of the multidisciplinary healthcare team who are at the forefront of care. Continuing assessment of OPLWH, and a suitably conducive environment, need to be taken into consideration when developing and implementing a suitable programme for exercise and physical activity for OPLWH. Challenges such as the stigma associated with HIV, and associated comorbidities related to ageing, need to be addressed when structuring an intervention programme that is sustainable in resource-poor communities.

Background Concussion in sports has received a great deal of media attention and may result in short and longer-lasting symptoms, especially in adolescents. Although significant strides have been made in the identification and management of concussion, less is known about the primary prevention of this condition. The aims of this scoping review are to (1) summarize the current research of physical conditioning strategies to reduce or prevent concussion incidence in individuals participating in sport, especially adolescents, and (2) to identify gaps in the knowledge base. Our research question was what is known from the existing literature about physical preparation strategies to reduce or prevent concussion in adult and adolescent sports? Methods Three literature searches were conducted by information officers at two universities at six-month intervals, using five electronic databases (PubMed; WorldCat.org ; Mendeley; EBSCOHost and Ovid MEDLINE). To increase the search range, subject experts were consulted and articles and reference lists were hand searched. A scoping review methodology identified eligible studies that analyzed physical preparation techniques on modifiable physical risk factors in athletes to reduce the incidence of concussion. The PRISMA-ScR checklist guided the reporting of the findings. Results A total of 1414 possible articles were identified, after duplicates removed, and articles analyzed against the inclusion and exclusion criteria, only 9 articles qualified for analysis. Two articles were found from studying reference lists. Thus, a total of 11 articles were included in the final evaluation for the purposes of this study. Data are reported from mostly adolescent subjects participating in nine different sports from three countries. Findings are presented with specific reference to previously recognized modifiable risk factors of concussion which include neck strength, neck size, cervical stiffness, type of sport, and pre-activity exercises. Conclusions There is limited research examining the physical preparation of athletes, especially in adolescents, to reduce or prevent concussion, and conflicting evidence in the few small sample studies that were identified. This scoping review identifies the research gap for a potentially vital modifiable risk factor, notably in the physical preparation of children and adolescents to reduce or prevent sports-related concussion.

Improvements in physical, mental, and overall quality of life are well documented in younger HIV populations who exercise. Exercise guidelines exist for younger HIV populations, but none for older people living with HIV (OPLWH), especially 50 years of age and older. Our aim was to map the existing literature on the effects of exercise and physical activity prescriptions for OPLWH. We conducted a scoping review using the methodological framework proposed by the Joanna Briggs Institute. Online searches on five research databases yielded 503 published articles. Fifteen studies met the study's inclusion criteria. The most commonly used parameters of exercise included aerobic and strength training, as well as a combination of both. The physical, psychological and Quality of Life (QoL) impact of physical activity and its effect on OPLWH is evidently beneficial. Overall, a positive correlation between exercise and physical, mental and functional status was observed. No adverse side effects, or safety and efficacy concerns, during the use of exercise were reported. This review confirms the dearth of evidence on physical activity and exercise in the context of OPLWH. Of greater concern is the fact that there were no studies conducted in sub-Saharan Africa, the global region with by far the highest HIV burden.

