Rugby carries a risk for serious injuries, including acute spinal cord injuries. The lifetime health consequences of these injuries may be far-reaching. In this study, out of the Life After the Game project of Marelise Badenhorst, we aimed to describe barriers and facilitators to healthcare and rehabilitation, in individuals with rugby-related spinal cord injuries in South Africa.
Methods
This study adopted a pragmatic qualitative approach. Stratified purposive sampling was used to select interviews from players from a variety of socio-economic status and geographical areas for inclusion in this study. The final sample consisted of thirty-one (n = 31) participants. Thematic analysis was used to analyze the data.
Results
Four themes with associated categories were derived from the data:
Healthcare for quality of life
“You never actually stop. I still do rehab now . . . I tell people it never really stops, because you go through dif- ferent phases in your life and at every new phase, you have to learn to do something differently, or like I am getting older now, and less independent, so I have to learn to do some things differently now. It is all part of rehab and it is important for my life . . . [P43]”
The public system – Issues of access and quality
“I don’t like a physio that only do what they have to do . . . they just stretch you. Give me something to do . . . give me something to work on my core . . . because that is what I need ...” [P85]
“I go to hospital in (in town), I have to arrange a car ... and then how much you pay depends on if the guy that is fetching you, whether he is good or bad guy . . .” [P68]
The private system – Balancing income, cost of care and health insurance
“Yes see, my medical aid is completely depleted . . . so I had to do fundraising ... all the players that played with me ... I live off that fund for my medical things now ... if it wasn’t for that it would be chaos! It costs a lot to buy all the bags and stuff.” [P27]
Factors that play a role across systems
“I get support from fund (Players’ Fund). The fund makes it easier for me, for my equipment ... like my wheel- chair ... they support me ... to add onto the DG (dis- ability grant) I have ... because I can tell you ... I don’t have any money in the bank.” [P36]
The first theme highlighted the meaning and importance that participants placed on healthcare as a component of quality of life. The remaining themes described the participants’ experiences of barriers or facilitators present within the private, public or both healthcare systems.Participants described long-term, accessible, affordable, quality healthcare and rehabilitation as important contributors to their quality of life. Even though public healthcare is accessible from a cost point of view, quality of care, availability of rehabilitation services and factors such as affordability and availability of adequate transport remain a barrier for lower socio-economic groups.
Conclusion
This is the first study to provide a comprehensive description of the perception of healthcare and rehabilitation related barriers and facilitators, as an important component of quality of life in a South African rugby-related SCI population. This population is unique, as the support from a dedicated organization enabled participants to overcome some barriers, highlighting the challenges of the healthcare system in maintaining the health of people with spinal cord injuries. Every effort should be made to create equitable access to healthcare and rehabilitation for persons with spinal cord injuries in South Africa.
You can read the full paper here (paywalled)
Badenhorst M, Verhagen E, Lambert M, van Mechelen W, Brown J. Accessing healthcare as a person with a rugby-related spinal cord injury in South Africa: the injured player's perspective. Physiother Theory Pract. 2021 Jan 24:1-17. doi: 10.1080/09593985.2021.1872753.