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Item Open Access Development of a clinical hand rehabilitation guideline for second to fifth metacarpal fractures in South Africa(University of the Free State, 2023) Keller, Monique Marié; Barnes, Roline Yvette; Brandt, CorliaIn countries, such as South Africa, with limited resources and inequities in their healthcare delivery services optimal hand rehabilitation is essential in their quest to enable individuals sustaining second-to-fifth metacarpal fractures to return without delay to pre-injury functioning and to work safely. Sub-optimal hand rehabilitation service delivery impacts the already strained South African healthcare system, where individuals may return to hospitals or clinics with associated complications leading to time off from work and thus negative socioeconomic consequences (Poolman et al, 2005). Second to fifth metacarpal fractures are generally sustained as a result of motor vehicle accidents, trauma and violence, and in most cases, where the hand makes contact with an object. A fracture of the neck of the fifth metacarpal is one of the most frequent of the hand injuries to be sustained. The problem is that there are no guidelines and best-evidence information available to guide clinical practice which leaves a gap in the knowledge base in this respect. The result is that owing to the individual’s hand not being optimally managed, there would then be a possible delay in returning to work, and more seriously, disability and dysfunction. Three research phases were undertaken to achieve the aim of developing a clinical hand rehabilitation guideline for adults, male and female, between the ages of 20 and 59 years, after conservative and surgical management following a single or multiple second to fifth metacarpal fractures. The first phase included a systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) principles. The second phase involved a two-staged feasibility study and a cross-sectional study, and included healthy adult participants who met the inclusion criteria. The participants donned two gloves with force sensing resistors (FSR) attached with glue to the finger pads which allowed the finger and grasp forces to be measured. The basic and instrumental activities of daily living (ADL) were performed in a laboratory. The FSR testing phase allowed for the inclusion of grasp types in the guideline, as well as the categorisation of ADL tasks into light, moderate and heavy task categories. The categorisation of ADL tasks allowed the clinicians to give advice, according to the timelines for bone healing, about returning to pre-injury tasks. The third phase involved an eDelphi method, with consideration being given to the Conducting and Reporting of DElphi Studies (CREDES), with recommendations included. In this case, the experts participated in a three-round eDelphi method to reach consensus and to further develop and finalise the clinical hand rehabilitation guideline. The guideline methodology was developed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. After three phases of the study, with the final phase being the eDelphi method, expert consensus was reached on 32 recommendations. A hand rehabilitation guideline consisting of the 32 recommendations was developed by the researcher to inform this research’s clinical guideline which is presented in the format of the European Society of Cardiology (ESC).Item Open Access A framework for the integration of simulation in undergraduate physiotherapy: contextualised for South Africa(University of the Free State, 2020) Van der Merwe, Anke; Barnes, R. Y.; Labuschagne, M. J.This thesis aims to describe the process of developing a framework for integrating simulation in the South African undergraduate physiotherapy programme. An exploratory multi-method research design comprising three study phases was utilised in the framework development. A systematic review, utilising deductive content analysis, identified the key elements making up the frameworks that were designed to facilitate the curricular integration of simulation. Following the review, a Delphi survey was compiled to develop a conceptual framework for integrating simulation in the South African undergraduate physiotherapy programme. Contextualisation and credibility were ensured by means of a validation meeting. The systematic review included eight articles, which have an almost equal distribution of low and high finding reliability. In total 18 descriptive themes, grouped under four analytical themes, were identified. Analytical themes identified were planning, implementation, evaluation and revision. All articles noted thoughtful planning of simulation-based learning experiences (SBLEs), including stipulating learning outcomes, considering resources and debriefing. Only three articles included the execution of needs analyses and identified the need for simulation-based educator training prior to simulation integration. Data obtained from the review was formulated into a Delphi survey and distributed to purposively selected international and national experts in healthcare education and/or simulation. Results from the Delphi survey confirm the importance of curriculum development, SBLE design, resource availability and development of learning outcomes. Panel members also highlighted educator competence as essential. Analysis of both institutional and student needs were deemed essential, with societal needs being regarded as merely useful. The majority of statements pertaining to student preparation, student assessment and mastery learning/deliberate practice only achieved stability during the Delphi survey. Following the Delphi survey, the conceptual framework was developed by the researcher, and it was refined further during a validation meeting. Participants in the validation meeting suggested modifying the unidirectional framework illustration, which resulted in adjustment of the framework. Noteworthy was the importance of addressing all stakeholder needs, including societal needs. A collaborative approach to simulation