Background Concussions in Rugby Union are common with an increased risk to adolescent players. Coaches are key to injury prevention and a greater understanding of their knowledge and sentiments may guide future initiatives. There is a lack of data on rugby coaches, especially in South Africa. This study aimed to investigate the knowledge and opinions of high school rugby coaches regarding concussion management. Methods This cross-sectional study of 37 high school rugby coaches in South Africa, was conducted via a self-reported questionnaire. Concussion knowledge was scored for correct answers only with closed-question scaling methods to measure the importance of items of concussion management using a graphical rating scale. An attitude scale (Likert) was used to assess self-reported opinions and behaviours. Associations were calculated for participant characteristics and overall concussion injury knowledge. Results More participants showed good overall knowledge of ≥ 75% ( n  = 22, 59% vs. n  = 15, 40%), especially those with greater coaching experience ( p  = 0.021). Player welfare was perceived more important than player performance (185 vs. 164), with concussion prevention most important (184 of 185). Appealing characteristics of an injury prevention programme were the improvement of player skill (173, SD ± 0.75, mean 4.68), being adaptable (171, ± 0.86, 4.62), and being completed in the warm-up (167, ± 0.93, 4.51). The biggest perceived barriers were duration (138, ± 1.59, mean 3.73), effort (130, ± 1.56, 3.51), compliance and lack of knowledge (both 127, ± 1.68, 3.43). Conclusion These results support the implementation of ongoing concussion education for rugby coaches and identify areas for promoting awareness and knowledge of concussion injury prevention, identification, and specific management of younger athletes. Appealing characteristics and barriers are highlighted and may allow for improved implementation and adherence to concussion prevention programmes. Key points • The risk of concussion to female athletes and younger athletes was under-reported and should be addressed in future coach-focused education initiatives. • Successive educational approaches may be effective in coaches’ knowledge retention, although the most appropriate delivery methods should be researched further. • The ideal injury prevention programme should improve player skill whilst reducing the risk of injury, be adaptable, completed during the warm-up and not take much time or effort to complete.

Background People with disabilities (PWDs) remain among the poorest and least empowered population. They experience limited access to basic services, especially in low- and middle-income countries (LMIC). The infringement of their human rights remains at an alarming level, despite the availability of the community-based rehabilitation (CBR) strategy and the United Nations Convention on the Rights of People with Disabilities (UNCRPD). CBR, as a strategy for poverty alleviation, social inclusion and equalisation of opportunity, has broadened its scope from a mere strategy for access to health and rehabilitation services to include education, livelihood, social inclusivity and empowerment. CBR is implemented across the world in the majority of LMIC signatories to the UNCRPD. South Africa is among the countries that are implementing CBR. However, the extent and the nature of implementation is not known. This study, therefore, aims to map out the empirical evidence of the implementation of CBR in South Africa. Method The study is a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Review (PRISMA-ScR) methodology. The information will be extracted and captured on a data charting template that will be used through each phase of the study. The review will be guided by the following research question validated by the amended population-concept-context framework according to the Joanna Briggs Institute methodology for scoping reviews: ‘An investigation into CBR implementation in South Africa.’ The search will be conducted in the following electronic databases Google Scholar, PubMed, Medline, and Cochrane, etc, using Boolean logic. Restrictions will be set for years (Jan. 2009–Dec. 2019), English language peer-reviewed studies based on South Africa. The search output will be screened for primary studies on Community based rehabilitation in South Africa. Two independent reviewers will conduct title and abstract screening to identify potential eligible studies. After which full-text screening on the potential eligible studies and assessed for inclusion by the two independent reviewers. The Mixed Method Appraisal Tool will be applied to assess the quality of the studies included in the review. Discussion The gathered evidence from the selected studies will be discussed in relation to the research questions using a narrative to identify and explore emergent themes. The review will provide a baseline of evidence on the implementation of CBR and will highlight gaps regarding the implementation of CBR in a South African Context. The gaps identified will be used to develop a framework that will guide implementation of CBR in South Africa.

Background: Community-based rehabilitation (CBR) is a World Health Organization (WHO) strategy for social inclusion, equalisation of opportunities and provision of essential services for people with disabilities (PWDs). Community-based rehabilitation is a multi-sectoral strategy that requires all stakeholders to participate equally in its implementation. KwaZulu-Natal has implemented CBR for over two decades, with various stakeholders at the forefront of implementation. However, the status of stakeholder engagement, collaboration and coordination is unknown.Objective: The objective of our study was to understand how CBR is implemented in KwaZulu-Natal and the roles of each stakeholder in its implementation, with a focus, on managers from government and non-governmental organisations.Method: A descriptive explorative approach using semi-structured interviews was used to collect data from 20 managers from various stakeholders involved in implementing CBR in KwaZulu-Natal. Data were transcribed and analysed using thematic analysis.Results: The findings revealed five dominant themes: (1) the understanding of concepts, (2) missed opportunities for implementing CBR, (3) barriers to implementing CBR, (4) benefits to implementing CBR and (5) recommendations for future implementation.Conclusion: A formal management structure with clear roles and responsibilities was fundamental for implementation. Collaboration, coordination and planning were believed to be the critical roles of managers in the implementation of CBR. Training, awareness and sharing of resources among stakeholders were also identified as important factors in implementing CBR in KwaZulu-Natal.Clinical implications: Our study will assist managers and clinicians to improve their planning and implementation of CBR.

