Browsing by Author "Grimmer, Karen"
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- ItemContextualised strategies to increase childhood and adolescent vaccination coverage in South Africa : a mixed-methods study(BMJ Publishing, 2020-06-04) Wiysonge, Charles Shey; Mahasha, Phetole Walter; Ndwandwe, Duduzile Edith; Ngcobo, Ntombenhle; Grimmer, Karen; Dizon, Janine; Burnett, Rosemary J.; Cooper, SaraIntroduction Despite the unparalleled success of immunisation in the control of vaccine preventable diseases, immunisation coverage in South Africa remains suboptimal. While many evidence-based interventions have successfully improved vaccination coverage in other countries, they are not necessarily appropriate to the immunisation needs, barriers and facilitators of South Africa. The aim of this research is to investigate barriers and facilitators to optimal vaccination uptake, and develop contextualised strategies and implementation plans to increase childhood and adolescent vaccination coverage in South Africa. Methods The study will employ a mixed-methods research design. It will be conducted over three iterative phases and use the Adopt, Contextualise or Adapt (ACA) model as an overarching conceptual framework. Phase 1 will identify, and develop a sampling frame of, immunisation stakeholders involved in the design, planning and implementation of childhood and human papillomavirus immunisation programmes in South Africa. Phase 2 will identify the main barriers and facilitators to, and solutions for, increasing vaccination coverage. This phase will comprise exploratory qualitative research with stakeholders and a review of existing systematic reviews on interventions for improving vaccination coverage. Using the findings from Phase 2 and the ACA model, Phase 3 will develop a set of proposed interventions and implementation action plans for improving immunisation coverage in South Africa. These plans will be discussed, revised and finalised through a series of participatory stakeholder workshops and an online questionnaire, conducted as part of Phase 3.
- ItemCross-cultural adaptation, content validation, and reliability of the Nigerian Composite Lifestyle CVD Risk Factors Questionnaire for adolescents among Yoruba rural adolescents in Nigeria(Medical Association of Malawi, 2017) Odunaiya, Nse A.; Louw, Quinette A.; Grimmer, KarenBackground: Assessment of lifestyle risk factors must be culturally and contextually relevant and available in local languages. This paper reports on a study which aimed to cross-culturally adapt a composite lifestyle cardiovascular disease (CVD) risk factors questionnaire into an African language (Yoruba) and test some of its psychometric properties, such as content validity and test–retest reliability in comparison to the original English version. Methods: This study utilised a cross-sectional design. Translation of the English version of the questionnaire into Yoruba was undertaken using the guideline by Beaton et al. The translated instrument was presented to 21 rural adolescents to assess comprehensibility and clarity, using a sample of convenience. A test–retest reliability exercise was conducted among 150 rural adolescents, using purposive sampling. Data were analysed using an intraclass correlation (ICC ) model 3, Cohen kappa statistics and prevalence rates. Results: ICC ranged between 0.4 and 0.8. The Yoruba version was completed in 15 to 20 minutes, and it was reported to be culturally appropriate and acceptable for rural Nigerian adolescents. Conclusions: The Yoruba translation of the Nigerian composite lifestyle risk factors questionnaire performs at least as well as the original English version in terms of content validity and reliability. It took a shorter time to complete and thus may be more acceptable to rural adolescents.
- ItemDevelopment of a cost effective three-dimensional posture analysis tool : validity and reliability(BioMed Central, 2013-12) Brink, Yolandi; Louw, Quinette; Grimmer, Karen; Schreve, Kristiaan; Van der Westhuizen, Gareth; Jordaan, EsmeBackground: The lack of clear understanding of the association between sitting posture and adolescent musculoskeletal pain, might reflect invalid and/or unreliable posture measurement instruments. The psychometric properties of any new measurement instrument should be demonstrated prior to use for research or clinical purposes. This paper describes psychometric testing of a new three-dimensional (3D), portable, non-invasive posture analysis tool (3D-PAT), from sequential studies using a mannequin and high school students. Methods: The first study compared the 3D-(X-, Y- and Z-) coordinates of reflective markers placed on a mannequin using the 3D-PAT, and the Vicon motion analysis system. This study also tested the reliability of taking repeated measures of the 3D-coordinates of the reflective markers. The second study determined the concurrent validity and test-retest reliability of the 3D-PAT measurements of nine sitting postural angles of high school students undertaking a standard computing task. In both studies, concordance correlation coefficients and Intraclass correlation coefficients described test-retest reliability, whilst Pearson product moment correlation coefficients and Bland-Altman plots demonstrated concurrent validity. Results: The 3D-PAT provides reliable and valid 3D measurements of five of the nine postural angles i.e. head flexion, neck flexion, cranio-cervical angle, trunk flexion and head lateral bending in adolescents undertaking a standard task. Conclusions: The 3D-PAT is appropriate for research and clinical settings to measure five upper quadrant postural angles in three dimensions. As a measurement instrument it can provide further understanding of the relationship between sitting posture, changes to sitting posture and adolescent musculoskeletal pain.
