The extent of coaching behaviour and practices in supervision processes of PhD students

The extent to which coaching behaviour is practiced in PhD supervision is unknown. Supervision and elements of supervision have been studied extensively but not coaching and supervision. The aim of this study was to assess the extent to which coaching behaviours were practiced by supervisors while engaging with PhD students during supervision. A cross sectional survey using a self-administered structured questionnaire was used on an online platform (REDCap). Descriptive and correlational statistics were used to determine the extent to which each coaching and supervision phenomenon were practiced. Three hundred and eighty students registered for a PhD for longer than six months in a Faculty of Health Sciences were invited to participate in the study and 76 participated. Low to moderate levels in coaching behaviour and practice, personal support, supervisor availability and research academic support are reported. Personal support and the level of satisfaction with supervision were significant predictors of coaching behaviour and practice. This study established the extent of different supervisory behaviours and coaching behaviour and practice among supervisors. Coaching in this study was not practised largely with a third of the students interviewed experiencing coaching behaviour and practice

Micro, meso and macro issues emerging from focus group discussions: Contributions to a physiotherapy HIV curriculum

Background. Physiotherapy in South Africa has not defined its contribution to the management of HIV. As part of developing an appropriate HIV/AIDS physiotherapy curriculum, focus group discussions (FGDs) with physiotherapy clinicians and educators were undertaken.Objectives. To understand the perceptions and experiences of HIV management in refining an HIV physiotherapy curriculum.Methods. Six focus groups chosen using purposive sampling ensured representation from experienced and newly qualified academics and clinicians. Interpretive content analysis strengthened the knowledge areas required in practice and attitudes based on the groups’ experiences of HIV management. Concepts were identified, and de- and recontextualised to develop categories and themes.Results and discussion. Five themes emerged: the need to include HIV in the physiotherapy curriculum; a physiotherapy-specific HIV curriculum; co-ordinated curriculum design; underlying concerns relating to HIV management and inclusion in the curriculum; and the need for professional development. Further analysis and abstraction highlighted micro, meso and macro issues. Micro issues included content, while meso-level concerns included perceived gaps in the curriculum and recommendations to respond to issues such as therapists’ coping and burnout, therapists’ attitude to HIV, and organisational problems threatening the application of knowledge regarding this condition. At a macro level, participants felt that the political nature of HIV and curriculum structure were problematic and that there was a need for continuous staff development.Conclusion. A list of topics related to HIV, which tallied well with evidence in the literature and patients’ clinical presentations, emerged. The need for a complex, well-designed programme for the physiotherapy management of HIV emerged and was informed by the difficulties experienced at the micro, meso and macro levels of the curriculum

