Browsing by Author "Louw, Q."

Now showing 1 - 6 of 6
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    Barriers and enablers for the development and implementation of allied health clinical practice guidelines in South African primary healthcare settings : a qualitative study
    (BioMed Central, 2017) Dizon, J. M.; Grimmer, K.; Louw, Q.; Machingaidze, S.; Parker, H.; Pillen, H.
    Background: The South African allied health (AH) primary healthcare (PHC) workforce is challenged with the complex rehabilitation needs of escalating patient numbers. The application of evidence-based care using clinical practice guidelines (CPGs) is one way to make efficient and effective use of resources. Although CPGs are common for AH in high-income countries, there is limited understanding of how to do this in low- to middle-income countries. This paper describes barriers and enablers for AH CPG uptake in South African PHC. Methods: Semi-structured individual interviews were undertaken with 25 South African AH managers, policymakers, clinicians and academics to explore perspectives on CPGs. Interviews were conducted by researcher dyads, one being familiar with South African AH PHC practice and the other with CPG expertise. Rigour and transparency of data collection was ensured. Interview transcripts were analysed by structuring content into codes, categories and themes. Exemplar quotations were extracted to support themes. Results: CPGs were generally perceived to be relevant to assist AH providers to address the challenges of consistently providing evidence-based care in South African PHC settings. CPGs were considered to be tools for managing clinical, social and economic complexities of AH PHC practice, particularly if CPG recommendations were contextusalised. CPG uptake was one way to deal with increasing pressures to make efficient use of scarce financial resources, and to demonstrate professional legitimacy. Themes comprised organisational infrastructures and capacities for CPG uptake, interactions between AH actors and interaction with broader political structures, the nature of AH evidence in CPGs, and effectively implementing CPGs into practice. Conclusion: CPGs contextualised to local circumstances offer South African PHC AH services with an efficient vehicle for putting evidence into practice. There are challenges to doing this, related to local barriers such as geography, AH training, workforce availability, scarce resources, an escalating number of patients requiring complex rehabilitation, and local knowledge. Concerted attempts to implement locally relevant CPGs for AH primary care in South Africa are required to improve widespread commitment to evidence-based care, as well as to plan efficient and effective service delivery models.
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    Building capacity for development and implementation of clinical practice guidelines
    (Health and Medical Publishing Group, 2017) Louw, Q.; Dizon, J. M.; Grimmer, K.; McCaul, M.; Kredo, T.; Young, T.
    Robust, reliable and transparent methodologies are necessary to ensure that clinical practice guidelines (CPGs) meet international criteria. In South Africa (SA) and other low- and middle-income countries, upskilling and training of individuals in the processes of CPG development is needed. Since de novo CPG development is time-consuming and expensive, new emerging CPG-development approaches (adopting, contextualising, adapting and updating existing good-quality CPGs) are potentially more appropriate for our context. These emerging CPG-development methods are either not included or sparsely covered in existing training opportunities. The SA Guidelines Excellence (SAGE) team has responded innovatively to the need for CPG training in SA. We have revised an existing SA course and developed an online, open-access CPG-development toolkit. This Guideline Toolkit is a comprehensive guideline resource designed to assist individuals who are interested in knowing how to develop CPGs. Findings from the SAGE project can now be implemented with this innovative CPG training programme. This level of CPG capacity development has the potential to influence CPG knowledge, development, practices and uptake by clinicians, managers, academics and policy-makers around the country.
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    Building capacity in primary care rehabilitation clinical practice guidelines : a South African initiative
    (BioMed Central, 2018-09-29) Louw, Q.; Grimmer, K.; Dizon, J. M; Machingaidze, S.; Parker, H.; Ernstzen, D.
    Background: The large number of South Africans with disability who cannot access good quality rehabilitation presents a public health and human rights challenge. A cost-effective, efficient approach is required to address this. Implementation of high-quality, contextually relevant clinical practice guidelines (CPGs) could be a solution; however, this requires significant investment in innovative capacity-building. Methods: A qualitative descriptive national study was conducted to explore the perspectives of South African stakeholders in rehabilitation, regarding CPG capacity-building. Twenty rehabilitation professionals (physiotherapists, occupational therapists, speech language therapists, podiatrists, rehabilitation managers or directors) were interviewed. Transcribed interview data were analysed using a deductive content analysis approach, mapping findings to an international capacity-building framework to produce new knowledge. Results: Capacity-building is required in content, purpose and construction of locally relevant CPGs, as well as personal, workforce and systems capacity. Principles and strategies were derived to underpin implementation of CPGs that are user friendly, context specific, relevant to the needs of end-users, and achievable within available resources. Collaboration, networks and communication are required at national, provincial and regional level, within and between sectors. A central agency for CPG methods, writing, implementation and evaluation is indicated. Conclusion: South African rehabilitation can benefit from a multi-level CPG capacity-building focusing on performance, personal, workforce and systems issues.
