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Carvajal J.1, Khagi A.2, Tiwari M.3, Sheppard P.4, Shrestha S.5
1International Organization of Migration / AmeriCares, Chautara, Sindhupalchowk, Nepal, 2Handicap International Nepal, Chautara, Nepal, 3Physiotherapist, Somerville, United States, 4London School of Hygiene and Tropical Medicine, London, United Kingdom, 5International Medical Corps, Gorkha, Nepal
Background: As a result of the devastating Gorkha earthquake and aftershocks in Nepal on April 25 and May 12, 2015, over 22,000 people were injured. After receiving emergency medical treatment for largely orthopaedic trauma and neurological injuries, many individuals required physiotherapy in order to successfully return to their homes. Sindhulpalchowk was one of the worst hit districts with over 2,100 injuries. The International Organization for Migration therefore opened an Injury and Rehabilitation Unit (IRU) in Sindhupalchowk in November 2015, where it continued operations until the end of July 2016. Inpatients at the IRU received services from an interdisciplinary health team which included doctors, nurses, a community outreach team, a counselor, a health focal point, physiotherapists (PTs), and two physiotherapist trainers (PTTs). The IRU, with support from PTTs, was the first of its kind in post-disaster rehabilitation.
Purpose: To contribute to optimal function and treatment outcomes among earthquake survivors requiring injury rehabilitation care in Sindhupalchowk district through interdisciplinary care.
Methods: Eligible patients from Sindhupalchowk were identified by the community outreach team and screened by the medical officer and PTs prior to admission to the IRU. Patients were assessed by one of the PTs, treated and periodically reassessed thereafter, over a 4 to 12 week period. The patients participated in active physiotherapy programmes, including individual exercise programs and group exercise. The PTs provided manual therapy and modalities when indicated. The PTTs worked with the PTs one-on-one and on a group basis to enhance physiotherapy assessments, optimize the treatment provided and ensure thorough documentation of patients progress. Each of the PTTs provided theoretical and hands on training to the PTs for a period of 4 months in areas where knowledge and skills were identified to be limited. Examples of workshop topics included differential diagnosis, prognosis and manual therapy. The PTTs also provided feedback to the interdisciplinary team on how to increase efficiency of the IRU and provide interdisciplinary care consistent with current best practice.
Results: The PTs improved in various areas of competency including patient assessment, critical reasoning and treatment skills. Through the use of the PT-PTT model of providing job specific continuing education to the PTs, they were able to provide more effective and efficient treatment for patients, which resulted in patients being discharged sooner and having better functional outcomes. The IRU ran more efficiently by implementing suggestions provided by the PTTs.
Conclusion(s): The PT-PTT collaborative model is effective at building capacity within local physiotherapy staff in Nepal over a relatively short term of 4 to 8 months. Patients also benefited through receiving efficient and effective care which allowed them to achieve optimal outcomes. Future PT-PTT collaborations should be undertaken in other settings outside of post-disaster settings to determine the generalizability of the findings of this study to other settings.
Implications: The PT-PTT model can be used to enhance the quality of physiotherapy care in a relatively short time frame in post-disaster settings in Nepal and other countries. This model should be considered when planning for rehabilitation in other post-disaster settings.
Funding acknowledgements: Our work was funded by the International Organization for Migration (IOM) and AmeriCares.
Topic: Disaster management
Ethics approval: Ethics approval was given by the Nepal Health Research Council.
All authors, affiliations and abstracts have been published as submitted.
