The development of items for a physiotherapy clinical programme evaluation tool.

Background: Evaluating a physiotherapy clinical education programme is challenging, given its complex and multidimensional nature, resulting in a paucity of research on the topic. Objectives: The objective of our study, which was part of a larger study, was to identify items that could be included in a tool to evaluate a physiotherapy clinical education programme in South Africa. Method: A qualitative study utilising focused group discussions including academics, clinical educators and clinicians was undertaken. A broad script that delved into clinical education experience was used. An inductive thematic content analysis using MaxQda version 2018.2 was undertaken; the data were coded, and similar foci were categorised and subcategorised. This process led to the identification of themes. Both triangulation of the data (member checks, field note comparison, observer reflection and verification of the data) and assuring the data's trustworthiness (credibility, dependability and confirmability) were undertaken. Results: Fourteen focus group discussions were held countrywide. Three themes emerged from the data. A macro theme included all governance issues, a meso theme included all structural issues and a micro theme included all aspects related to clinical experience. Conclusion: The complex nature of clinical physiotherapy education and its diversity can be seen in these emerging themes. All the categories and subcategories making up these themes must now be considered in the next step of developing this tool. Clinical implications: Quality assurance and minimal training standards may be ensured.

A tool to evaluate physiotherapy clinical education in South Africa.

Background: Physiotherapy clinical education is complex. The dynamic learning milieu is fluid and multidimensional, which contributes to the complexity of the clinical learning experience. Consequently, there are numerous factors which impact the clinical learning experience which cannot be measured objectively - a gap which led to the development of our study. Objectives: To develop, validate, and test the reliability of an assessment tool that evaluates the effectiveness and quality of physiotherapy clinical education programmes. Method: A mixed methods approach in three phases included physiotherapy academics, clinical educators, and clinicians throughout South Africa. Phase One was a qualitative study: focus group discussions determined items and domains of the tool. Phase Two established the content and construct validity of the tool, a scoring system and a name for the tool, using the Delphi method. In Phase Three, factor analysis reduced the number of items, and the feasibility and utility of the tool was determined cross-sectionally. Results: The Vaneshveri Naidoo Clinical Programme Evaluation Tool (VN-CPET) of 58 items and six domains was developed and found to be valid, reliable (α = 0.75) and useful. The six domains of VN-CPET include governance; academic processes; learning exposure; clinical orientation; clinical supervision and quality assurance and monitoring and evaluation. Conclusion: The Vaneshveri Naidoo Clinical Programme Evaluation Tool is a valid, reliable and standardised tool, that evaluates the quality and effectiveness of physiotherapy clinical education programmes. Clinical implications: This tool can objectively evaluate the quality and effectiveness of physiotherapy clinical education programmes in South Africa, and other health science education programmes, both locally and globally, with minor modification.

A verbal descriptor incremental pain scale developed by South African Tswana-speaking patients with low back pain.

BACKGROUND: Measuring pain in patients whose home language is not English can be difficult as there may not be a scale available in their home language. Scales devised in other countries may also not be accurate after translation. OBJECTIVES: The aim of this study was to develop and test a new verbal pain descriptor scale in a Tswana-speaking population in South Africa with low back pain. METHOD: Two separate Tswana-speaking groups (20 males and 20 females) of patients with low back pain were asked to describe each of four categories of pain: mild, moderate, severe and worst. They then voted and descriptions obtaining more than 70% of the vote were taken to the next round of voting with both groups together. A final scale of one description for each category of pain (Tswana Verbal Pain Descriptor Scale - TVPDS) for both males and females was tested on a sample of 250 patients with low back pain and against three other non-verbal pain scales. RESULTS: All items on the final scale were approved by at least 70% of both male and female participants. The scores for the TVPDS correlated well with present pain perception (r = 0.729, p < 0.0001) measured on the numerical visual analogue scale. The TVPDS correlated well with the Wong-Baker FACES Pain Rating Scale (r = 0.695, p < 0.0001) and the Pakistani Coin Pain Scale (r = 0.717, p < 0.0001). CONCLUSION: The TVPDS has the potential to be a useful clinical scale but more testing in other languages is still required. CLINICAL IMPLICATIONS: This pain scale has the potential to be a useful scale to use for Tswana-speaking persons with low back pain and could also be useful for persons of other languages, if translated.

Injury and lumbar reposition sense in cricket pace bowlers in neutral and pace bowling specific body positions.