Mainstreaming HIV/AIDS in physiotherapy education and practice

PhD thesis, Faculty of Health Sciences, University of the Witwatersrand, 2008This thesis centres around the issues concerning HIV/AIDS and physiotherapy education, curriculum and practice. In particular, this thesis examines which HIV specific content should be included in a physiotherapy curriculum and ultimately presents a conceptual framework for HIV input into the curriculum. There is a vast body of literature available on HIV. For physiotherapists, however, apart from a brief review given by Nixon and Cott (2000) using the ICIDH, no comprehensive literature is available that places information on HIV into a framework that speaks to physiotherapists as part of the rehabilitation fraternity. The literature on impairments is descriptive and buried in the medical model as symptoms. Section one of the literature review placed the literature in such a framework and provided a comprehensive description using the ICF and related aspects that concern physiotherapists. The ICF captures all the elements of current rehabilitation theory and practice and the literature is presented in an ICF framework. In addition, important background information on prevalence, its determinants, treatment approaches and subsequent impacts were reviewed. As most of the literature available still remains in the medical model, the conditions that manifest and from which patients develop impairments, were reviewed. The effects of HIV on body systems are extensive and pervasive. In each body system HIV has direct effects on mature and maturing cells e.g. progenitor cells and mature muscle cells. In the musculoskeletal system HIV impacts on functional systems and organs resulting in pathophysiological changes that manifest as impairments such as muscle wasting. Conditions manifesting in all body systems were reviewed and outlined. Impairments such as pain, breathlessness and proximal muscle weakness were reported in the literature. In addition to impairments, analysis of the literature revealed studies that had found high levels of functional and activity limitations as well as impacts on Health-related Quality of Life in HIV. The literature also presents the current status of physiotherapy interventions. Many studies have reported that exercises are a safe and effective mode of intervention not-withstanding the limitations encountered. The second part of the literature review focussed on aspects concerned with curriculum. Previous studies have focused on establishing baseline knowledge, attitudes and practices (KAP) to HIV and the impact of training programmes on KAP. What the actual content was for health workers, in particular physiotherapists and the approach to incorporating HIV into curricula is a gap in the literature. To inform the overall aim, with context-appropriate HIV content, this study undertook a number of studies in order to obtain the necessary information on HIV, specific to physiotherapy. Therefore the overall approach was a mixed methods one employing both a quantitative and qualitative study mix. The first and second studies informed the clinical picture and were both cross-sectional and descriptive. In both studies descriptive statistics were used to analyse data, especially in determining the absence or presence of conditions. Study 1 sought to establish the level of referral to physiotherapy by retrospectively examining the patient records of patients admitted with HIVrelated conditions over a period of one year. Of the 732 patient records reviewed, 139 (19%) had diagnoses considered suitable for physiotherapy and 3% were referred to physiotherapy. Study 2 aimed to establish a relevant overview of the functional and participation limitations of people living with HIV. Two groups of patients were studied i.e. an in-patient group and an outpatient group. The out-patient group was from a well resourced mining out-patient setting. The ICF checklist was utilised to collect the data and statistical analysis was performed to indicate the presence or absence of impairments, activity limitations and participation restrictions. A logistic regression was done to determine the odds of activity, limitation or participation restriction given certain levels of domains. Both groups showed high levels of impairment. For the in-patient group loss of muscle power 75%(n=60) energy and drive 75%(n=60), disturbed sleep 71%(n=56), emotional problems 62%(49), mild-severe pain 80%(66), weight maintenance difficulties and diarrhoea were apparent. In the out-patient mining group memory problems, energy and drive functions 36%(n=18), sleep 24% (n=12) and emotional functions 28% (n=14), seeing 32% (n=17), hearing, vestibularproblems 28%(n=14) and pain 55%(n=28), blood pressure and respiratory problems 24%(n=12), weight maintenance 63%(n=32), sexual functions 22%(n=11) and reduced proximal muscular power 24%(n=12) were encountered. The in-patient group had high levels of activity limitations and participation restrictions, while the out-patient mining group did not. There was association between the different domains and in the in-patient group gender (p=0.02) and marital status (p=0.01) were likely to influence the activity and participation levels and the experience of the environment. The remaining three studies involved aspects related to informing the curriculum component of this thesis. Study 3 audited the universities’ curricular documents to establish what the current curriculum included. Seven of the eight universities that offer physiotherapy training were reviewed and their curricula were generally scanty on information regarding HIV/AIDS. When compared to the areas outlined as a result of the literature review, the study of the patients and focus groups with clinicians and academic staff, revealed some gaps, in particular; the types of conditionsand the influence of HIV on other body systems which are pertinent to the clinical reasoning process for the physiotherapist: The philosophy of care and approach to management and the physiotherapists’ role in HIV prevention, treatment and care were evident gaps. Study 4 sought to develop a framework of HIV content for a physiotherapy curriculum. This was done by integrating the results found so far and verifying and enriching this data by gaining clinicians’ and academics’ insights and perceptions around HIV, based on their clinical and educational experience. Focus group discussions were conducted and a qualitative approach was undertaken for data analysis. A framework for curricula content emerged from this exercise. In study 5 the framework of HIV content was used to develop a questionnaire that was sent out in the Delphi survey to academic staff with the aim to test the level of consensus. Eighty three components of the curriculum under four outcome areas (Appendix 7.2) were sent to 68 academic staff who were identified. Of the 68 academic staff, 58 were available and 47 responded and consented to participate. All but two topics obtained consensus set at 80% and the remaining two obtained consensus in the second round. The final chapter discusses the results of these studies and illustrates how these results on HIV affect and can be applied to the physiotherapy curriculum, when applied to the UNAIDS mainstreaming criteria. Applying the mainstreaming principles to the process of including HIV content into the curriculum, ensures that the process is not done in a piece meal fashion but encompasses all important facets which were identified. The programme, if systematically implemented, could result in a coordinated outcome accounting for all the important facets. A conceptual framework is drawn from the results of this thesis illustrating the three levels of curriculum taxonomy: At the micro level, through the body systems, the meso level through the role of physiotherapy, dealing with internal and external domains and teaching approaches. The macro level is accounted for by the facilitatory activities such as advocacy among clinicians and academics and forming strategic partnerships at all levels

