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Nuhu A.1, Kirenga L.2, Mann M.3, Dunleavy K.4, Chevan J.5, Pascal M.6
1University of Rwanda College of Medicine and Health Sciences, Physiotherapy, Kigali, Rwanda, 2Rwanda Military Hospital, Physiotherapy, Kigali, Rwanda, 3Johns Hopkins Bloomberg School of Public Health, International Health, Baltimore, MD, United States, 4University of Florida, Physical Therapy, Gainesville, FL, United States, 5Springfield College, Physical Therapy, Springfield, MA, United States, 6Misericordia, Physical Therapy, Dallas, PA, United States
Background: The Advancement of Rwandan Rehabilitation Services Project (ARRSP) training program was administered by Health Volunteers Overseas from March 2013 -May 2015. Goals of the ARRSP were to provide professional development courses to upgrade rehabilitation standards and to improve awareness of physiotherapy in Rwanda to increase utilization of rehabilitation services and reach under-served populations. In the needs assessment and during courses in the project, it was noted that physiotherapists performed minimal documentation of services and patient outcomes. The final course of the training program focused on leadership and professionalism to promote advocacy, increase awareness about physiotherapy and continue to improve clinical practice in the physiotherapy profession. The deficit in documentation and outcomes measurement in clinical practice was addressed further in the last course, titled the Leadership Institute (LI).
Purpose: This paper describes the methods aimed to improve the quality and consistency of documentation, including outcome measurement, to promote professionalism and demonstrate the benefits of physiotherapy services in Rwanda.
Methods: 71 Rwandan physiotherapists participated in the LI. A portion of class time was used for group discussion to determine barriers and solutions for more effective documentation. During earlier training in previous ARRSP courses, therapists had been introduced to use of the Patient Specific Functional Scale (PSFS) and other outcome measures. PSFS data was collected by participants and compiled to demonstrate using outcome measures to show individual and group improvement, and how data from a group of patients can be used to demonstrate the effectiveness of physiotherapy services. During the LI course (April May 2015), the primary course instructor visited 19 physiotherapy departments throughout Rwanda to assess documentation and work with participants to identify areas for improvement. Follow-up interviews of 52 physiotherapists were conducted a year later using individual and group meetings, and electronically via email and mobile communication platforms (WhatsApp, Hangouts).
Results: During the initial clinic visits, only 15.8% of clinics were completing occasional progress notes or discharge summaries, 26.3% were performing an outcome measure during initial examination, and 10.5% of those interviewed were repeating the measure. At follow-up, 32.6% of therapists interviewed were consistently using outcome measures at initial evaluation and in subsequent visits; 11.1% were consistently using outcome measures during the initial evaluation only. Inconsistent use of outcome measures was noted by 32.6% of therapists, while 16.3% reported that they rarely or never used outcome measures. The use of outcome measures at any point improved from 15.8% to 83.7%, with follow-up measurements improving from 10.5% to 32.6%.
Conclusion(s): Group discussions, training about the importance of documentation and outcome measures, and individual mentoring in the clinic resulted in reports of improvements in consistency of documentation and use of outcome measures; enhancing professional practice standards.
Implications: While documentation and outcome measures can be used to demonstrate patient progress, effectiveness of services, and to advocate for services to under-served populations, these methods are not always used consistently or effectively. Methods to enhance these aspects of professionalism may be useful in countries or areas attempting to demonstrate the effectiveness of physiotherapy.
Funding acknowledgements: The Advancement of Rwandan Rehabilitation Services Project (ARRSP) was funded by the United States Agency for International Development (USAID).
Topic: Professional issues
Ethics approval: Ethics approval was not required for the Leadership Institute. Follow-up methods were approved by the Misericordia University Institutional Review Board.
All authors, affiliations and abstracts have been published as submitted.
