Knowledge of undergraduate physiotherapy students in the Western Cape regarding the correct administration of bronchodilators via metered dose inhalers

BACKGROUND: International studies have shown that there is a lack of practical and theoretical knowledge amongst various health professionals regarding the correct administration of bronchodilators via metered dose inhalers that may result in poor outcomes and negative side effects in patients. The aim was to evaluate the knowledge of undergraduate physiotherapy students in the Western Cape regarding the correct administration of bronchodilators via metered dose inhalers. METHOD: A cross-sectional quantitative descriptive survey including 330 participants was conducted. Data were collected using a self-developed, self-administered English questionnaire. Analysis included descriptive and inferential statistical tests with results significant at p ? 0.05. RESULTS: Similar to other studies significantly fewer students had the correct knowledge with regards to the correct administration of BD's via MDI's in relation to the correct steps (p=0.000), overdose (p=0.000), side effects (p=0.000) and contra-indications (p=0.000) of BD administration via MDI. CONCLUSION: Teaching and learning should be directed towards improving theoretical and practical skills with regards to the correct administration of BD via MDI. Dosage, side effects and contra-indications of BD usage are aspects that also need to be emphasized in the respiratory physiotherapy curriculum. This will assist in ensuring accurate demonstration and education for safe patient administration. Regular evaluation of technical skills and theory is also recommended

Public sector physiotherapists’ organisation and profile: Implications for intensive care service

Background: Physiotherapists are essential in the management of hospitalised patients. The way in which a physiotherapy service is offered in intensive care units (ICUs) can affect ICU patient outcomes. Objectives: To provide a clear picture of the organisation and structure of physiotherapy departments, the number and types of ICUs requiring physiotherapy services and the profile of physiotherapists working in South African public-sector central, regional and tertiary hospitals that house Level I–IV ICUs. Method: Cross-sectional survey design using SurveyMonkey, analysed descriptively. Results: One hundred and seventy units (the majority Level I, functioning as mixed [37%, n = 58] and neonatal [22%, n = 37] units) are serviced by 66 physiotherapy departments. The majority of physiotherapists (61.5%, n = 265) were younger than 30 years, had a bachelor’s degree (95.1%, n = 408) and were employed in production Level I and community service posts (51%, n = 217) with a physiotherapy-to-hospital-bed ratio of 1:69. Conclusion: Insight into the organisational structure of physiotherapy departments and physiotherapists working in public-sector hospitals with ICU facilities in South Africa was provided. It is evident that physiotherapists employed within this sector are young and early in their career development. The large number of ICUs functioning within these hospitals and high bed-to-physiotherapist ratio is concerning, highlighting the high burden of care within this sector and the possible effect on physiotherapy services in the ICUs. Clinical implications: A high burden of care is placed on public-sector hospital-based physiotherapists. The number of senior-level posts within this sector raises concern. It is not clear how the current staffing levels, physiotherapist profile and structure of hospital-based physiotherapy departments affect patient outcomes

Mentoring and coaching in promoting publications in the Department of Physiotherapy at a local university in South Africa

A growing shift towards research and evidence based practice in academia is associated with requirements to disseminate research results in the form of publication in peer reviewed journals. Mentoring has been identified as an important component of developing young authors, as it increases confidence and competence, and facilitates professional development. This led to the formation of a support group to stimulate peer-review publication in the physiotherapy department at the University of the Western Cape. The Kirkpatrick Framework of Evaluation was used to evaluate the success of the mentoring process which made use of a participatory action research methodology. The writing group consisted of nine academic members of staff and took place over ten weeks. The programme included writing, giving feedback, discussion and peer review on a weekly basis. Focus group discussions were taped and transcribed in order to evaluate the mentoring process by identifying relationships within the data and categorising key concepts, which were shaped into a thematic framework. The findings indicated that participants experienced a variety of emotions throughout the programme, with an overall feeling of personal growth by the end. In addition, participants also reported improved writing, reviewing and communication skills. Six months following the programme, six participants had submitted at least one article to a peer reviewed journal. It is clear from this study that some academics still find the task of writing and reviewing articles daunting, and that guidance and support in the form of a writing programme can be useful.Embargo notic

Prevalence and ergonomic risk factors of work-related musculoskeletal injuries amongst underground mine workers in Zambia

