A tailored training programme for South African physiotherapists on the use of evidence-based clinical practice guidelines when treating patients with acute and sub-acute low back pain
| dc.contributor.advisor | Brink, Yolandi | en_ZA |
| dc.contributor.advisor | Grimmer, Karen Anne | en_ZA |
| dc.contributor.author | Stander, Jessica | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy. | en_ZA |
| dc.date.accessioned | 2020-10-07T09:39:54Z | |
| dc.date.accessioned | 2021-02-01T07:54:16Z | |
| dc.date.available | 2020-10-07T09:39:54Z | |
| dc.date.available | 2021-02-01T07:54:16Z | |
| dc.date.issued | 2020-12 | |
| dc.description | Thesis (PhD)--Stellenbosch University, 2020. | en_ZA |
| dc.description.abstract | ENGLISH SUMMARY: Introduction: Over the last 30 years there has been increasing international recognition of the importance of, and challenges involved in, applying best-available evidence to ensure consistent delivery of best-practice care to patients. This is called knowledge translation (KT). One KT vehicle is good quality clinical practice guidelines (CPGs), which summarise best-available evidence into concise recommendations for practice. This study was undertaken to fill a gap in knowledge about how best to educate South African physiotherapists (PTs) working in primary healthcare settings, about how to apply CPGs to inform diagnostic and management decisions. South African primary healthcare settings are generally resource-constrained, which can limit access to, and availability of, effective, and cost- and time-efficient care. This study focused on low back pain (LBP), the fourth-most common burden of disease in South Africa, and the most common primary healthcare condition treated by PTs. Methods: A multi-stage, mixed methods study was designed to develop and test a tailored training programme (TTP) that addressed factors influencing CPG uptake by South African primary healthcare PTs. The Implementation of Change model informed the study framework. Three set-up phases underpinned the draft TTP’s content and delivery method (two literature scoping reviews, and individual interviews exploring PTs’ perceptions of, and experiences with, CPG use). An expert validation study confirmed TTP content and delivery methods. The feasibility, acceptability and likely impact of the TTP was then piloted. Participants’ self-perception of CPG use and understanding of CPGs was captured pre-post TTP using surveys. Recorded discussions during the TTP, and after its completion were analysed descriptively for evidence of personal barriers and growth. Outcomes included knowledge, attitudes and behaviours. Results: The TTP content and delivery method was based on PTs’ learning needs and styles, and typical primary healthcare cases. The TTP consisted of a one-day interactive face-to-face KT session based on case studies, preceded by six podcasts (one-hour total), based on participants’ knowledge needs, attitudes and time constraints. The TTP was evaluated by 11 rural primary healthcare PTs. Pre-TTP evaluations demonstrated scepticism towards CPG-use in clinical practice, with most participants seemingly unaware of the nature, intent and construction of CPGs, or how to access or implement them. However, most participants identified areas of clinical practice where they required guidance, and all indicated an interest in learning more about providing evidence-based care. Immediate post TTP, evaluations showed improvements in knowledge, attitudes and skills in CPGs, and feedback was that the TTP was of unanticipated value in assisting PTs to use CPGs to better manage patients with LBP. Post TTP follow-up demonstrated significant behaviour change with PTs using CPGs more regularly, for patients with LBP, and other challenging conditions. Conclusion: The careful evidence based staged TTP development ensured that it addressed South African primary healthcare PTs’ needs and concerns. Its content and delivery methods were feasible and acceptable, and the TTP appeared to be effective in improving knowledge, attitudes and behaviours in the short and longer-term for rural PTs in one province of South Africa. The TTP is valid and ready for wider application to larger PT groups in primary healthcare settings. