Expert consensus on the minimum clinical standards of practice for Nigerian physiotherapists working in intensive care units: A modified Delphi study

Exploring current physiotherapy practices in the care of people who are potential lung donors: A qualitative study

OBJECTIVE

The aim of this study was to determine physiotherapists' current practices and perspectives regarding their role in caring for people who are potential lung donors in the intensive care unit (ICU).

METHODS

A qualitative descriptive design was used. Qualitative data were collected through audio-recorded, semistructured focus groups with a purposive sample of physiotherapists with experience working with people who are potential lung donors in ICUs. Two investigators completed independent thematic analysis to identify themes.

RESULTS

Seven focus groups were completed with 27 physiotherapists at six metropolitan health services in Victoria, Australia. Six key themes were identified: (i) physiotherapists' involvement in care was highly variable; (ii) physiotherapists were not aware of existing evidence or guidelines for the care of people who are potential donors and followed usual practices; (iii) a consistent vision of the physiotherapy role was lacking; (iv) physiotherapists' engagement with the team routinely involved in care of people who are potential donors varied considerably; (v) physiotherapists faced practice challenges associated with delivering care to potential donors; and (vi) several enablers could support a role for physiotherapy in this patient population.

CONCLUSIONS

Variability in physiotherapy practice is associated with local ICU culture, physiotherapy leadership capabilities, knowledge, and experience. The spectrum of practice ranged from physiotherapists being highly engaged to being completely uninvolved. Physiotherapists held mixed perspectives regarding whether physiotherapists should have a role in managing people who are potential lung donors. It would benefit the profession to develop consensus and standardisation of the role of physiotherapists in caring for these patients.

TWEETABLE ABSTRACT

Variability in views and practices amongst physiotherapists who provide care to patients who are potential lung donors in the ICU.

Developing tailored intervention strategies for implementation of stratified care to low back pain with physiotherapists in Nigeria: a Delphi study

BACKGROUND

Stratified care approach involving use of the STarT-Back tool to optimise care for patients with low back pain is gaining widespread attention in western countries. However, adoption and implementation of this approach in low-and-middle-income countries will be restricted by context-specific factors that need to be addressed. This study aimed to develop with physiotherapists, tailored intervention strategies for the implementation of stratified care for patients with low back pain.

METHODS

A two-round web-based Delphi survey was conducted among purposively sampled physiotherapists with a minimum of three years of clinical experience, with post-graduation certification or specialists. Thirty statements on barriers and enablers for implementation were extracted from the qualitative phase. Statements were rated by a Delphi panel with additional open-ended feedback. After each Delphi round, participants received feedback which informed their subsequent responses. Additional qualitative feedback were analysed using qualitative content analysis. The criteria for consensus and stability were pre-determined using percentage agreement (≥ 75%), median value (≥ 4), Inter-quartile range (≤ 1), and Wilcoxon matched-pairs test respectively.

RESULTS

Participants in the first round were 139 and 125 of them completed the study, yielding a response rate of 90%. Participants were aged 35.2 (SD6.6) years, and 55 (39.6%) were female. Consensus was achieved in 25/30 statements. Wilcoxon's test showed stability in responses after the 5 statements failed to reach consensus: 'translate the STarT-Back Tool to pidgin language' 71% (p = 0.76), 'begin implementation with government hospitals' 63% (p = 0.11), 'share knowledge with traditional bone setters' 35% (p = 0.67), 'get second opinion on clinician's advice' 63% (p = 0.24) and 'carry out online consultations' 65% (p = 0.41). Four statements strengthened by additional qualitative data achieved the highest consensus: 'patient education' (96%), 'quality improvement appraisals' (96%), 'undergraduate training on psychosocial care' (96%) and 'patient-clinician communication' (95%).

CONCLUSION

There was concordance of opinion that patients should be educated to correct misplaced expectations and proper time for communication is vital to implementation. This communication should be learned at undergraduate level, and for already qualified clinicians, quality improvement appraisals are key to sustained and effective care. These recommendations provide a framework for future research on monitored implementation of stratified care in middle-income countries.