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“ASSESSING THE STANDARDS OF PHYSICAL THERAPY SERVICES IN TERTIARY CARE HOSPITALS IN PESHAWAR”

SESSION 2010-11

Submitted By

Dr. Mahboob-ur-Rehman

Supervised By

Dr. Saadullah Afridi

FACULTY OF HEALTH SCIENCES

GANDHARAUNIVERSITY,

PESHAWAR

THIS DISSERTATION TITLED

“Assessing the standards of Physical Therapy Services in Tertiary Care Hospitals in Peshawar”

is submitted to the R & D council of ICMS Faculty of Health Sciences Gandhara University Peshawar as partial fulfillment for the requirement of the award of EMBA degree by the Gandhara University Peshawar.

Dr. Mahboob-ur-Rehman

Author

DECLARATION

I declare that the dissertation titled

“Assessing the standards of Physical Therapy Services in Tertiary Care Hospitals in Peshawar”

is the product of my original research work, No part of this project has been copied from any other source expect the italics, underlined, within brackets or bold ones, whose references has been quoted at the reference part of the project.

DR. Mahboob-ur-Rehman

SUPERVISOR REPORT

Certified that I Dr. Saadullah Afridi working as Director ICMS Gandhara University has supervised the entire project activities of Dr. Mahboob-ur-Rehman. During the period of 2010 to 2011

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Supervisor Signature

R & D EVALUATION

Recommendation

  1. Approved and Marked
  2. Returned for Review & fresh Viva
  3. Only returned for review of Dissertation.
  4. Rejected

Member (1)Member (2)

______

______

______

Director EDC

ACKNOWLEDGMENT

First of all I would like to thank ALMIGHTY ALLAH for His kind support and mercy at every difficult situation. I am thankful to Him for accomplishing this study. I am again thankful to Allah for blessing me with opportunities in life.

I am very thankful to my thesis supervisor Dr Sadullah Khan for his guidance, support, counselling and encouragement throughout my thesis work. His expert comments and feedback helped me to shape sound thesis document. I have learnt a lot from him from the protocol development phase till the framing of thesis report.

I am indebted to my Friend Mr. Sher Bahadur for his technical guidance and expert comments in development of data collection tools. His timely support helped me in data analysis and framing of thesis results.

I am again grateful to my Program Director Dr. Sadullah Khan for his constant support during my entire masters especially during thesis. I have learned a lot from him in the past years. He always encouraged me and gave me appropriate guidance to overcome my weaknesses and groomed my skills. I admire him greatly and give him my highest respects as elder and as an ideal teacher.

I am also thankful to my entire MBA faculty and staff for their humble support.

I would like to acknowledge the cooperation of my colleagues from MBA, Physiotherapy & staff from HMC whose presence and moral support proved to be a great stimulus for me.

.

DR. Mahboob-ur-Rehman

AUTHOR


TABLE OF CONTENTS

ABSTRACT

Acronyms

CHAPTER 1

INTRODUCTION

Introduction

CHAPTER 2

METHODOLOGY

METHODOLOGY

Study setting

Study Method

Research Method

Study Population

Inclusion criteria

Exclusion Criteria

Study Period

SAMPLING STRATEGY

Survey tool

Pre-testing

Data collection process

QUALITY ASSURANCE AND CONTROL

Data editing

Ethical Consideration

DATA ANALYSIS

CHAPTER 3

RESULTS

RESULT

PRESENTATION OF QUANTITATIVE DATA FINDINGS

ANALYSIS OF IN-DEPTH INTERVIEWS

CHAPTER 4

DISCUSSION

DISCUSSION

Recommendations

Policy Implications of our study

CONCLUSION

Strength and limitation of the study

References:

Annexure 1 : Consent Form

ABSTRACT

Background

In many countries, the need for physical therapists to use standardized measures has been recognized and is recommended in clinical practice guidelines. A lack of follow up of international standards in daily practice may hamper rehabilitation services.

Objectives:

The aims of our study was to investigate the Physiotherapy standard practiced by physical therapists in tertiary care hospitals in Peshawar

Methods:

To get a complete and valid overview of Physiotherapy standards, a checklist of modified Australian Physiotherapy standards were used. We conducted a facility survey to evaluate the physiotherapy services against each standard.