- ItemKnee movement patterns of injured and uninjured adolescent basketball players when landing from a jump : a case-control study(BioMed Central, 2006-03) Louw, Quinette; Grimmer, Karen; Vaughan, ChristopherBackground: A common knee injury mechanism sustained during basketball is landing badly from a jump. Landing is a complex task and requires good coordination, dynamic muscle control and flexibility. For adolescents whose coordination and motor control has not fully matured, landing badly from a jump can present a significant risk for injury. There is currently limited biomechanical information regarding the lower limb kinetics of adolescents when jumping, specifically regarding jump kinematics comparing injured with uninjured adolescents. This study reports on an investigation of biomechanical differences in landing patterns of uninjured and injured adolescent basketball players. Methods: A matched case-control study design was employed. Twenty-two basketball players aged 14–16 years participated in the study: eleven previously knee-injured and eleven uninjured players matched with cases for age, gender, weight, height and years of play, and playing for the same club. Six high-speed, three-dimensional Vicon 370 cameras (120 Hz), Vicon biomechanical software and SAS Version 8 software were employed to analyse landing patterns when subjects performed a "jump shot". Linear correlations determined functional relationships between the biomechanical performance of lower limb joints, and paired t-tests determined differences between the normalised peak biomechanical parameters. Results: The average peak vertical ground reaction forces between the cases and controls were similar. The average peak ground reaction forces between the cases and controls were moderately correlated (r = -0.47). The control (uninjured) players had significantly greater hip and knee flexion angles and significantly greater eccentric activity on landing than the uninjured cases (p < 0.01). Conclusion: The findings of the study indicate that players with a history of knee injuries had biomechanically compromised landing techniques when compared with uninjured players matched for gender, age and club. Descriptions (norms) of expected levels of knee control, proprioceptive acuity and eccentric strength relative to landing from a jump, at different ages and physical developmental stages, would assist clinicians and coaches to identify players with inappropriate knee performance comparable to their age or developmental stage.
- ItemLearning styles of physiotherapists : a systematic scoping review(BMC (part of Springer Nature), 2019-01-03) Stander, Jessica; Grimmer, Karen; Brink, YolandiBackground: Understanding students’ learning styles, and modifying teaching styles and material accordingly, is an essential to delivering quality education. Knowing more about the learning styles of physiotherapy learners will assist educators’ planning and delivering of learning activities. The purpose of this scoping review was to explore what is published about physiotherapy learning styles. Methods: An adapted Arksey and O’Malley framework was applied to undertake this systematic scoping review. Nine electronic databases (CINAHL, BIOMED CENTRAL, Cochrane, Web of Science, PROQUEST, PubMed, OTseeker, Scopus, ERIC) were searched using the keywords: ‘learning styles’ and ‘physiotherapy’. English-language, primary research articles that investigated physiotherapy learners’ learning styles were sought. Results: Of 396 potentially-relevant articles, 15 were included in this review. The studies mostly reflected undergraduate students (910 undergraduates, 361 postgraduates, 23 professionals), in developed countries. Nine articles used the Kolb’s experiential learning theory (ELT); one study applied Honey and Mumford’s approach; two studies used the Gregorc model of cognition and three studies did not specify an underlying theory. Outcome measures included different versions of Kolb’s Learning Style Inventory, the visual-aural-read/write-kinesthetic questionnaire, Gregorc style delineator, Felder Silverman’s Index of Learning Survey, and Honey and Mumford’s Learning Style Questionnaire. The preferred physiotherapy learning styles, according to the ELT, seem to be Converger (learns “hands-on” and applying previously attained knowledge) and Assimilator (gathers and organises information to make the most sense). Conclusions: Both physiotherapy learners and physiotherapists have specific learning styles of active participation, underpinned with practical examples of theoretical concepts. More research is needed in developing countries, and on postgraduate and professional physiotherapy learners’ learning styles. Also, further research should focus on defining and describing physiotherapy learning styles in a way to be used as an industry standard; and developing valid and reliable learning style outcome measures applicable across physiotherapy learners and settings.
