Barth CA1, Montenegro N1
1International Committee of the Red Cross (ICRC), Physical Rehabilitation, Geneva, Switzerland

Background: 23 ICRC physiotherapy standards (PTS) were derived from WCPT international standards and adapated to low resource and conflict contexts. PTS implementation was launched in 2017 asking ICRC physiotherapists worldwide to carry out a gap analysis using a standardized form to examine implementation, training needs and to guide decision-making.

Purpose: Purpose of this project was
  • to examine PTS implementation and identify differences between 23 individual standards and between various ICRC-supported projects
  • to make informed decisions on future implementation and specific PTS trainings

Methods: ICRC physiotherapists used a standardized gap analysis form. It guides through 23 standards with questions on implementation, answered in a 4 level rating scale (no, poor, average, yes). The original form contained 97 questions of which 5 were excluded as non-applicable in certain contexts. In most contexts ICRC physiotherapists carried out the exercise together with local colleagues.
Of the returned analyses 15 countries were selected of which 3 analysed 2 or 3 projects (20 datasets in total), reflecting the diversity of ICRC contexts:
  • projects in Africa (11), the Middle East (2), Asia (7)
  • multilingual (9 anglo-, 5 arabo-, 5 franco-, 1 lusophone)
  • hospital (1) and rehabilitation (19) settings
  • settings from protracted conflict to development
  • in-country PT education systems from non-existing to BSc level
20 datasets of 92 questions each were analysed in MS excel; of 1840 responses 43 were excluded from analysis (= total 1797) for invalid (double or missing) responses.

Results: The standards “respect for the individual” and “multidisciplinary communication” came out strongest (implementation in >=90% of all projects “average”/“yes), the least implemented standards were “quality improvement by commitment of the physiotherapist” and “- by user feedback” (implementation in >60% of all projects “poor”/“no”).
In-depth analysis of overall implementation rates in individual projects indicated a relation between PT staff education level (eg. graduates from recognized academic programme = projects with high implementation rates), intensity and duration of ICRC support, and general stability of a context. This tendency was not evaluated statistically due to a number of 'soft factors' and the heterogenity of the participating contexts.

Conclusion(s): The findings provide evidence to justify resources for future analyses and trainings. The gap analysis form proved a valuable tool to subsequently monitor and evaluate PTS implementation and to support decisions related to objectives-setting and training. 5 questions need reformulating to be applicable for all projects. Given the low implementation of “quality improvement” standards, this subject will be put on top of the future ICRC training agenda. Further analyses are needed to investigate reasons for poor implementation and to evaluate customized trainings.

Implications: This worldwide analysis for ICRC supported projects gives an overview of PTS implementation in low resource and conflict settings. It will inform future decisions on
  • How projects can collaborate transnationally to support PTS implementation (peer-to-peer mentoring from ´stronger´ to ´weaker´ projects)
  • How training institutions and member organisations can be supported to incorporate PTS into physiotherapy education curricula and in CPD courses
  • How PTS related research with a focus on quality improvement in clinical practice will have to be designed

Keywords: Physiotherapy standards, low resource setting, ICRC

Funding acknowledgements: n/a

Topic: Professional issues; Disaster management; Education: continuing professional development

Ethics approval required: No
Institution: International Committee of the Red Cross
Ethics committee: Commission Cantonal d’Ethique et Recherche” (CCER) of Geneva
Reason not required: Analysis of secondary data that were routinely collected for institutional purposes; data are not on individuals but on processes

All authors, affiliations and abstracts have been published as submitted.

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