Conclusions:

The overall equitable services are available but where less than 30% score is achieved from this study needs to be enhanced and there should be a healthy competition between the private and public sector is left behind as revealed from the study. The professional development, behavior and attitude of the staff, risk and safety measures and necessary support by the government to recognize the importance of physiotherapy and rehabilitation may help in development of this profession and prevention of physical disabilities at large.

Acronyms

HMCHayatabad Medical Complex

KTHKhyber Teaching Hospital

RMIRehman Medical Institute

PHC Primary Health Care

HPCHabib Physiotherapy Complex

RHC Rural Health Centre

LBPLow Back Pain

FSFrozen Shoulder

HODHead of Department

PTPhysiotherapy

BPTBachelor of Physiotherapy

CPDContinuing Professional Development

DOPDoctor of physiotherapy

DoH Department of Health

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CHAPTER 1

INTRODUCTION

Introduction/Background

Today many developing countries lack standards due to resource constraint, failure to understand the concept of quality and enormity of the subject resulting in poor planning of human resource, infrastructure/facility, equipment and service (1, 2). The terror consequences are disease transmissions, physical disability, loss of lives and increase in economic burden to the family pacifically and nation at large (1).

The physical therapy service standards describe components of the physiotherapy service for which the organization is responsible, in order to maintain the safety and quality of service to patients, and provide an environment favorable to the safety of staff and patients. The standards provide a benchmark against which the service can be measured, and a framework for an organization to review and improve its service provision(2).

The service standards are intended to apply to all physiotherapy services, including those in medical and public health services, independent and voluntary sectors, both large and small, and in all settings(3).

The service standards are not minimum, nor standards of excellence, but they are considered to be achievable. It is acknowledged that not all services will be able to meet all of the standards, but they are judged to be measures that all services should aspire to as part of their professional responsibility to both patients and staff(3).

The physiotherapy professional’s commitment to society is to promote optimal health and function in individuals by pursuing excellence in practice. These standards apply to all physiotherapists, whether newly qualified or highly specialized, in direct or indirect contact with patients, care givers, and other professional colleagues. Physiotherapy practice is more than direct patient contact; it includes how services are structured, managed and delivered (4).

Physiotherapy is a health profession that assesses and provides treatment to individuals to develop, maintain and restore maximum movement and function throughout lifespan. This includes providing treatment in circumstances where movement and function are threatened by aging, injury, disease or environmental factors. Functional movement is central to what it means to be healthy(5, 6).

Physiotherapy is concerned with identifying and maximizing quality of life and movement potential within the specialty of health promotion, prevention, treatment/intervention, rehabilitation and maintain of quality of life (3, 7). This covers physical, psychological, emotional, and social well being of human being. Physiotherapy involves the interaction between physiotherapists, patients/clients, other health professionals, families, care givers, and communities in a process where movement potential is assessed and goals are agreed upon, using knowledge and skills sole to physiotherapists(6, 7).

Physiotherapy is a dynamic profession, which uses a range of treatment techniques to restore movement and function within the body or Physiotherapy is a health profession concerned with maximizing mobility and quality of life, by using clinical reasoning to select and apply appropriate treatment(8). Physiotherapy is a branch of healthcare science that mainly concentrates on the physical aspects of an individual's healthcare, by treating their physical ailments. It works towards this by maintenance and rehabilitation of the individual's physical activity, which is nothing but bringing back the lost activity to near normal perfection. Physiotherapy uses physical agents for the treatment of patients.

Doctor of Physiotherapy & Rehabilitation Medicine is defined as the development of a person from impairment or disability to the fullest physical, psychological, social, vocational & educational potential consistent with his or her physiological or anatomic impairment & environmental limitations(8).

Scope of physiotherapy practice is very diverse of vital in areas of orthopedics, neurology, cardio-pulmonology & Integumentary medicine.Physiotherapy Practice has a long history & modern clinical practice is heavily reliant on research & evidence based practice, intended to overcome quackery in the field of physiotherapy(9, 10).

However with the increased recognition of physiotherapist skill’s in diagnosing, treating & preventing illness & injuries has necessitated the profession to re-evaluate its goals for the future & move forward to have more autonomy in patient care. Physiotherapy is a profession in great demand nationally and internationally(9, 10).

