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Makalla A.1, Philips J.2, Karachi F.2
1Muhimbili National Hospital, Rehabilitative Medicine, Dar es Salaam, Tanzania, 2University of the Western Cape, Physiotherapy, Cape Town, South Africa
Background: Cardiac surgeries have evolved over the years; but patients are not free from post-operative complications. These pulmonary complications are an important cause of morbidity leading to significant prolonged hospitalisation, mortality and overall hospital costs. However, the position of physiotherapists in the prevention or diminishing of these complications is not well defined predominantly in developing countries.
Purpose: The aim of this study was to investigate the post-operative role of physiotherapy following cardiac surgery at Muhimbili National Hospital.
Methods: An explanatory sequential mixed method study design was used. A descriptive retrospective study design was chosen for the quantitative phase using a convenient sample of all above 18 years, 105 patients records operated from January 2010 to 31st December 2013. With regards to the qualitative phase, 2 Cardiac Surgeons and 10 Physiotherapists working in the setting were conveniently sampled to explore their perceptions on the post-operative role of physiotherapy in the management of patients following cardiac surgery at Muhimbili National Hospital.
Results: The mean age of the study sample was 30.6 (SD=10.5) with more than half (54.3%) being females. The results show that Rheumatic Heart Disease accounted for the majority (74.3%) of cardiac diseases. Double valve repair accounted for 71.4%. A decline in the number of surgeries performed were noted from 2010 (48.6%) to 2013 (10.5%). The mean number of days spent in Intensive Care Unit (ICU) were 6.4 (SD=5.3) and in the ward 12.2 (SD=7.8). A total of 21.4% of the sample developed post-operative complications and 10.5% of the total sample died. A substantial number of patients (77.7%) were referred for physiotherapy treatment post-operatively, with most of these referrals (70.0%) on the first day post-operatively. The majority (37.8%) of the patients received 3 physiotherapy sessions in the ICU with most of these patients (79.3%) being seen once a day in the ICU and (65.8%) in the ward. Physiotherapists prescribed (53.7%) a combination of breathing exercises, thoracic mobilisation, incentive spirometry and ambulation in the ICU. A combination of breathing exercises, thoracic mobilisations, endurance training and posture correction was frequently (89.5%) prescribed in the ward
Content analysis was used to analyse qualitative data. Cardiac Surgeons reported poor co-operation from physiotherapists, inadequate skills and a lack of motivation to work in the Cardiac Unit. Physiotherapists revealed that they were less trained and exposed to the field of cardiac rehabilitation.
Conclusion(s): Rheumatic Heart Disease was and still is major leading cause for cardiac surgeries in Tanzania. Following cardiac surgery, more than two third of patients received physiotherapy services in the intensive care unit and before hospital discharge leading early hospital discharge. However poor communication in the interdisciplinary team and lack of trained Physiotherapists in the field of cardio-pulmonary is setbacks which need to be addressed.
Implications: lack of standard treatment procedure among Physiotherapists in the setting brings variations in this world of evidence based practice. Thus there is a need of developing treatment guideline that can be used in different setups in both developing and developing countries.
Funding acknowledgements: My unquantifiable gratitude go to Tina Everett and John for their financial support which made an enormous difference to me
Topic: Cardiorespiratory
Ethics approval: Ethical clearance was obtained from the University of the Western Cape, South Africa and Muhimbili National Hospital, Tanzania.
All authors, affiliations and abstracts have been published as submitted.