integration was emphasised by participants especially in a resource-restricted South African setting. Participants refined terminology, so that it was more applicable to the South African education environment. The framework was finalised by the researcher, who applied constructive and cognitive load education theories and the data of the current study. A framework depicting both the fluidity between framework elements and the need to adjust education approaches to optimise student training was designed/developed. The framework emphasises the preparation required by both educators and students. Curriculum and SBLE authenticity are essential framework components for optimising preparation of graduates for practice, which expects graduates to possess increased and complex skills early in their careers. The final product is a credible and contextualised framework for the integration of simulation in the South African undergraduate physiotherapy programme. Though it is generic in nature, it may be applicable for use in any healthcare programme. It is recommended that a dedicated simulation expert, who is well versed in simulation-based education, is appointed to drive framework implementation; to ensure that all stakeholder needs are addressed, and to promote the sustainability of the integrated framework. Engagement with national regulating bodies regarding the inclusion of simulation as part of the mandatory undergraduate physiotherapy training requirements is recommended. Further research, exploring the practical use of SBLEs for mastery learning/deliberate practice and assessment purposes, is required. Investigation into a standardised approach to peer assessment in SBLEs is advised, to encourage student participation. In light of national resource restrictions, the researcher recommends research is undertaken in relation to the development and/or identification of validated outcome measures that calculate the return on investment of simulation integration at institutional level.Item Open Access The development of a framework for the education and training of undergraduate physiotherapy students(University of the Free State, 2002) Krause, Maria Wichura; Viljoen, M. J.; Nel, M. M.English: Higher education and health care have undergone profound changes over the past decade, world-wide but particularly in South Africa. Physiotherapy as a profession cannot stand apart from this, and therefore the education and -training of professional physiotherapists need to be taken under scrutiny. The purpose of this research was to develop a framework with a view to making a contribution to physiotherapy education and training and health care. The research comprised a literature survey (examining educational and health requirements, needs and trends), interviews with physiotherapy educators in the United Kingdom, (to investigate aspects of their education and training), and departmental workshops in the Faculty of Health Sciences, University of the Free State (to reflect on and brainstorm the physiotherapy curriculum of the Department of Physiotherapy of this University). The physiotherapy curricula of a number of institutions offering physiotherapy education and training were studied as well. The literature survey paid attention to the transformation of the health care system in South Africa, the transformation of higher education and academic and educational requirements in South Africa, national and international trends in physiotherapy education, and the physiotherapy requirements of the population of South Africa. Based on the results of these exercises, a measuring instrument for the education and training of professional physiotherapists was compiled. The Delphi technique was employed as research method to test the measuring instrument. The Delphi technique is used to gain expert opinions on a matter or research problem. Delphi comprises submitting a questionnaire/research instrument to a panel of experts to elicit opinions and ideas. The instrument is implemented over a number of rounds until an acceptable degree of consensus is reached regarding the questions that were asked. In this study the instrument was converted into a checklist, comprising statements which were to be rated on a 5-point rating scale, and an opportunity for respondents comment on the statements. Seven domain experts were selected as respondents. Two rounds of the Delphi technique were required before acceptable consensus was reached and a final framework for the development of a physiotherapy education and training programme could be compiled. In short this framework comprises a vision and a mission for professional physical therapy, the objectives of physiotherapy education and training and definitions of physiotherapy as a profession and the physiotherapist as a qualified, registered professional health care worker. This is followed by the exit level outcomes of a physiotherapist education and training programme, as well as the specific and critical (non-context specific) outcomes that should be achieved to obtain a qualification. The themes that ought to be covered in order to be able to reach the outcomes are described, as well as requirements for the education and training progress and structure, in which aspects such as teaching and training approaches, student selection, recognition of prior learning, mobility and portability are attended to. This framework, which is the result of an in-depth and comprehensive study of higher education demands and requirements, the history of physiotherapy as health care profession and current needs of and trends in the profession, and the demands and requirements of health care in South Africa with special emphasis on physiotherapy, has the potential to be used over the wide front of physiotherapy education and training. The framework has been designed in a way which will enable institutions offering physiotherapy education and training to use it in developing innovative curricula. Through this a contribution can be made to physiotherapy education and training specifically, but also to health care.