HIV/AIDS in Physiotherapy Education – Mainstreaming Using UN Principles

HIV /AID S remains at epidemic levels in South Africa with onein ten people affected by the HI virus. The United Nations program for AID S(UNAID S) has defined five principles that can be used to mainstream HIV .The five key principles are: the development of a clearly defined entry point;use of existing policies, structures and frameworks; advocacy sensitizationand capacity building; distinguishing between the external (institutionalinterventions) and internal (staff risks and vulnerability) domain; and developingstrategic partnerships. A proposed HIV curriculum for physiotherapists wasbeen developed from a series of studies undertaken to understand the issues related to HIV using the principles ofmainstreaming.The purpose of this paper is to explore how each principle of mainstreaming can be applied in physiotherapyeducation and curricula.Each mainstreaming principle was considered and ways in which it could be mainstreamed into physiotherapytraining and practice, using data from the patients’, academics’ and clinicians’ experience were proposed.The five principles can be used in South African settings. In principle one the aetiology, approaches to treatment,management of conditions and symptoms are used to identify entry points for introducing HIV teaching. Relevantexamples of conditions associated with HIV include pain, stroke, specific muscle weakness patterns, fatigue andcardiopulmonary system problems (e.g. breathlessness). The role of physiotherapy in HIV management is also a goodentry point.For principle two, policies were considered. Pertinent areas such as antiretroviral use, frameworks such as theInternational Classification of Function (ICF), Worthington’s rehabilitation framework and CBR can also be integratedwith HIV physiotherapy curriculum and practice. Sensitised and aware staff as promoted in principle three,can advocate for affected patients and role model appropriate practice and attitudes in HIV management thuscontributing to reducing stigma and burnout. Integrating policies with the need to avoid risks and correct inappropriateattitudes of staff is promoted and promoting strategic partnerships and collaborative work will help provideappropriate services.Using the mainstreaming principles allows for the inclusion of HIV content in physiotherapy education and practice.Both physiotherapy curriculum and continuous professional development may use this information to respondappropriately

Investigating the interaction between human immunodeficiency virus, nutrition, and disability: A cross-sectional observational study

