Doctoral Degrees (Physiotherapy)

Permanent URI for this collection

https://scholar.sun.ac.za/handle/10019.1/100737

Browse

Browsing Doctoral Degrees (Physiotherapy) by Author "Karachi, Farhana"

Now showing 1 - 1 of 1
  • Thumbnail Image
    Item
    Implementation and evaluation of a validated evidence-based physiotherapy protocol in a surgical icu : a controlled before and after study
    (Stellenbosch : Stellenbosch University, 2018-12) Karachi, Farhana; Hanekom, S. D.; Gosselink, R.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
    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.