Towards a needs-based design of the physical rehabilitation workforce in South Africa : trend analysis [1990–2017] and a 5-year forecasting for the most impactful health conditions based on global burden of disease estimates
Date
2021-05-13
Journal Title
Journal ISSN
Volume Title
Publisher
Springer Nature
Abstract
Background: Rehabilitation can improve function in many people with chronic health conditions. It is important to
consider priority conditions requiring rehabilitation, so it can be realistically positioned and costed in national
health financing systems like South Africa (SA)‘s proposed National Health Insurance (NHI). This paper describes
temporal trends of top-ranked conditions on years lived with disability (YLDs) rates in SA, for which physical
rehabilitation can ameliorate associated disability.
Methods: This study is a systematic synthesis of publicly available Global Burden of Disease (GBD) 2017 estimates.
The top 11 conditions contributing most to YLDs and for which evidence-based rehabilitation interventions exist
were identified. Age-standardized rates per 100,000 and YLDs counts were extracted from 1990 to 2017.
Significance of changes in temporal trends was determined using Mann-Kendall trend tests. Best-fit rates of yearly
changes were calculated per condition, using GBD estimates (2012–2017), and extrapolated (by imposing the bestfit
regression line onto results for each subsequent predicted year) as forecasts (2018–2022).
Results: Trends for YLDs counts per condition year (1990–2017) and forecasted values (2018–2022) showed an overall
steady increase for all conditions, except HIV and respiratory conditions. YLDs counts almost doubled from 1990 to 2017,
with a 17% predicted increase from 2017 to 2022. The proportionate contribution to YLDs counts reduced over time for all
conditions, except HIV. Although age-standardized YLDs rates appear relatively stable over the analyzed periods for all
conditions (except HIV, respiratory conditions and type 2 diabetes), trend changes in YLDs rates over 28 years were
significant for all conditions, except neonatal (p = 0.855), hearing loss (p = 0.100) and musculoskeletal conditions (p = 0.300).
Significant trend decreases were apparent for 4/9 conditions, implying that another 5/9 conditions showed trend increases
over 28 years. Predicted all-age prevalence in 2022 suggests relatively large increases for cardiovascular disease and heart
failure, and burns, while relative decreases are predicted for fractures and dislocations, stroke, and musculoskeletal conditions.
Conclusion: Rehabilitation needs in SA are potentially massive and unmet, highlighting the need for innovative and
context-specific rehabilitation that considers current local needs and projected changes. These findings should be considered
when designing the NHI and other schemes in SA to ensure human and financial resources are deployed efficiently.
Description
Louw, Q., et al. 2021. Towards a needs-based design of the physical rehabilitation workforce in South Africa: trend analysis [1990–2017] and a 5-year forecasting for the most impactful health conditions based on global burden of disease estimates. BMC Public Health, 21:913, doi:10.1186/s12889-021-10962-y.
The original publication is available at https://bmcpublichealth.biomedcentral.com/
The original publication is available at https://bmcpublichealth.biomedcentral.com/
Keywords
Physical therapists -- South Africa, Hospitals -- Rehabilitation services -- South Africa, Physical therapy -- South Africa
Citation
Louw, Q., et al. 2021. Towards a needs-based design of the physical rehabilitation workforce in South Africa: trend analysis [1990–2017] and a 5-year forecasting for the most impactful health conditions based on global burden of disease estimates. BMC Public Health, 21:913, doi:10.1186/s12889-021-10962-y