Background: The average lifespan of people with human immunodeficiency virus (HIV) has increased because of the enhanced access to anti-retroviral treatment. This increased longevity has led to a heightened focus on the comorbidities which may arise, allowing a clearer understanding of the contextual, personal, psychological and functional problems and their interrelations. Disability (functional limitations) and insufficient nutritional intake may interact cyclically with HIV and/or acquired immunodeficiency syndrome (AIDS); however, no research to date has investigated this interaction.   Aims: The objective of this article was to report on the nutritional outcomes using albumin and body mass index outcomes as a subset of a larger study among adults living with HIV and/or AIDS.   Setting: This study was conducted at a large HIV clinic based in an urban area in Johannesburg, South Africa, which provides HIV treatment and support to over 6000 persons with HIV and TB. This clinic is part of a large public health regional hospital where extensive HIV research is undertaken.   Methods: This study was a cross-sectional observational study. The sample composed of 278 participants between 18 and 65 years of age and had been on highly active antiretroviral therapy (HAART) for more than six months. Statistical analyses were performed using the Statistical Package for the Social Sciences.   Results: The results indicated that albumin level had significant inverse associations with functional limitations and physical health symptoms. Women were significantly more likely to have lower nutritional levels. A logistic regression analysis suggested that gender and physical health symptoms were the primary predictors of albumin levels.   Conclusion: The findings presented in this article can be applied to HIV and/or AIDS treatment programmes, such as HAART. It re-emphasises the importance of providing individuals on anti-retroviral therapy with affordable and adequate nutrition, education on the importance of nutritional intake and the benefits of potentially adopting supplement programmes. As females seem to be more adversely affected by low nutritional levels, with the findings showing an increased likelihood of developing physical health symptoms, focus also needs to be given to cultural or social factors that impact nutritional intake in women

Perceptions of integrated rehabilitation service delivery in a metropolitan district

Background: There is a recognised need for rehabilitation services at primary health care (PHC) level. In addition, there are clear policies (international and national) and guidelines for use by healthcare planners in South Africa to implement rehabilitation services. Although rehabilitation services are provided on the primary platform, its operationalisation has not been in an integrated manner. Clarity on the level of integration within existing PHC rehabilitation service delivery is required for its inclusion in a reengineered PHC. Aim: The study explored the extent to which rehabilitation services are integrated into PHC service delivery based on the expressed reality of rehabilitation professionals. Setting: The Johannesburg Metropolitan District of Gauteng, South Africa. Methods: In-depth interviews with 12 PHC rehabilitation professionals were completed to elicit their experiences with PHC rehabilitation services. Results: The theme the current state of rehabilitation services – ‘this is the reality; you need to do what you need to do’ along with its two subcategories, was generated from this study. The theme describes the expressed reality of suboptimal, underdeveloped and poorly integrated rehabilitation services within the Johannesburg Metropolitan District. Rehabilitation service providers have adapted service delivery by including isolated components of rehabilitation integration models, but this has not yielded an integrated service. Conclusion: Rehabilitation services although recognised as a crucial service in PHC must be critically analysed and adapted to develop integrated service delivery models. There should be a shift from selected coping mechanisms to targeted, integrated services. Contribution: The study describes PHC rehabilitation services and explores best practice models for integrated service planning and delivery

Factors informing the development of a clinical pathway and patients' quality of life after a non-union fracture of the lower limb

Supporting Information File S1: SF-36 QuestionnaireDATA AVAILABILITY STATEMENT: Data for this study are available upon request.Patients with non-union fractures spend extended periods of time in the hospital following poor healing. Patients have to make several follow-up visits for medical and rehabilitation purposes. However, the clinical pathways and quality of life of these patients are unknown. This prospective study aimed to identify the clinical pathways (CPs) of 22 patients with lower-limb non-union fractures whilst determining their quality of life. Data were collected from hospital records from admission to discharge, utilizing a CP questionnaire. We used the same questionnaire to track patients’ follow-up frequency, involvement in activities of daily living, and final outcomes at six months. We used the Short Form-36 questionnaire to assess patients’ initial quality of life. The Kruskal–Wallis test compared the quality of life domains across different fracture sites. We examined CPs using medians and inter-quantile ranges. During the six-month follow-up period, 12 patients with lower-limb non-union fractures were readmitted. All of the patients had impairments, limited activity, and participation restrictions. Lower-limb fractures can have a substantial impact on emotional and physical health, and lower-limb non-union fractures may have an even greater effect on the emotional and physical health of patients, necessitating a more holistic approach to patient care.https://www.mdpi.com/journal/healthcarePhysiotherap