- ItemMapping South African allied health primary care clinical guideline activity : establishing a stakeholder reference sample(BioMed Central, 2016-10-10) Dizon, Janine Margarita; Grimmer, Karen; Machingaidze, Shingai; McLaren, Pam; Louw, QuinetteENGLISH SUMMARY : Background: Little is known about allied health (AH) clinical practice guideline (CPG) activity in South Africa, and particularly in relation to primary health care (PHC). This paper reports on a scoping study undertaken to establish a reference framework, from which a comprehensive maximum variation sample could be selected. This was required to underpin robust sampling for a qualitative study aimed at understanding South African primary care AH therapy CPG activities. This paper builds on findings from the South African Guidelines Evaluation (Project SAGE) Flagship grant. Methods: South African government websites were searched for structures of departments and portfolios, and available CPGs. Professional AH association websites were searched for CPGs, purposively-identified key informants were interviewed, and CPGs previously identified for priority South African primary care conditions were critiqued for AH therapy involvement. Results: Key informants described potentially complex relationships between players who may be engaged in South African AH CPGs, in both public and private sectors. There were disability/rehabilitation portfolios at national and provincial governments, but no uniformity in provincial government organisation of, or support for, PHC AH services. There were no AH primary care therapy CPGs on government websites, although there was ‘clinical guidance’ in various forms on professional association websites. Only two CPGs of priority South African PHC conditions included mention of any AH therapy (physiotherapy for adult asthma and chronic obstructive pulmonary disease). Conclusion: A comprehensive and wide-reaching stakeholder reference framework would be required in order to capture the heterogeneity of AH primary care CPG activity in South Africa. This should involve the voices of national and purposively-selected provincial governments, academic institutions, consultants, public sector managers and clinicians, private practitioners, professional associations, and private sector insurers. Provincial governments should be selected to reflect heterogeneity in local economics, population demographics and availability of university AH training programs. This investigation should aim to determine the areas of PHC in which AH are engaged.
- ItemNext generation clinical guidance for primary care in South Africa – credible, consistent and pragmatic(Public Library of Science, 2018-03-30) Machingaidze, Shingai; Grimmer, Karen; Louw, Quinette; Kredo, Tamara; Young, Taryn; Volmink, JimmyBackground: Agreed international development standards underpin high quality de novo clinical practice guidelines (CPGs). There is however, no international consensus on how high quality CPGs should ‘look’; or on whether high quality CPGs from one country can be viably implemented elsewhere. Writing de novo CPGs is generally resource-intensive and expensive, making this challenging in resource-poor environments. This paper proposes an alternative, efficient method of producing high quality CPGs in such circumstances, using existing CPGs layered by local knowledge, contexts and products. Methods: We undertook a mixed methods case study in South African (SA) primary healthcare (PHC), building on findings from four independent studies. These comprised an overview of international CPG activities; a rapid literature review on international CPG development practices; critical appraisal of 16 purposively-sampled SA PHC CPGs; and additional interrogation of these CPGs regarding how, why and for whom, they had been produced, and how they ‘looked’. Results: Despite a common aim to improve SA PHC healthcare practices, the included CPGs had different, unclear and inconsistent production processes, terminology and evidence presentation styles. None aligned with international quality standards. However many included innovative succinct guidance for end-users (which we classified as evidence-based summary recommendations, patient management tools or protocols). We developed a three-tiered model, a checklist and a glossary of common terms, for more efficient future production of better quality, contextually-relevant, locally-implementable SA PHC CPGs. Tier 1 involves transparent synthesis of existing high quality CPG recommendations; Tier 2 reflects local expertise to layer Tier 1 evidence with local contexts; and Tier 3 comprises tailored locally-relevant end-user guidance. Conclusion: Our model could be relevant for any resource-poor environment. It should reduce effort and costs in finding and synthesising available research evidence, whilst efficiently focusing scant resources on contextually-relevant evidence-based guidance, and implementation.
