Bell’s palsy (BP), a fairly common disorder predominantly prevalent in the adult age group,
affects nerves and muscles in the face causing paralysis or dropping of one side of the face.
Clients with Bell’s palsy face many challenges, including psychological, physical and emotional.
A long recovery period and/or delayed complete healing could lead to a negative effect on many
aspects of an individual's life. How society perceives the person could negatively influence the
client’s self-confidence. The management of Bell’s palsy depends on the individual case and
may include medication, physiotherapy and as a last option, surgery. The aim of the study was
to investigate the management of Bell’s palsy at primary health care level in the Cape
Metropolitan District of the Western Cape. The study specific objectives was to investigate the
management or treatment protocol of clients with Bell’s palsy, to determine the tendency for
referral for physiotherapy, to determine whether an association exists between the type of
management or treatment received and the recovery of clients with Bell’s palsy and to explore
the impact Bell's Palsy has on the clients. The over-arching design of the study was the
sequential explanatory mixed methods design where qualitative data was used to assist in
explaining and interpreting the findings of a primarily quantitative study. Stratified random
sampling was done proportionately to ensure equal representation. A self-administered
questionnaire, comprising of four sections, was used to collect quantitative data that was
analysed using SPSS version 21. Descriptive statistics was employed to summarise the data on
the socio-demographic information of the clients. Inferential statistics was used to determine the
distributions of cases in the various groups. Significant differences tested for using the Chisquare
test and effect size through Cramer’s V tests. A semi-structured interview guide was
developed based on the results of the analysis of the quantitative data. Focus group discussions
were employed to a sub-sample of the clients with Bell’s palsy. Permission an ethical clearance
will be obtained from Senate Higher Degrees Committee at the University of the Western Cape iii
(UWC), the Western Cape Department of Health and the facility managers of the participating
CHCs. Results showed that most of the participants (61.8%) had the symptoms of Bell’s palsy
for more than a year. Only 19.5% (n=24) of the participants underwent special investigations to
diagnose the disease, of which more than half (n=14, 58.3%) had blood tests done. Anxiety and
being concerned about the symptoms were reported by 29.3% and 35.0% of the participants
respectively. The majority of the participants received physiotherapy treatment (n=110, 89.4%)
for the symptoms. Therapeutic exercises were received by all the participants referred for
physiotherapy. The psychological impact of the diseases was significantly higher in participants
with a low physical function score and a fairly low effect size was calculated (Cramer’s V =
0.237). Participants with a low social well-being score had a significant longer duration of
symptoms and the psychological impact of the disease were more distinct in these participants.
Significantly more participants with a lower total FDI reported to have a negative psychological
impact of the disease. Results of the qualitative data indicate that Bell’s palsy negatively affects
the clients’ physical health as they experience difficulty with eating, drinking, vision and speech.
Furthermore, the psychological impact of the disease should not be underestimated as the
participants were negatively affected, both emotionally and economically. The participants
reported a positive experience with the combination of medication and physiotherapy treatment.
Physiotherapy treatment on its own, especially exercises also contributed to a very positive
outcome of results. Not all the participants were aware of physiotherapy services offered in the
management of Bell’s palsy and the long waiting periods for an appointment to see a doctor at
the CHCs were identified as problematic. Conclusion: There is a need to increase awareness
about the management of Bell’s palsy, especially the role physiotherapy interventions could play
in the management of the disease at primary health care level. The development and
implementation of policy guidelines for the management of Bell’s palsy to incorporate aspects of
international research and policy is recommended. In addition, psychological treatment should
be offered for each client.