Work-related musculoskeletal injuries (WMSIs) are common in both developed and third world countries. Most researchers agree that exposure to ergonomic risk factors is a major contributor to these injuries. Objective: The aim of this study was to determine the prevalence of and ergonomic risk factors associated with WMSIs amongst underground mine workers in Kitwe, Zambia. Methods: A cross-sectional quantitative study was conducted using a sample size of 500 workers. A stratified random sampling method according to mining work activity type was used to obtain the sample. Data was collected by means of a structured questionnaire, and the Statistical Package for Social Sciences (SPSS) was used to analyze data using descriptive and inferential statistical methods. Results were significant at 5%. Results: A response rate of 40.4% (202) was obtained. The 12-month prevalence of WMSIs was 42.6%. The mean age of the workers was 40.31 years (SD +/− 8.57 years). Electricians and mechanics reported the highest injury frequencies. The back was the most affected body part. Ergonomic risk factors consistently reported by workers included poor postures and heavy lifting. There were significant (p=0.020) associations between working with the back bent and sustaining a back injury. Significant (p=0.049) associations were also found between injuries of the wrists/hands and grasping an unsupported object(s). Conclusions: This study revealed significant associations between WMSIs and ergonomic risk factors like working with the back bent and grasping object.Web of Scienc

Implementation and evaluation of a validated evidence-based physiotherapy protocol in a surgical icu : a controlled before and after study