The effect of the Hambisela programme on stress levels and quality of life of primary caregivers of children with cerebral palsy: A pilot study

Background: Caregivers of children with cerebral palsy (CP) are at risk of having high stress levels and poor quality of life (QOL) which could have a detrimental effect on themselves and their children. Taking caregivers’ well-being into consideration is therefore important when providing rehabilitation to children with CP. Interventions to mediate primary caregiver stress and QOL using an educational tool have not been tested in this population in South Africa. Objectives: The aim of this study was to determine the effect of a group-based educational intervention, Hambisela, on stress levels and QOL of primary caregivers of children with CP in Mamelodi, a township in Gauteng, South Africa. Method: Eighteen primary caregivers of children with CP participated in a quasi-experimental pretest–post-test pilot study. Hambisela, a group-based educational intervention, was carried out once a week over 8 consecutive weeks. Caregiver stress and QOL were assessed before and after the intervention using the Parenting Stress Index-Short Form (PSI-SF) and the Paediatric Quality of Life-Family Impact Module (PedsQLTM-FIM). Sociodemographic information was assessed using a demographic questionnaire. The Gross Motor Function Classification System (GMFCS) was used to assess the gross motor level of severity of CP in the children. Results: Data were collected for 18 participants at baseline and 16 participants at follow-up. At baseline, 14 (87.5%) participants had clinically significant stress which reduced to 11 (68.8%) at follow-up. There was no significant change in primary caregiver’s stress levels (p = 0.72) and QOL (p = 0.85) after the Hambisela programme. Higher levels of education were moderately associated with lower levels of primary caregiver stress (r = −0.50; p = 0.03). Conclusion: Most primary caregivers in this pilot study suffered from clinically significant stress levels. Hambisela, as an educational intervention, was not effective in reducing the stress or improving the QOL in these primary caregivers of children with CP. Future studies with a larger sample size are needed to investigate the high stress levels of primary caregivers of children with CP. Clinical implications: Rehabilitation services for children with disabilities should include assessments to identify caregivers with high stress levels. Holistic management programmes should also include care for the carers

Status of referral to physiotherapy among hiv positive patients at Chris Hani Baragwaneth hospital johannesburg South Africa 2005

HIV continues to be a major health problem in South Africa. The multiple diagnoses that the disease presents with, needs a holistic and comprehensive management approach. Physiotherapy and rehabilitation play a role in this management approach. Understanding the full scope of conditions that are present and those that are suitable for physiotherapy intervention is an essential prerequisite to developing appropriate curricula, intervention models or systems. It is accepted that HIV rehabilitation interventions are based largely on functional deficits ( O’Dell  1996), however  in South Africa functional deficits have not been fully explored. A common starting point, with the medical model of management was considered to be at the diagnosis level as this information would be more readily available than functional deficits. Purpose: This study aimed to establish how much and in which aeitiology is physiotherapy involved in the management of HIV within an inpatient hospital setting at Chris Hani Baragwaneth Hospital. This minor study forms part of a larger study establishing physiotherapy curricula needs. Method: Aretrospective review of patient records was carried out in order to identify conditions suitable for physiotherapy and to determine the referral patterns to physiotherapy. Findings: Of the 732 records reviewed and used in the study, 47% (n=344) of the patients were HIV positive. From these records, 19% (n=139) had diagnoses considered suitable for physiotherapy and only 2% (n=3) of these 139 patients were referred to physiotherapy. Conclusion: Almost half of the patients in the medical units were HIV positive. Although the referral rate was very low, some of these patients presented with diagnosis that are traditionally seen by physiotherapists.  None of the patients’ records indicated examination of the patients’ physical status such as exercise tolerance, mobility, muscle strength, lung function or pain. This study is by no means fully representative of the full scope of the epidemiology of conditions that can be seen by physiotherapists or their referral status but does give some indication of what conditions are, and could potentially interface with physiotherapy