title: A protocol for the methodological steps used to evaluate the alignment of rehabilitation services in the Western Cape, South Africa with the National Rehabilitation Policy.
abstract: Rehabilitation medicine plays an integral part in attainment of optimal functioning after injury or disease. The National Rehabilitation Policy of South Africa (NRP) (2000) highlights the need for access to professional health care services, redistribution and optimal utilisation of resources and research in the field of disability and rehabilitation. The government further ratified the Convention on the Rights of Persons with Disabilities (CRPD) (2007), which validate the urgency in advancing the agenda of persons with disabilities. This paper outlines the methodological plan for evaluating rehabilitation services in the Western Cape, South Africa against the aims and objectives of the NRP as well as its principles and concepts. The evaluation process further focused on specific articles in the CRPD that were aligned with disability, health and rehabilitation.
  
  
  
  A mixed-method design was used to evaluate the alignment of rehabilitation services with the NRP in the Western Cape. Four rehabilitation study settings were selected to ensure that both inpatient and outpatient rehabilitation levels of care were covered at different contexts (rural and peri-urban). The sites were checked for the most prevalent rehabilitation-related conditions to ensure the identification of suitable instruments for measuring rehabilitation outcomes. Each study setting was linked to two researchers with one exploring the rehabilitation organizational structure of the sites and the other exploring the client outcomes after receiving rehabilitation services. Patients were evaluated at baseline and discharge, within seven days after admission and seven days prior to discharge. The evaluation was based on the rehabilitation organizational capacity to provide patient-oriented rehabilitation and the measurement of rehabilitation outcomes. Kaplan's framework of organisational capacity was used in the context of each study setting. For the measurement of service users' outcomes, the International Classification of Functioning, Disability and Health was used (ICF). Standardised outcome measures were adopted for the domains of impairment, activity and participation. The World Health Organisation Community-Based Rehabilitation guidelines were used as guiding principles and concepts as suggested in the NRP.
  
  
  
  This is a groundbreaking methodological exploration that offers both study methods and instruments to measure rehabilitation services at both in-patient and out-patient rehabilitation services.
authors.affiliation: Centre for Rehabilitation Studies, Medicine and Health Science Faculty, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Gubela
authors.initials: G
authors.lastname: Mji
authors.affiliation: Physiotherapy Department, University of the Western Cape, Cape Town, South Africa.
authors.forename: Anthea
authors.initials: A
authors.lastname: Rhoda
authors.affiliation: Physiotherapy Department, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Sue
authors.initials: S
authors.lastname: Statham
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. conran.joseph@ki.se.|Physiotherapy Department, University of the Western Cape, Cape Town, South Africa. conran.joseph@ki.se.
authors.forename: Conran
authors.initials: C
authors.lastname: Joseph
mesh_terms: D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011787:Quality of Health Care / Q000592:standards*; D012050:Rehabilitation, Vocational / Q000379:methods / Q000592:standards*; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology
keywords: Community based rehabilitation (CBR); Evaluation of rehabilitation policy; International Classification for Functioning Health and Disability (ICF); Kaplan’s Framework for Organisational Capacity; National Rehabilitation Policy of South Africa (NRP); Realistic evaluation research; Rights based approach to rehabilitation; United Nations Convention for Persons with Disabilities (UNCRPD)