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    Ergonomic chair intervention : effect on chronic upper quadrant dysfunction, disability and productivity in female computer workers
    (AOSIS Publishing, 2014) Hoeben, C.; Louw, Q.
    ENGLISH SUMMARY : AIM: To compare the effect of two ergonomic chairs on upper quadrant musculoskeletal pain and tension, disability and productivity among female computer workers in the office workplace. METHODS: A series of two N=1 studies were conducted using the A-B-A-C-A design whereby an intervention ergonomic chair was compared to a less adjustable control ergonomic chair using visual analogue scales (VAS) for pain and muscle spasm, the Neck Disability Index and the Work Productivity and Activity Impairment questionnaire. The female participants were assessed over the four week phases as they performed high intensity visual display unit work. The results were compiled and tabulated. RESULTS: Both the control and intervention ergonomic chairs showed a reduction in both the mean and variance of pain and muscle spasm. The second participant also showed an increase in productivity with both chairs. CONCLUSION: The introduction of an ergonomic chair shows a reduction in VAS intensity and frequency for pain and muscle spasm, as well as a reduction in variance of the symptoms. Both chairs showed a similar reduction in symptoms, thus indicating almost equivalent benefit from the use of both ergonomic chairs.
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    Physiotherapy for acute ankle sprains : how do we compare to evidence based clinical guidelines?
    (AOSIS Publishing, 2014) Simpson, H.; Crous, L.; Louw, Q.
    Ankle sprains are reportedly the most common lower limb injury amongst active individuals. The aim of this study was to investigate whether treatment interventions employed by physiotherapist during the first week of functional rehabilitation of an ankle sprain were aligned with evidence-based guidelines for acute ankle sprains.
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    Standardising evidence strength grading for recommendations from multiple clinical practice guidelines : a South African case study
    (BMC (part of Springer Nature), 2018-08-29) Grimmer, K.; Louw, Q.; Dizon, J. M.; van Niekerk, S. M.; Ernstzen, D.; Wiysonge, Charles S.
    Background: Significant resources are required to write de novo clinical practice guidelines (CPGs). There are many freely-available CPGs internationally, for many health conditions. Developing countries rarely have the resources for de novo CPGs, and there could be efficiencies in using CPGs developed elsewhere. This paper outlines a novel process developed and tested in a resource-constrained country (South Africa) to synthesise findings from multiple international CPGs on allied health (AH) stroke rehabilitation. Methods: Methodologists, policy-makers, content experts and consumers collaborated to describe the pathway of an ‘average’ stroke patient through the South African public healthcare system and pose questions about bestpractice stroke rehabilitation along this pathway. A comprehensive search identified international guidance documents published since January 2010. These were scanned for relevance to the South African AH stroke rehabilitation questions and critically appraised for methodological quality. Recommendations were extracted from guidance documents for each question. Strength of the body of evidence (SoBE) gradings underpinning recommendations were standardised, and composite recommendations were developed using qualitative synthesis. An algorithm was developed to guide assignment of overall SoBE gradings to composite recommendations. Results: Sixteen CPGs were identified, and all were included, as they answered different project questions differently. Methodological quality varied and was unrelated to currency. Seven clusters, outlining 20 composite recommendations were proposed (organise for best practice rehabilitation, operationalise strategies for best practice communication throughout the patient journey, admit to an acute hospital, refer to inpatient rehabilitation, action inpatient rehabilitation, discharge from inpatient rehabilitation and longer-term community-based rehabilitation). Conclusion: The methodological development process, tested by writing a South African AH stroke rehabilitation guideline from existing evidence sources, took 9 months. The process was efficient, collaborative, effective, rewarding and positive. Using the proposed methods, similar synthesis of existing evidence could be conducted in shorter time periods, in other resource-constrained countries, avoiding the need for expensive and time-consuming de novo CPG development.