ABSTRACT
PURPOSE: Rehabilitation outcomes are important for patients, professionals and policy makers. Most outcome measures (OMs) were developed for "Western" contexts and may be inadequate for low-resource and conflict settings, where the ability to demonstrate impact would be critical to strengthening the sector. This study aims to understand perspectives of physiotherapists from challenging environments regarding current practices, value, barriers, and facilitators of measuring rehabilitation outcomes. MATERIALS & METHODS: Focus group discussions were held in English with 35 physiotherapists from 18 countries. Audio recordings were transcribed verbatim, anonymised, and analysed using reflexive thematic analysis. RESULTS: Four themes emerged illustrating the levels at which outcomes and measures were discussed: User (patients, families), provider (physiotherapists, rehabilitation workers), application (OMs), and structure (management, health system). Participants discussed diversity in current practices and patient populations, utility of OMs and a neglected rehabilitation sector lacking investment. Barriers to progressing outcome measurement included lacking patient health literacy, rehabilitation provider training, valid OMs, and leadership. Participants suggested improved patient involvement, routine outcome measurement by using, developing, or adapting simple, context- and stakeholder-relevant OMs, and support from management. CONCLUSIONS: These insights illustrate the need of and provide robust recommendations for context-adapted development of rehabilitation outcome measurement in various challenging contexts.
Rehabilitation outcomes are important to show impact in low-resource and conflict settings, but most outcome measures originate from "Western" contextsExperience of physiotherapists from low-resource and conflict settings reveals the barriers and facilitators to measuring rehabilitation outcomes in their workplacesParticipants' suggest to use or develop simple scales that are contextualised and stakeholder-relevant for standard, routine measurementThis study highlights the need to improve the measurement of rehabilitation outcomes in challenging contexts and provides guidance on how to do so.
ABSTRACT
BACKGROUND AND AIM: There is a strong correlation between disability and poverty and it is acknowledged that until disability issues are addressed, the goal of poverty reduction in low-income countries is unlikely to be achieved. Despite the high prevalence of disability in developing countries, there remains a significant shortage of rehabilitation professionals as highlighted by the WHO report, Human resources for Health (2006). The purpose of this project was to develop a collaborative and sustainable partnership to strengthen educational and research capacity in global health, disability, and rehabilitation between two physiotherapy schools; University College Dublin, Ireland, and Mbarara University of Science and Technology, Uganda. This article aims to describe the approach used and initial project outcomes. METHODS: This project involved a bilateral visit to both institutions by two members of staff of respective physiotherapy programs. These visits entailed stakeholder meetings, clinical site visits, and workshops to identify the priorities for the partnership and shape the collaboration going forward. Appreciative inquiry methodology was used during the workshops and the four-dimensional framework for curriculum development was used to guide analysis and underpin findings. FINDINGS: The key priorities identified were (i) development of joint global health learning initiative, (ii) to explore the possibility of postgraduate learning and research opportunities for Ugandan colleagues, and (iii) to develop joint clinical placements. The rationale and context and a plan of action is described. DISCUSSION AND CONCLUSION: The project is ambitious and in order to be sustainable, the importance of long-term interinstitutional commitment and further funding cannot be ignored. This work provides a framework for other universities and institutions wishing to undertake similar activities. Such partnerships provide rich learning opportunities for students and health professionals and facilitate a deeper understanding of global health issues, social and cultural health determinants, and development of enhanced professional skills.
ABSTRACT
Clubfoot is a congenital structural impairment that, if untreated or inadequately treated, leads to deformity. Effective management is dependent on the compliance of parents to the treatment for clubfoot. A cross-sectional descriptive survey using a questionnaire identified the barriers parents encounter in bringing their children for treatment during the plaster-casting stage of managing clubfoot at the Talipes Clinics at Mbarara Regional Hospital and Mulago Hospital in Uganda. A total of 167 parents participated in the study. Ninety percent of the parents had attended weekly clinics with 67% indicating that they did not know about clubfoot and its treatment. The study found a significant association between compliance and transport costs (P = 0.014); distance travelled (P = 0.005); and family support (P = 0.028). Other barriers highlighted include the need to improve the communication skills between clinicians offering treatment to children with clubfoot and their parents. Informed parents could assist with compliance to treatment.