- ItemPhysical rehabilitation needs in the BRICS nations from 1990 to 2017 : cross-national analyses using data from the global burden of disease study(MDPI, 2020-06) Jesus, Tiago S.; Landry, Michel D.; Hoenig, Helen; Zeng, Yi; Kamalakannan, Sureshkumar; Britto, Raquel R.; Pogosova, Nana; Sokolova, Olga; Grimmer, Karen; Louw, QuinetteBackground: This study analyzes the current and evolving physical rehabilitation needs of BRICS nations (Brazil, Russian Federation, India, China, South Africa), a coalition of large emergent economies increasingly important for global health. Methods: Secondary, cross-national analyses of data on Years Lived with Disability (YLDs) were extracted from the Global Burden of Disease Study 2017. Total physical rehabilitation needs, and those stratified per major condition groups are analyzed for the year 2017 (current needs), and for every year since 1990 (evolution over time). ANOVAs are used to detect significant yearly changes. Results: Total physical rehabilitation needs have increased significantly from 1990 to 2017 in each of the BRICS nations, in every metric analyzed (YLD Counts, YLDs per 100,000 people, and percentage of YLDs relevant to physical rehabilitation; all p < 0.01). Musculoskeletal & pain conditions were leading cause of physical rehabilitation needs across the BRICS nations but to varying degrees: from 36% in South Africa to 60% in Brazil. Country-specific trends include: 25% of South African needs were from HIV-related conditions (no other BRICS nation had more than 1%); India had both absolute and relative growths of pediatric rehabilitation needs (p < 0.01); China had an exponential growth in the per-capita needs from neurological and neoplastic conditions (p < 0.01; r2 = 0.97); Brazil had a both absolute and relative growth of needs coming from musculoskeletal & pain conditions (p < 0.01); and the Russian Federation had the highest neurological rehabilitation needs per capita in 2017 (over than three times those of India, South Africa or Brazil). Conclusions: total physical rehabilitation needs have been increasing in each of the BRICS nations, both in absolute and relative values. Apart from the common growing trend, each of the BRICS nations had own patterns for the amount, typology, and evolution of their physical rehabilitation needs, which must be taken into account while planning for health and physical rehabilitation programs, policies and resources.
- ItemThe prevalence of underweight, overweight and obesity in a multiracial group of urban adolescent schoolchildren in the Cape Metropole area of Cape Town(MedPharm Publications, 2014-10) Van Niekerk, Sjan-Mari; Grimmer, Karen; Louw, QuinetteAbstract Objective: The objective was to determine the prevalence of underweight, overweight and obesity in high school learners in the Cape Town area. Design: A cross-sectional study was conducted. Setting: High schools in the Cape Metropole Area of the Western Cape. Subjects: A complex cluster sampling procedure was followed. Thirty-six students per school were selected from each randomly selected school. Thirteen- to 18-year-old pupils were eligible for inclusion. Outcome measures: Height and weight measurements. Results: The sample comprised 689 students. There were considerably more underweight adolescent boys than adolescent girls (17.3% boys to 9.9% girls), and double the frequency of overweight adolescent girls than adolescent boys (7.7% girls to 3.5% boys). The 14-year-old boys had the highest prevalence of underweight (55.2%), and the 17-year-old girls the highest prevalence of overweight (22%). The highest prevalence of obesity was found in 15-year-old boys (11.1%), who also demonstrated a relatively high prevalence of underweight (30.2%). Conclusion: This study reported on a substantial percentage of underweight adolescents (27.1%). Noteworthy levels of overweight and obesity in adolescent girls added to the substantial prevalence of underweight in adolescent boys. Africa has enough to contend with in respect of transmissible diseases, without additional lifestyle-based health burdens.
