EXPLORING THE NEED FOR LOWER LIMB PROSTHETIC GUIDELINES IN SOUTH AFRICA'S PRIVATE HEALTHCARE SECTOR
Authors: Theron Bennie , Visagie Surona 
Published: February 2025

BACKGROUND: Evidence based guidelines can assist with prosthetic component selection and clinical intervention. There is limited evidence on lower limb prosthetic prescription guidelines in the South African private health care sector.
OBJECTIVE: To explore the need for lower limb prosthetic prescription guidelines in the South African private healthcare sector.
METHODOLOGY: Three main funders of lower limb prosthetics in the South African private healthcare sector (Road Accident Fund (RAF), Workmen’s Compensation Fund (WCA), and Council of Medical Schemes (CMS)) were explored using a case study design. Data were collected from six regulatory documents, sixteen purposively sampled prosthetic users, who received services from these funders, and seven key informants. Documents were assessed with the Appraisal of Guidelines for Research & Evaluation II (AGREE II), across six domains. Data from users and key informants were collected with telephonic, semi-structured interviews guided by interview schedules. Interview schedules were self-developed and tailored for each participant group. AGREE II data were analyzed descriptively. Inductive thematic analysis was used for interview data.
FINDINGS: Across cases, the “Scope and Purpose” domain scored the highest: 50% (WCA), 47% (CMS), and 22% (RAF). “Editorial Independence” scored 0% for all three cases. Other challenging domains were “Applicability” (WCA: 17%, CMS: 6%, RAF: 6%) and “Rigour of Development” (WCA: 8%, CMS: 25%, RAF: 0%). The following three cross-case themes emerged from the interviews: “Guideline Availability and Necessity” showed that guidelines were seldom used and that guidelines could be beneficial;  “Purpose of a Lower Limb Prosthetic Guideline” indicated that guidelines can support accessible, equitable, ethical, and transparent services; and “Guideline Development Requirements” explained that an evidence based collaborative process, facilitated by an independent body should underscore guideline development.
CONCLUSION: Evidence based, standardized, transparent guidelines will be beneficial to direct prosthetic service delivery in the South African private healthcare sector. The guidelines must be applicable, rigorously developed, and show editorial independence.
Layman's Abstract
Guidelines that provide directions to funders and service providers can help with selection of suitable prosthetic components. There is little information on the use of guidelines in prosthetic service provision in South Africa's private healthcare sector. This study wanted to determine if there was a need to use guidelines for prescribing lower limb prosthetics in South Africa's private healthcare sector and whether guidelines were currently used in the sector. The Road Accident Fund, Workmen’s Compensation Fund, and Council of Medical Schemes were studied. Six documents that guided services at the three organizations were reviewed. In addition, sixteen prosthetic users who received services from the organizations and seven experts were interviewed. The results showed that the scope and purpose of the documents was partially defined. The documents were developed by the organizations and not reviewed by independent stakeholders such as service users. The methods used to develop the documents and the use of evidence during development were poorly described. The documents also do not describe how the guidelines provided can be put into practice, how much it will cost, what barriers to expect, and how these can be overcome. These documents cannot serve as guidelines in their current format. The interviewees felt that guidelines could be helpful to the industry as a way of enabling fair, accessible, and transparent prosthetic services. Guidelines should take current evidence into consideration. The development process that must be driven by an independent organization rather than government or the funders and involve all stakeholders.   
Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/44450/33671
How To Cite: Theron B, Visagie S. Exploring the need for lower limb prosthetic guidelines in South Africa's private healthcare sector. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No. 8. Https://doi.org/10.33137/cpoj.v7i2.44450
Corresponding Author: Mr. Bennie Theron, CPO, MScAffiliation: University of Stellenbosch, Division of Disability and Rehabilitation Studies, South Africa.E-Mail: Benjetheron@live.comORCID ID: https://orcid.org/0009-0006-0487-9050