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Inleiding: Die afgelope 30 jaar was daar toenemende internasionale erkenning van die belangrikheid van en uitdagings verbonde aan die toepassing van die beste beskikbare navorsing om pasiente optimaal te behandel. Dit word kennisvertaling genoem. Een kennisvertaling middel is goeie kwaliteit kliniese praktykriglyne (KPR), wat die beste beskikbare navorsing opsom in bondige aanbevelings vir praktyk. Hierdie studie is onderneem om ‘n kennisleemte te vul oor die beste manier om Suid-Afrikaanse fisioterapeute in primere gesondheidsorginstellings op te voed, en hoe om KPR toe te pas om diagnostiese en behandelingsbesluite te neem. Suid-Afrikaanse primere gesondheidsorginstellings het oor die algemeen beperkte hulpbronne, wat toegang tot en beskikbaarheid van effektiewe, koste- en tyddoeltreffende sorg kan beperk. Hierdie studie het gefokus op lae rugpyn (LRP), die vierde algemeenste siektelas in Suid-Afrika, en die algemeenste primere gesondheidsorgtoestand wat deur fisioterapeute behandel word. Metode: 'n Meervoudige, gemengde metodestudie is ontwerp om 'n pasgemaakte opleidingsprogram (POP) te ontwikkel en te toets wat die opname van KPR deur Suid-Afrikaanse primere gesondheidsorgfisioterapeute beinvloed. Die “Implementation of Change”-model het die studieraamwerk ingelig. Die inhoud en leweringsmetode van die konsep POP (twee literatuur-hersienings en individuele onderhoude oor fisioterapeute se persepsies van en ervarings met KPR-gebruik), is gebaseer op drie voorbereidingsfases. 'n Spesifieke geldigheidsstudie het POP-inhoud en leweringsmetodes bevestig. Die uitvoerbaarheid, aanvaarbaarheid en waarskynlike impak van die POP is daarna geloods. Deelnemers se selfpersepsie van KPR-gebruik en die begrip van KPRs is voor en na die POP met behulp van opnames vasgestel. Opgeneemde besprekings tydens die POP, en na voltooiing daarvan is beskrywend ontleed vir bewyse van persoonlike hindernisse en groei. Uitkomste sluit kennis, houdings en gedrag in. Resultate: Die POP-inhoud en leweringsmetode was gebaseer op fisioterapeute se leerbehoeftes en -style, en tipiese gesondheidsorggevalle. Die POP het bestaan uit 'n eendag-interaktiewe kennisvertaling-sessie van aangesig tot aangesig gebaseer op gevallestudies, voorafgegaan deur ses potgooie (een uur in totaal), gebaseer op deelnemers se kennisbehoeftes, houdings en tydsbeperkings. Die POP is deur 11 landelike fisioterapeute geevalueer. Voor-POP-evaluerings het skeptisisme getoon ten opsigte van KPR-gebruik in kliniese praktyk, met die meeste deelnemers wat skynbaar onbewus was van die aard, opset en ontwerp van KPR, of hoe hulle toegang tot of implementering daarvan verkry. Die meeste deelnemers het areas van kliniese praktyk geidentifiseer waar hulle leiding benodig, en almal het aangedui dat hulle meer wou leer oor bewysgebaseerde sorg. Onmiddellik na POP, het verbeterings in evaluerings van kennis, houdings en vaardighede in KPRs getoon. Terugvoering was dat die POP van onvoorsiene waarde was om fisioterapeute te help om KPRs te gebruik om pasiente met LRP beter te behandel. Na-TTP-opvolg het beduidende gedragsverandering getoon met fisioterapeute se gereelde gebruik van KPR vir pasiente met LRP, en ander uitdagende toestande. Gevolgtrekking: Die noukeurige bewysgebaseerde, gefaseerde POP-ontwikkeling het verseker dat dit die behoeftes en hindernisse van Suid-Afrikaanse fisioterapeute aanspreek. Die inhoud en afleweringsmetodes daarvan was haalbaar en aanvaarbaar, en die POP blyk effektief te wees in die verbetering van kennis, houdings en gedrag op kort en langer termyn vir landelike fisioterapeute in een provinsie van Suid-Afrika. Die POP is geldig en gereed vir toepassing op groter fisioterapiegroepe in primêre gesondheidsinstellings. | af_ZA |
| dc.description.version | Doctorate | |
| dc.embargo.terms | 2023-12-31 | |
| dc.format.extent | xvii, 229 pages : illustrations, includes annexures | |
| dc.identifier.uri | http://hdl.handle.net/10019.1/109416 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | |
| dc.rights.holder | Stellenbosch University | |
| dc.subject.lcsh | Physical therapy -- Manpower -- South Africa | en_ZA |
| dc.subject.lcsh | Physical therapists -- Training of -- South Africa | en_ZA |
| dc.subject.lcsh | Physical therapists -- Education -- South Africa | en_ZA |
| dc.subject.name | UCTD | |
| dc.title | A tailored training programme for South African physiotherapists on the use of evidence-based clinical practice guidelines when treating patients with acute and sub-acute low back pain | en_ZA |
| dc.type | Thesis | en_ZA |