- ItemSouth African clinical practice guidelines quality measured with complex and rapid appraisal instruments(BioMed Central, 2016-04-27) Grimmer, Karen; Machingaidze, Shingai; Dizon, Janine; Kredo, Tamara; Louw, Quinette; Young, TarynENGLISH SUMMARY : Background: Critically appraising the quality of clinical practice guidelines (CPGs) is an essential element of evidence implementation. Critical appraisal considers the quality of CPG construction and reporting processes, and the credibility of the body of evidence underpinning ecommendations. To date, the focus on CPG critical appraisal has come from researchers and evaluators, using complex appraisal instruments. Rapid critical appraisal is a relatively new approach for CPGs, which targets busy end-users such as service managers and clinicians. This paper compares the findings of two critical appraisal instruments: a rapid instrument (iCAHE) and a complex instrument (AGREE II). They were applied independently to 16 purposively-sampled, heterogeneous South African CPGs, written for eleven primary health care conditions/health areas. Overall scores, and scores in the two instruments’ common domains Scope and Purpose, Stakeholder involvement, Underlying evidence/Rigour of Development, Clarity), were compared using Pearson r correlations and intraclass correlation coefficients. CPGs with differences of 10 % or greater between scores were identified and reasons sought for such differences. The time taken to apply the instruments was recorded. Results: Both instruments identified the generally poor quality of the included CPGs, particularly in Rigour of Development. Correlation and agreement between instrument scores was moderate, and there were no overall significant score differences. Large differences in scores for some CPGs could be explained by differences in instrument construction and focus, and CPG construction. The iCAHE instrument was demonstrably quicker to use than the AGREE II instrument. Conclusions: Either instrument could be used with confidence to assess the quality of CPGs. The choice of appraisal instrument depends on the needs and time of end-users. Having an alternative (rapid) critical appraisal tool will potentially encourage busy end-users to identify and use good quality CPGs to inform practice decisions.
- ItemA South African experience in applying the Adopt–Contextualise–Adapt framework to stroke rehabilitation clinical practice guidelines(BMC (part of Springer Nature), 2019-06-06) Grimmer, Karen; Louw, Quinette; Dizon, Janine M.; Brown, Sjan-Mari; Ernstzen, Dawn; Wiysonge, Charles S.Background: Clinical practice guideline (CPG) activity has escalated internationally in the last 20 years, leading to increasingly sophisticated methods for CPG developers and implementers. Despite this, there remains a lack of practical support for end-users in terms of effectively and efficiently implementing CPG recommendations into local practice. This paper describes South African experiences in implementing international CPG recommendations for best practice stroke rehabilitation into local contexts, using a purpose-build approach. Methods: Composite recommendations were synthesised from 16 international CPGs to address end-user questions about best practice rehabilitation for South African stroke survivors. End-user representatives on the project team included methodologists, policy-makers, clinicians, managers, educators, researchers and stroke survivors. The Adopt–Contextualise–Adapt model was applied as a decision-guide to streamline discussions on endorsement and development of implementation strategies. Where recommendations required contextualisation to address local barriers before they could be effectively implemented, prompts were provided to identify barriers and possible solutions. Where recommendations could not be implemented without additional local evidence (adaptation), options were identified to establish new evidence. Findings: The structured implementation process was efficient in terms of time, effort, resources and problem solving. The process empowered the project team to make practical decisions about local uptake of international recommendations, develop local implementation strategies, and determine who was responsible, for what and when. Different implementation strategies for the same recommendation were identified for different settings, to address different barriers. Conclusion: The South African evidence translation experience could be useful for evidence implementers in other countries, when translating CPG recommendations developed elsewhere, into local practice.
- ItemSouth African Guidelines Excellence (SAGE) : clinical practice guidelines - quality and credibility(Health and Medical Publishing Group, 2015) Machingaidze, Shingai; Kredo, Tamara; Louw, Quinette; Young, Taryn; Grimmer, KarenENGLISH SUMMARY : In this editorial, the first in a series of six, we present issues critical to CPG development and uptake, relevant to South Africa (SA) and beyond. While recent local efforts to improve CPG quality and credibility in SA are commendable, opportunities to progress SA CPG quality and uptake are limited by the lack of a central, nationally recognised and accepted CPG development unit. Such a unit has the potential to significantly increase SA efforts to improve and standardise high-quality, credible CPG development, reporting and uptake. To this end, the Project SAGE (South African Guidelines Excellence) team is engaging in a 3-year stakeholder-driven process that aims to better understand the guideline development arena in SA, and improve the standard of local guideline development, adaptation, contextualisation, and ultimately implementation of primary healthcare guidelines.