Thesis (PhD)--Stellenbosch University, 2018.ENGLISH SUMMARY : Overall Aim: to implement and evaluate a tailored best-practice multifaceted implementation strategy (intervention) for the effective uptake of a validated evidence-based physiotherapy protocol for the management of patients in a surgical intensive care unit (ICU) in the Western Cape, South Africa (SA). Method: A phased, multipronged design. Phase 1 (survey): described i) the profile of the public sector physiotherapists and their department organisation and structure and ii) the profile and current practices of the public ICU physiotherapists and ICU organisation and structure in which they work. Phase 2 (systematic review): identified best-practice implementation strategies for the effective uptake of evidence-based clinical practice guidelines (CPGs) and protocols. Phase 3a) Nominal Group Technique (NGT): tailored the implementation strategies to the targeted physiotherapists; and b) controlled before and after (CBA) trial: implemented and evaluated the intervention for the uptake of the ICU physiotherapy protocol in a surgical ICU. Results: The physiotherapy survey received a 70% (n=46/66) response. 429 young, early-career physiotherapists with mainly Bachelor degrees, in production (‘junior’) level posts, in departments organised and structured on a departmental model with a hierarchal ranking of posts and physiotherapy to hospital bed ratio of 1:69 was identified. The ICU physiotherapy survey received a 34% (n=58/170) response. ICU physiotherapists had no ICU post-graduate training, 1-5years of ICU work experience, ICU services and practices that varied. Education, audit and feedback, reminders, support, multidisciplinary implementation team and plan, communication and case discussion including telemedicine strategies were identified. Multifaceted implementation strategies are four times more effective (OR: 4.07, 95%CI: 2.93-5.65; p<0.00001, I=89%) than single strategies in improving process of care measures in the ICU. The tailored intervention included an educational handbook, workshop series, grand rounds/bedside teaching sessions and reminders (pocket cards and posters). 1509 patients were included in the 16month CBA trial analysis. Experimental Unit A had a higher TISS-28unit day score [2.3units, p=0.004] in the implementation phase compared to the baseline (pre-implementation phase) in Unit A and all phases in control Unit B. Time to first physiotherapy contact after ICU admission in the implementation phase was longer [adj. OR 1.2, 95%CI:1-1.4, p=0.02] in Unit A than the pre-implementation phase and pre-and implementation phase in Unit B. There was no change in time to first physiotherapy [adj. OR 0.9, 95%CI:0.7-1.1, p=0.19] and first nurse [adj. OR 1, 95%CI: 0.7-1.6, p=0.84] mobilisation into a chair after ICU admission and time to physiotherapy post-extubation [adj. OR 1, 95%CI: 0.9-1.2, p=0.83] in the implementation phase regardless of unit and phase. Patients in unit A were more likely to receive the physiotherapy process of care than patients in unit B at baseline. There was no difference in hospital mortality [adj. OR 1.1, 95%CI: 0.6 - 2, p = 0.78], ICU mortality [adj. OR 1.22, 95%CI: 0.59 - 2.52, p=0.59], intubation [adj. OR 1.1, 95%CI: 0.8 - 1.5, p=0.68] nor proportion of failed extubations [adj. OR 1.2, 95%CI: 0.8 – 2, p=0.39] in the implementation phase between Unit A and B. Conclusion: A tailored best-practice multifaceted implementation strategy and implementation fidelity alone did not facilitate effective uptake of and adherence to the protocol. ICU physiotherapy profile, organisation and structure and practice variation, high baseline process of care adoption rates, healthcare professional behaviour, attitude, knowledge and self-efficacy influenced protocol adherence. The use of a framework to guide ICU implementation initiatives and contextualize the implementation process in a resource limited setting is supported.AFRIKAANSE OPSOMMING : Oorhoofse doelwit: Implementering en evalueering van 'n pasgemaakte, beste-praktyk, veelvlakkige implementeringstrategie (intervensie) vir die effektiewe opname van 'n gevalideerde bewysgebaseerde fisioterapieprotokol vir die bestuur van pasiënte in 'n chirurgiese intensiewe sorgeenheid (ICU) in die Wes-Kaap, Suid Afrika (SA). Metode: 'N Fase, veelvoudige ontwerp. Fase 1 (opname): beskryf i) die profiel van die openbare sektor fisioterapeute en hul departement organisasie en struktuur en ii) die profiel en huidige praktyke van die openbare ICU fisioterapeute en ICU organisasie en struktuur waarin hulle werk. Fase 2 (sistematiese oorsig): bestepraktyk implementeringstrategieë vir die effektiewe opname van bewysgebaseerde kliniese praktyk riglyne (GPG's) en protokolle was geïdentifiseer. Fase 3a) Nominale Groeptegniek (NGT): Die implementeringstrategieë vir die geteikende fisioterapeute is aangepas; en b) beheer voor en na (CBA) verhoor: die intervensie vir die opname van die intensiewe sorg fisioterapie protokol in 'n chirurgiese intensiewe sorgeenheid was geïmplementeer en geëvalueer. Resultate: Die fisioterapie opname vraelys het 'n 70% (n = 46/66) reaksie ontvang. 429 jong, vroeë loopbaanfisioterapeute met hoofsaaklik Baccalaureusgrade, in produksie ('junior') vlakposte, in afdelings georganiseer en gestruktureer op 'n departementele model met 'n hiërargiese rangorde van poste en fisioterapie tot hospitaalbedverhouding van 1:69, is geïdentifiseer. Die intensiewe sorgeenheid fisioterapie opname vraelys het 'n 34% (n = 58/170) reaksie ontvang. Intensiewe sorgeenheid fisioterapeute het geen intensiewe sorg nagraadse opleiding gehad nie, 1-5jaar van intensiewe sorg werkservaring, intensiewe sorgeenheid dienste en praktyke wat wissel. Onderwys, oudit en terugvoer, herinnerings, ondersteuning, multi-dissiplinêre implementeringspan en plan, kommunikasie en gevallestudie, insluitend telemedisynstrategieë, is geïdentifiseer. Veelvlakkige implementeringstrategieë is vier keer meer effektief (OR: 4.07, 95% CI: 2.93-5.65; p <0.00001, I = 89%) as enkele strategieë om die proses van versorgingsmaatreëls in die intensiewe sorgeenheid te verbeter. Die aangepaste intervensie het 'n opvoedkundige handboek, werkswinkelreeks, wyk ronde/bedkant-lesings en onthounotas (sakkaarte en plakkate) ingesluit. 1509 pasiënte is ingesluit in die 16-maande CBA proef analise. Eksperimentele Eenheid A het 'n hoër TISS-28 eenheidspunt [2.3 eenhede, p = 0.004] in die implementeringsfase in vergelyking met die basislyn (pre-implementeringsfase) in Eenheid A en alle fases in beheer Eenheid B gehad. Tyd tot eerste fisioterapie kontak na intensiewe sorgeenheids toelating in die implementeringsfase was langer [adj. OR 1.2, 95% CI: 1-1.4, p = 0.02] in Eenheid A as die voor-implementeringsfase en voor- en implementeringsfase in Eenheid B. Daar was geen verandering in tyd vir eerste fisioterapie [adj. OR 0.9, 95% CI: 0.7-1.1, p = 0.19] en eerste verpleegster [adj. OR 1, 95% CI: 0.7-1.6, p = 0.84] mobilisering in 'n stoel na die intensiewe sorgeenheid toelating en tyd na fisioterapie na extubasie [adj. OR 1, 95% CI: 0.9-1.2, p = 0.83] in die implementeringsfase nie, ongeag van eenheid en fase. Pasiënte in Eenheid A was meer geneig om die fisioterapie sorg proses te ontvang as pasiënte in eenheid B by basislyn. Daar was geen verskil in hospitaalsterfte [adj. OR 1.1, 95% CI: 0.6 - 2, p = 0.78], intensiewe sorg sterfte [adj. OR 1.22, 95% CI: 0.59 - 2.52, p = 0.59], intubasie [adj. OR 1.1, 95% CI: 0.8 - 1.5, p = 0.68] of proporsie van mislukte ekstubasies [adj. OR 1.2, 95% CI: 0.8 - 2, p = 0.39] in die implementeringsfase tussen Eenhede A en B. Gevolgtrekking: 'n Gepaste, beste-praktyk, veelvlakkige implementeringstrategie en implementeringstrouheid het nie die effektiewe opname en aaneming van die protokol vergemaklik nie. Die intensiewe sorg fisioterapie profiel, organisasie en struktuur en praktyk variasie, hoë basislyn sorg proses aaneming, gesondheidsorg professionele gedrag, houding, kennis en selfdoeltreffendheid het the aaneming van die protokol beïnvloed. Die gebruik van 'n raamwerk om intensiewe sorg implementeringsinisiatiewe te rig en die implementeringsproses in 'n hulpbron beperkte omgewing te kontekstualiseer, word ondersteun

