van der Walt J(1, Eksteen C2, Maree C3
1University of Pretoria, Physiotherapy, Pretoria, South Africa, 2Sefako Magatho Health Sciences University, Physiotherapy, Pretoria, South Africa, 3University of Pretoria, Nursing Science, Pretoria, South Africa
Background: The incidence of premature infant births in South Africa (SA) is estimated to be 84 000 per year. A concern is that premature birth is associated with lower educational qualifications, decreased rate of employment and a higher need for social grants in adulthood due to the increased risk of disability because of complications that may occur post birth. Physiotherapists have a unique window of opportunity to influence infants' neuro-musculoskeletal system and motor organisation, as well as to monitor the respiratory function to decrease the risk of impairment in the neonatal intensive care unit (NICU), high care unit (HCU) or kangaroo mother care (KMC) wards. A concern is that physiotherapists working in NICUs, HCUs or KMC wards in high-income countries have well-defined clinical practice guidelines (CPGs) to guide the standard of practice, which is non-existing in upper-middle-income countries like SA. Ethical approval was obtained (99/2014).
Purpose: The primary aim of the study was to contextualise a CPG for physiotherapists treating prematurely born infants in the NICUs, HCUs or KMC wards who are at risk of developing complications.
Methods: A mixed method research approach was used. Phase one was qualitative, consisting of focus group discussions with consenting multidisciplinary team members, interviews / survey questionnaire with consenting parents / caregivers to determine the current patient journeys of prematurely born infants in SA. An integrative literature search was done to identify current CPGs for physiotherapy management of infants in the NICU, HCU or KMC wards. Phase two entailed the compilation of a questionnaire consisting of evidence-based statements based on the identified literature and the patient journeys. The evidence-based statements were validated in phase three with a Delphi method (quantitative) and included recommendations by the expert participants in the contextualised CPG.
Results: In phase one, four possible patient journeys for prematurely born infants in SA were identified. Seven CPGs or position statements were identified and critically appraised by three appraisers using the AGREE II tool. Three CPGs / position statements were found to be valid for the inclusion in this study. With the authors' of the selected CPG / position statements' permission, their statements were re-formulated based on the four patient journeys or used as is in a list of evidence-based statements appropriate for the SA health care context. The evidence-based statements were tested by clinical and academic physiotherapy experts working in the NICUs, HCUs or KMC wards in SA. The statements that they graded >80% to be relevant and valid for use in their place of work were included in the CPG.
Conclusion(s): A clinical practice guideline was contextualised for the use of physiotherapists working in the NICU, HCU or KMC ward in SA. Future research is encouraged to determine the uptake of the CPG into physiotherapy practice in SA.
Implications: The implication could be that the physiotherapy management of the prematurely born infant in the NICU, HCU and KMC ward in SA could potentially be standardised, resulting in standardisation in the quality and safety of care while reducing unwarranted costs and patient outcomes.
Keywords: Prematurely born infants, Physiotherapy, Clinical practice guidelines
Funding acknowledgements: The researcher received a bursary for the purpose of obtaining a PhD (Physiotherapy) from the University of Pretoria.
Purpose: The primary aim of the study was to contextualise a CPG for physiotherapists treating prematurely born infants in the NICUs, HCUs or KMC wards who are at risk of developing complications.
Methods: A mixed method research approach was used. Phase one was qualitative, consisting of focus group discussions with consenting multidisciplinary team members, interviews / survey questionnaire with consenting parents / caregivers to determine the current patient journeys of prematurely born infants in SA. An integrative literature search was done to identify current CPGs for physiotherapy management of infants in the NICU, HCU or KMC wards. Phase two entailed the compilation of a questionnaire consisting of evidence-based statements based on the identified literature and the patient journeys. The evidence-based statements were validated in phase three with a Delphi method (quantitative) and included recommendations by the expert participants in the contextualised CPG.
Results: In phase one, four possible patient journeys for prematurely born infants in SA were identified. Seven CPGs or position statements were identified and critically appraised by three appraisers using the AGREE II tool. Three CPGs / position statements were found to be valid for the inclusion in this study. With the authors' of the selected CPG / position statements' permission, their statements were re-formulated based on the four patient journeys or used as is in a list of evidence-based statements appropriate for the SA health care context. The evidence-based statements were tested by clinical and academic physiotherapy experts working in the NICUs, HCUs or KMC wards in SA. The statements that they graded >80% to be relevant and valid for use in their place of work were included in the CPG.
Conclusion(s): A clinical practice guideline was contextualised for the use of physiotherapists working in the NICU, HCU or KMC ward in SA. Future research is encouraged to determine the uptake of the CPG into physiotherapy practice in SA.
Implications: The implication could be that the physiotherapy management of the prematurely born infant in the NICU, HCU and KMC ward in SA could potentially be standardised, resulting in standardisation in the quality and safety of care while reducing unwarranted costs and patient outcomes.
Keywords: Prematurely born infants, Physiotherapy, Clinical practice guidelines
Funding acknowledgements: The researcher received a bursary for the purpose of obtaining a PhD (Physiotherapy) from the University of Pretoria.
Topic: Paediatrics; Critical care
Ethics approval required: Yes
Institution: University of Pretoria
Ethics committee: Faculty of Health Sciences Research Ethics Committee
Ethics number: 99/2014
All authors, affiliations and abstracts have been published as submitted.