- ItemSouth African Guidelines Excellence (SAGE) : efficient, effective and unbiased clinical practice guideline teams(Health & Medical Publishing Group, 2016) Grimmer, Karen; Dizon, Janine Margarita; Louw, Quinette; Kredo, Tamara; Young, Taryn; Machingaidze, ShingaiENGLISH SUMMARY : A range of different evidence-based methods for clinical practice guideline activities have been established, and there is common agreement in these that poorly conceived CPG team composition and management can jeopardise CPG integrity. Recognised CPG initiatives therefore provide guidance on CPG team construction and management. In this editorial, we outline steps for effective, efficient and outcome-focused CPG team membership, roles and management: (i) determine responsibilities and tasks; (ii) identify ‘experts’ and their ‘voices’; (iii) identify a CPG team leader; (iv) determine and declare conflicts of interest; (v) determine CPG team terms of reference; (vi) establish CPG timeframes and tailored capacity development; and (vii) establish consensus. Writing CPGs can be time-consuming and expensive.Efforts therefore need to be underpinned by efficient, respectful and agreed processes. Justifying CPG team membership, declaring conflicts of interest, identifying efficient ways of hearing constituent ‘voices’, defining and time-lining team tasks and roles, providing necessary training, and respecting individuals’ efforts and time should ensure that CPG team members enjoy their experiences. This will contribute to growing CPG expertise in South Africa and beyond.
- ItemSouth African Guidelines Excellence (SAGE) : What’s in a name?(Health & Medical Publishing Group, 2016) Kredo, Tamara; Machingaidze, Shingai; Louw, Quinette; Young, Taryn; Grimmer, KarenENGLISH SUMMARY : Project SAGE (South African Guidelines Excellence) is a 3-year research project, funded by the South African Medical Research Council, through the South African University Flagship Project scheme (http://www.mrc.ac.za/cochrane/sage.htm). Using stakeholder-driven processes, SAGE will provide tools to assist effective South African (SA) clinical practice guideline (CPG) activities in developing, adapting, adopting, contextualising and implementing primary care CPGs. In a resource-limited setting such as SA, where access to resources for health is limited, ensuring best use of effective and cost-effective primary care diagnostics and treatments is key to reducing waste, improving access and hence improving quality of care.
- ItemThe spinal posture of computing adolescents in a real-life setting(BioMed Central, 2014-06) Brink, Yolandi; Louw, Quinette; Grimmer, Karen; Jordaan, EsmeBackground: It is assumed that good postural alignment is associated with the less likelihood of musculoskeletal pain symptoms. Encouraging good sitting postures have not reported consequent musculoskeletal pain reduction in school-based populations, possibly due to a lack of clear understanding of good posture. Therefore this paper describes the variability of postural angles in a cohort of asymptomatic high-school students whilst working on desk-top computers in a school computer classroom and to report on the relationship between the postural angles and age, gender, height, weight and computer use. Methods: The baseline data from a 12 month longitudinal study is reported. The study was conducted in South African school computer classrooms. 194 Grade 10 high-school students, from randomly selected high-schools, aged 15–17 years, enrolled in Computer Application Technology for the first time, asymptomatic during the preceding month, and from whom written informed consent were obtained, participated in the study. The 3D Posture Analysis Tool captured five postural angles (head flexion, neck flexion, cranio-cervical angle, trunk flexion and head lateral bend) while the students were working on desk-top computers. Height, weight and computer use were also measured. Individual and combinations of postural angles were analysed. Results: 944 Students were screened for eligibility of which the data of 194 students are reported. Trunk flexion was the most variable angle. Increased neck flexion and the combination of increased head flexion, neck flexion and trunk flexion were significantly associated with increased weight and BMI (p = 0.0001). Conclusions: High-school students sit with greater ranges of trunk flexion (leaning forward or reclining) when using the classroom computer. Increased weight is significantly associated with increased sagittal plane postural angles.
- ItemA systematic review protocol on the effectiveness of therapeutic exercises utilised by physiotherapists to improve function in patients with burns(BMC (part of Springer Nature), 2017) Mudawarima, Tapfuma; Chiwaridzo, Matthew; Jelsma, Jennifer; Grimmer, Karen; Muchemwa, Faith ChengetayiBackground: Therapeutic exercises play a crucial role in the management of burn injuries. The broad objective of this review is to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. Population = adults and children/adolescents with burns of any aspect of their bodies. Interventions = any aerobic and/or strength exercises delivered as part of a rehabilitation programme by anyone (e.g. physiotherapists, occupational therapists, nurses, doctors, community workers and patients themselves). Comparators = any comparator. Outcomes = any measure of outcome (e.g. quality of life, pain, muscle strength, range of movement, fear or quality of movement). Settings = any setting in any country. Methods/design: A systematic review will be conducted by two blinded independent reviewers who will search articles on PubMed, CiNAHL, Cochrane library, Medline, Pedro, OTseeker, EMBASE, PsychINFO and EBSCOhost using predefined criteria. Studies of human participants of any age suffering from burns will be eligible, and there will be no restrictions on total body surface area. Only randomised controlled trials will be considered for this review, and the methodological quality of studies meeting the selection criteria will be evaluated using the Cochrane Collaboration tool for assessing risk of bias. The PRISMA reporting standards will be used to write the review. A narrative analysis of the findings will be done, but if pooling is possible, meta-analysis will be considered. Discussion: Burns may have a long-lasting impact on both psychological and physical functioning and thus it is important to identify and evaluate the effects of current and past aerobic and strength exercises on patients with burns. By identifying the characteristics of effective exercise programmes, guidelines can be suggested for developing intervention programmes aimed at improving the function of patients with burns. The safety and precautions of exercise regimes and the optimal frequency, duration, time and intensity will also be examined to inform further intervention.