BACKGROUND AND CONTEXT: The cricket pace bowling action consists of a complex sequence of forceful actions, involving practiced, particular movements of the lumbar spine. The nature and repetition of the pace bowling action is known to be associated with a high incidence of low back injuries. PURPOSE: This study aimed to establish whether lumbar proprioception (as measured by joint position sense) in the neutral lumbar spine position as well as lumbar positions corresponding to those at front foot placement and ball release positions of the cricket pace bowling action were related to previous injury and injury sustained during the cricket season under review. Injuries specifically sustained during the bowling action and those specific to the low back were explicitly investigated. STUDY SETTING: Longitudinal study with participants tested at the start and monitored over the duration of a cricket season. PARTICIPANT SAMPLE: Seventeen male cricket pace bowlers between the ages of 18 and 26 years participated in this study. OUTCOME MEASURES: Physiological outcome measures were used. Lumbar position sense was established using electrogoniometry. METHODS: Lumbar reposition error was measured in three positions (neutral lumbar spine, front foot placement, and ball release bowling positions). In each position, lumbar orientation was determined in the sagittal (flexion-extension) and coronal (left-right lateral flexion) planes. Wilcoxon matched-pairs ranks and Kruskal-Wallis tests were used to establish the relationship between variables. RESULTS: Reposition error was associated with general injuries sustained in the past and during the cricket season under review, low back injuries, as well as injuries sustained during the bowling action (p<.05). CONCLUSION: Lumbar position sense, as a measure of proprioception, was related to injury in general, injuries sustained during the bowling action, and, especially, low back injury sustained in the past. Low back injury prevention methods are particularly needed because of the high load nature of the pace bowling action. If the proprioception of the lumbar spine is improved in pace bowlers, their risk of lumbar injury can potentially be reduced.

Type 2 diabetes management: Patient knowledge and health care team perceptions, South Africa

Background: South African research indicates that the highest death rates between 2004 and 2005 were from diabetes mellitus.There is minimal research information on interactions between what patients know about their disease and what health professionals perceive that patients should know to control their disease well. Objectives: This study determined the knowledge that patients with type 2 diabetes have about the management of their disease; as well as the perceptions of the health care team about the services given to patients. Method: Qualitative data were collected using two focus groups and in-depth interviews. Patient focus group (n = 10) explored patients' knowledge about management of type 2 diabetes. Patients were recruited from Dr George Mukhari Hospital outpatients' diabetes clinic. Professional focus group (n = 8) explored the health care team's experiences; barriers and facilitators in managing the disease. Professional focus group participants were recruited because of their expertise in chronic disease management; working in the community (public health) or working directly with patients with type 2 diabetes. Five health care professionalswere interviewed using the same guide of questions as for the focus group. Results: Participants identified type 2 diabetes as a chronic disease that needs behaviour change for good control. Five major themes were identified: patients' knowledge; education programmes; behaviour change; support; and a patient-centred approach. Conclusion: Management of type 2 diabetes may be enhanced by reinforcing patients' knowledge; encouraging behaviour change whilst taking into consideration patients' backgrounds. The health care team needs to utilise a patient-centred approach

Retrieving physiotherapy patient records in selected health care facilities in South Africa--is record keeping compromised?

PURPOSE: The purpose of this study was to evaluate the process and feasibility of retrieving patient records in a variety of physiotherapy care settings in the Gauteng province in the Republic of South Africa. METHODS: Thirteen public and private health care facilities providing physiotherapy services were studied. Multiple methods of data collection (facility walk-through observation aided by a researcher designed checklist, in-depth interviews and attempting to retrieve physiotherapy records) were employed to evaluate the process of retrieving physiotherapy patient records, determine physiotherapy record retrieval rates and to determine the factors that were influencing record retrieval. RESULTS: The process of retrieving physiotherapy records was arduous and multi-faceted, with some health care facilities allowing patients to take their records home. A final retrieval rate of 46% (36.3% - 100%) was obtained. An odds ratio calculation revealed that it was 13.09 (CI: 8.99 - 19.13; p<0.001) times more possible to retrieve records of patients treated in private physiotherapy care settings (87.4% retrieval rate) than in public sector physiotherapy care settings (34.67% retrieval rate). CONCLUSIONS: This study concludes that the process of retrieving physiotherapy records was arduous and lacked uniformity in public sector hospitals. Further a low physiotherapy record retrieval rate was obtained.