Background Older people living with HIV (OPLWH) are expected to live longer in the era of antiretroviral treatment, but at the same time, they are at risk for developing various health complications as a consequence of a life with the infection, exposure to medications that carry their own toxicity and side effects, and the natural effects of aging on the immune system. Because senescence is an inherent process that can be accelerated by HIV, it is important to identify strategies that can modify this phenomenon. Emerging data suggests that while physical activity and exercise may not have a positive impact on viral replication and on the immune system of people living with HIV, it can elicit improvements in cardiorespiratory fitness, strength, body composition, and overall quality of life. The purpose of this study is to map out empirical evidence on the effects of physical activity and exercise in OPLWH. Methods The scoping review methods will be guided by the framework proposed by the Joanna Briggs Institute guidelines. Literature searches will be conducted in the following electronic databases (from inception onwards): PubMed/MEDLINE, Cochrane Library, and Google Scholar. Peer-reviewed journal papers will be included if they are written in English, involved human participants aged 50 years, and older with HIV and described a measure for physical, mental, or functional status of physical activity/exercise and/or the recommendations in OPLWH. Quantitative, qualitative, and mixed-method studies will be included in order to consider different aspects of measuring the effects of physical activity and exercise (e.g., quality of life, functional status, activities of daily living). Two reviewers will screen all citations and full-text articles. We will abstract data, organize them into themes and sub-themes, summarize them, and report the results using a narrative synthesis. The study methodological quality (or bias) will be appraised using a Mixed Methods Appraisal Tool. Discussion The evidence gathered from the selected studies will be discussed in relation to the research questions using a narrative to identify and explore emergent themes. The review will provide a baseline of evidence on exercise and physical activity interventions for OPLWH. It will highlight gaps regarding the use of exercise and physical activity and contribute to the design of an effective intervention approach to the rehabilitation of OPLWH. Systematic review registration Open Science Framework ( https://osf.io/728kp/ ).

ObjectivesTo explore experiences of physiotherapists working with adults living with Long COVID in Canada.DesignCross-sectional descriptive qualitative study involving online semi-structured interviews.ParticipantsWe recruited physiotherapists in Canada who self-identified as having clinically treated one or more adults living with Long COVID in the past year.Data collectionUsing an interview guide, we inquired about physiotherapists’ knowledge of Long COVID, assessment and treatment experiences, perspectives on physiotherapists’ roles, contextual and implementation factors influencing rehabilitative outcomes, and their recommendations for Long COVID rehabilitation. Interviews were audio-recorded, transcribed verbatim and analysed using a group-based thematic analytical approach. We administered a demographic questionnaire to describe sample characteristics.Results13 physiotherapists from five provinces participated; most were women (n=8; 62%) and practised in urban settings (n=11; 85%). Participants reported variable amounts of knowledge of existing guidelines and experiences working with adults living with Long COVID in the past year. Physiotherapists characterised their experiences working with adults living with Long COVID as a dynamic process involving: (1) a disruption to the profession (encountering a new patient population and pivoting to new models of care delivery), followed by (2) a cyclical process of learning curves and evolving roles of physiotherapists working with persons living with Long COVID (navigating uncertainty, keeping up with rapidly emerging evidence, trial and error, adapting mindset and rehabilitative approaches and growing prominence of roles as advocate and collaborator). Participants recommended the need for education and training, active and open-minded listening with patients, interdisciplinary models of care, and organisational- and system-level improvements to foster access to care.ConclusionsPhysiotherapists’ experiences involved a disruption to the profession followed by a dynamic process of learning curves and evolving roles in Long COVID rehabilitation. Not all participants demonstrated an in-depth understanding of existing Long COVID rehabilitation guidelines. Results may help inform physiotherapy education in Long COVID rehabilitation.