Survival and health related quality of life of patients 12 months following discharge from an adult surgical intensive care unit

Thesis (MScPhysio(Interdisciplinary Health Sciences. Physiotherapy))--University of Stellenbosch, 2005.Objectives: This study forms part of a baseline study conducted on patients admitted to an adult surgical ICU between June and October 2003. The survival rate and health related quality of life (HRQoL) of patients 12months following ICU discharge was determined. The correlation of selected demographic and ICU variables to survival and HRQoL was determined. Design: Prospective observational cohort study. Setting: Tenbed closed public tertiary adult surgical ICU. Patients: 180 subjects obtained from a previous baseline study. Measurements: The baseline study provided the demographic data and ICU variables. Survival rate was determined from a Kaplan Meier survival curve. A self-developed questionnaire was used to obtain other selected variables for comparison. A modified Short-Form 36 version 2 (SF-36v2) was use to measure HRQoL perceptions of patients. Results: The survival rate was 62% at 12 months following ICU admission. None of the selected variables were significantly correlated to the long-term survival outcome except for APACHE II which was negatively correlated to this outcome (p<0.01). Forty-six subjects took part in the HRQoL study. The mean HRQoL scores ranged between 43% and 53% for each of the SF-36 HRQoL domains. The physical functioning (43.5%), role play (44.5%) and role emotion (43.1%) domains had the lowest scores. APACHE II had a significantly negative correlation to the physical functioning domain of HRQoL (p=0.02). Age was positively correlated to social functioning (p<0.01) and role emotion (p=0.03). Patients employed after ICU had significantly higher scores for general health (p<0.01) than those who were not. Patients unsure of their TB status and HIV status had significantly lower scores in general health (p=0.02) and role emotion (p=0.05) respectively. ICU length of stay was negatively correlated to role play (p=0.05) and role emotion (p<0.01). Intubation period was negatively correlated to general health (p=0.04). Conclusion: APACHE II was the only variable significantly correlated to both long-term survival and the physical functioning domain of HRQoL. Although the long-term survival was comparable to that of international ICU populations the HRQoL outcomes were slightly lower. Similar to international studies and a South African study evaluating the HRQoL of aids sufferers and police, the current ICU population presented more limitation in the physical functioning, role play and role emotion domains of HRQoL