- ItemTo adopt, to adapt, or to contextualise? The big question in clinical practice guideline development(BioMed Central, 2016-09-13) Dizon, Janine Margarita; Machingaidze, Shingai; Grimmer, KarenENGLISH SUMMARY : Aim: Developing new clinical practice guidelines (CPGs) can be time-consuming and expensive. A more efficient approach could be to adopt, adapt or contextualise recommendations from existing good quality CPGs so that the resultant guidance is tailored to the local context. Results: The first steps are to search for international CPGs that have a similar purpose, end-users and patients to your situation. The second step is to critically appraise the methodological quality of the CPGs to ensure that your guidance is based on credible evidence. Then the decisions begin. Can you simply ‘adopt’ this (parent) clinical practice guidelines, and implement the recommendations in their entirety, without any changes, in your setting? If so, then no further work is required. However this situation is rare. What is more likely, is that even if recommendations from the parent clinical practice guidelines can be adopted, how they are implemented needs to address local issues. Thus you may need to ‘contextualise’ the guidance, by addressing implementation issues such as local workforce, training, health systems, equipment and/or access to services. Generally this means that additional information is required (Practice/Context Points) to support effective implementation of the clinical practice guidelines recommendations. In some cases, you may need to ‘adapt’ the guidance, where you will make changes to the recommendations so that care is relevant to your local environments. This may involve additional work to search for local research, or obtain local consensus, regarding how best to adapt recommendations. For example, adaptation might reflect substituting one drug for another (drugs have similar effects, but the alternative drug to the recommended one may be cheaper, more easily obtained or more culturally acceptable). There is lack of standardisation of clinical practice guidelines terminology, leading clinical practice guideline activities often being poorly conceptualised or reported. We provide an approach that would help improve efficiency and standardisation of clinical practice guidelines activities.
- ItemTraining programmes to improve evidence uptake and utilisation by physiotherapists : a systematic scoping review(BioMed Central, 2018-01-15) Stander, Jessica; Grimmer, Karen; Brink, YolandiBackground: Research training programmes are a knowledge translation (KT) intervention which aim to improve research evidence uptake by clinicians. Whilst KT training programmes have been reported to significantly improve evidence uptake by physiotherapists, it is unclear which aspects of training optimally assist KT into physiotherapy practice. The purpose of the review was to establish the body of evidence regarding KT training programmes to improve physiotherapists’ use of evidence-based practice (EBP) and clinical practice guidelines (CPG). Methods: A systematic scoping review was undertaken in line with the adapted Arksey and O’Malley framework. Nine electronic databases (CINAHL, BIOMED CENTRAL, Cochrane, Web of Science, PROQUEST, PUBMED, OTseeker, Scopus, ERIC) were searched. Targeted keywords identified primary research articles of any hierarchy, that described the nature and impact of KT training programmes for physiotherapists. Where systematic reviews were identified, the component primary studies were considered individually for relevance. Critical appraisal was not undertaken due to the nature of a scoping review, and data was reported descriptively. Results: Ten systematic reviews were identified (yielding four relevant primary studies). Five additional primary studies were identified (two randomised controlled trials, two non-randomised controlled trials and one pre-post study) which were not included in the original systematic reviews. This provided nine eligible primary research studies for review. The KT strategies were all multi-faceted. Interactive sessions, didactic sessions, printed material and discussion and feedback were consistently associated with effective outcomes. When KT strategies addressed local barriers to EBP utilisation, there were better success rates for EBP and CPG uptake, irrespective of the outcome measures used. There were no consistent ways of measuring outcome. Conclusion: Multi-faceted KT strategies designed to address local barriers to knowledge translation were most effective in improving EBP/ CPG uptake among physiotherapists.