Conceptual Framework

The Physiotherapy Services shall be organized and administered to provide services to patients requiring physiotherapy intervention and medical rehabilitation and other related services in accordance with accepted standards of practices

Although a large number of physical therapists work in hospitals, now more than 70 percent can be found in private physical therapy offices, rehabilitation centers, community health centers, nursing homes, home health agencies, corporate or industrial health centers, sports facilities, research institutions, schools, pediatric centers, and colleges and universities. Some physical therapists work as employees in these settings, while others are self-employed as owners or partners in private practices. Indeed, settings, employment arrangements, career responsibilities, and career opportunities depend on the interests and skills of each practitioner.

General Standards of Practice for physiotherapist

  • Qualifications
  • Competency
  • Ethics
  • Cultural Competence
  • Communication with patients
  • Confidentiality
  • Informed Choice and Consent
  • Environment
  • Infection Control
  • Emergency Procedures
  • Staffing
  • Continuing Professional Development
  • Clinical Practice
  • Continuous Quality Improvement.

Standards of Practice for Alberta Physiotherapists:

Professional Qualifications and Competence:

  • Entry to practice and essential competence.
  • Performance of restricted activities.

Physiotherapist-Client Relationship:

  • Client-centered service.
  • Professional boundaries.

Professionalism:

  • Legislative compliance
  • Conflict of interest
  • Title and credentials.

Practice Management:

  • Dual registration.
  • Concurrent treatment.
  • Safety.
  • Supervision.
  • Advertising and promotional activities.
  • Fees and billing.
  • Human resources
  • Record keeping and management.
  • Clinical, financial and equipment maintenance records.
  • Quality improvement.

According to Alberta Physiotherapists are regulated, primary health professionals who practice independently and/or as part of inter-professional teams to provide effective, ethical and safe client-centered service. Within the practice of physiotherapy, physiotherapists:

  • Assess, treat, prevent and manage injury, pain, disease and/or disorders.
  • Optimize client’s3 physical function, functional independence, mobility andQuality of life.
  • Educate clients and others4 about health, wellness, fitness and self-management.

Physiotherapy services are provided to individual clients as well as groups or Populations. Physiotherapists apply a client-centered, evidence informed approach to assessment, determining a physiotherapy diagnosis, treatment planning and intervention, and outcome evaluation. Inherent in the delivery of quality physiotherapy services is a focus on how services are structured and managed. Standards refer to the expected level of physiotherapist performance, for qualification to practice, clinical care, and professional practice5 that results in safe, ethical and effective physiotherapy service. The application of standards will vary depending upon the context of an individual’s physiotherapy practice. In response to emerging professional regulatory, legal and ethical expectations, the standards will evolve and undergo revision. The

Standards of Practice for Alberta Physiotherapists (standards) are now described in a compendium of foundational profession-specific documents including:

Essential Competencies for Physiotherapists inCanada, 2009.

  • Code of Ethics.
  • Standards for Practice described herein.

These standards were develop to:

Define performance expectations for the delivery of quality physiotherapy service.

  • Provide reference for the public, the profession and others regarding performance

Expectations for Alberta physiotherapists

  • Provide guidance for physiotherapists and others in evaluating and maintainingcompetence.
  • Provide a reference for reviewing and resolving professional practice and conduct issues.
  • Identify the outcomes that clients may expect when physiotherapists provide services.

In addition to being satisfied that the specific outcomes identified for each standard are met, clients will also be satisfied that:

  • Physiotherapy services delivered were safe and comprehensive.
  • They had an opportunity to provide input into the physiotherapy services received and were able to make choices based on information provided and felt the decisions were respected.
  • Physiotherapy services were provided in an honest, timely, professional and ethical manner.

CHAPTER 2

METHODOLOGY

METHODOLOGY

Study setting

The study was conducted in Peshawar Pakistan. Peshawar is the provincial Capital of the Khyber Pakhtunkhawa and is also the largest city in the Province. The city district enjoys tremendous historical, military, economic and political importance. The Federally Administered Tribal Areas (FATA) adjoining Peshawar, the Khyber Agency which lies to its West, Mohmand Agency to its North, Frontier Region (Semi-Tribal regions) Kohat to its South. The two settled districts of Charsadda and Nowshera are situated to its North and North-East respectively, whereas the Afghan border is approximately 40 Km to the West. Health Facility profile is shown in the following table

Table; 1:

No of heath facilities in Peshawar and six other districts of KPK

S. No / District / Health Profile Of Seven Districts of Khyber Pakhtunkhwa
Hospitals / Rural Health Centres / Basic Health Units / Dispanseries / MCH Centres / TB Clinics / Leprosy Centre / Total
1 / Charsadda / 5 / 5 / 3 / 38 / 2 / 2 / 55
2 / Mardan / 6 / 6 / 49 / 13 / 2 / 12 / 1 / 89
3 / Nowshera / 6 / 6 / 32 / 16 / 4 / 1 / 1 / 66
4 / Peshawar / 13 / 3 / 50 / 38 / 5 / 4 / 1 / 114
5 / Swabi / 4 / 4 / 40 / 8 / 3 / 1 / 1 / 61
6 / Swat / 8 / 3 / 41 / 17 / 3 / 22 / 3 / 97
7 / Lower Dir / 3 / 4 / 33 / 19 / 9 / 3 / 71
Grand Total / 45 / 31 / 248 / 149 / 28 / 42 / 10 / 553

The health services are provided to the community by 33 different health facilities which include:

  • 13 Hospitals
  • 3 Rural Health Centers (RHC).
  • 50 Basic Health Centers (BHU).
  • 38 Dispensaries.
  • 5 Maternal & Child Health Center MCH.

MATERIALS AND METHODS

Research Method

Quantitative research method is more rooted to the objective, and deductive elements. The descriptive design is used to gain more information about the standards of physiotherapy practices in tertiary care Hospitals in Peshawar. As in descriptive method there is no manipulation of variables and no attempt to establish causality. We conducted a survey to collect data about standards of physiotherapy followed in Physiotherapy department of tertiary care hospital in Peshawar and presented them in form of, frequencies, and percentages.

This was descriptive survey, based on checklist of standards. The individuals department was observed against each standard. This was again compared with documents.

Study Population

The study units comprised of those tertiary care hospitals where physiotherapy department was an operational condition. In Peshawar there are 6 public and private tertiary care hospital which have physiotherapy department. All physiotherapy departments were supposed to be included in the study.

Inclusion criteria

◘All those organization where physiotherapy department are properly operationalized

Exclusion Criteria

◘Those organization were excluded who were not welling to evaluate their department

◘Those organization where physiotherapy department were not properly operationalized

Study Period

The study was conducted during the month of February, March and April 2012. During this three month period activities undertaken included: data collection, analysis, making inference about the result and providing recommendations based on study findings.

SAMPLING STRATEGY

Our primary objective was to assess standards of Physiotherapy practices in the tertiary care hospitals in Peshawar, KPK Pakistan. There are total 6 tertiary care hospitals, namely Hayatabad Medical Complex (HMC), Khyber teaching Hospital (KTH), Leady Reading Hospital (LRH), Rehman Medical Hospital (RMI), North West Hospital and Habib Physiotherapy Complex (HPC). We used universal sampling technique and included all tertiary care facilities in Peshawar where physiotherapy department was operational.

Survey tool

Modified physiotherapy standards check list was used. After reviewing the physiotherapy department facility and services and the practice was assessed by reviewing the documentation of the services provided. The tool was modified according to the local context of service provision and their responsibilities. The check list consist of the following variables:

◙Effective quality improvement process.

◙ Taking care of risk and safety.

◙Audit of the department for the clinical improvement

◙Monitoring & Evaluation procedure for effectiveness of physiotherapy services.

◙Provision of evidence/research base rehabilitative services.

◙Procedure of dealing with complaints of Patient.

◙Professional development of physiotherapist.

◙Professional skills development of physiotherapist

◙Organization of Conferences/Workshop

◙In services training

◙Appraisal system.

◙Services planning, implementation & delivery.

◙Patient and family education

◙Equitable & fair services of physiotherapy according to need

◙Problem solving of physiotherapy services.

◙Assurance Safe environment.

◙Maintaining hydrotherapy pool’s environment.

◙Ensuring maximum safety during the utilization of hydrotherapy.

◙Patient’s record keeping

◙Availability of IT system for patient information

Pre-testing

To ensure the validation, the integrated modified tool was pre-tested. The pre-testing was done in physiotherapy clinics and small hospitals. The data collectors and facility physiotherapist were asked to note the areas where they felt difficulty in understanding or they felt that the specific variable not is pertained to physiotherapy services. After receiving their feedback necessary corrections were made and discussed with thesis supervisor before conducting the study.