Year: 2009
Type: dissertation
Study design: Observational Study
Abstract: This thesis centres around the issues concerning HIV/AIDS and physiotherapy education, \ncurriculum and practice. In particular, this thesis examines which HIV specific content should be \nincluded in a physiotherapy curriculum and ultimately presents a conceptual framework for HIV \ninput into the curriculum. \nThere is a vast body of literature available on HIV. For physiotherapists, however, apart from a brief \nreview given by Nixon and Cott (2000) using the ICIDH, no comprehensive literature is available \nthat places information on HIV into a framework that speaks to physiotherapists as part of the \nrehabilitation fraternity. The literature on impairments is descriptive and buried in the medical model \nas symptoms. Section one of the literature review placed the literature in such a framework and \nprovided a comprehensive description using the ICF and related aspects that concern \nphysiotherapists. The ICF captures all the elements of current rehabilitation theory and practice and \nthe literature is presented in an ICF framework. In addition, important background information on \nprevalence, its determinants, treatment approaches and subsequent impacts were reviewed. As \nmost of the literature available still remains in the medical model, the conditions that manifest and \nfrom which patients develop impairments, were reviewed. \nThe effects of HIV on body systems are extensive and pervasive. In each body system HIV has \ndirect effects on mature and maturing cells e.g. progenitor cells and mature muscle cells. In the \nmusculoskeletal system HIV impacts on functional systems and organs resulting in \npathophysiological changes that manifest as impairments such as muscle wasting. Conditions \nmanifesting in all body systems were reviewed and outlined. Impairments such as pain, \nbreathlessness and proximal muscle weakness were reported in the literature. In addition to \nimpairments, analysis of the literature revealed studies that had found high levels of functional and \nactivity limitations as well as impacts on Health-related Quality of Life in HIV. The literature also \npresents the current status of physiotherapy interventions. Many studies have reported that \nexercises are a safe and effective mode of intervention not-withstanding the limitations \nencountered. \nThe second part of the literature review focussed on aspects concerned with curriculum. Previous \nstudies have focused on establishing baseline knowledge, attitudes and practices (KAP) to HIV and \nthe impact of training programmes on KAP. What the actual content was for health workers, in \nparticular physiotherapists and the approach to incorporating HIV into curricula is a gap in the \nliterature. \nTo inform the overall aim, with context-appropriate HIV content, this study undertook a number of \nstudies in order to obtain the necessary information on HIV, specific to physiotherapy. Therefore \nthe overall approach was a mixed methods one employing both a quantitative and qualitative study \nmix. \nThe first and second studies informed the clinical picture and were both cross-sectional and \ndescriptive. In both studies descriptive statistics were used to analyse data, especially in \ndetermining the absence or presence of conditions. Study 1 sought to establish the level of referral \nto physiotherapy by retrospectively examining the patient records of patients admitted with HIVrelated \nconditions over a period of one year. Of the 732 patient records reviewed, 139 (19%) had \ndiagnoses considered suitable for physiotherapy and 3% were referred to physiotherapy. \nStudy 2 aimed to establish a relevant overview of the functional and participation limitations of \npeople living with HIV. Two groups of patients were studied i.e. an in-patient group and an outpatient \ngroup. The out-patient group was from a well resourced mining out-patient setting. The ICF \nchecklist was utilised to collect the data and statistical analysis was performed to indicate the \npresence or absence of impairments, activity limitations and participation restrictions. A logistic \nregression was done to determine the odds of activity, limitation or participation restriction given \ncertain levels of domains. Both groups showed high levels of impairment. For the in-patient group \nloss of muscle power 75%(n=60) energy and drive 75%(n=60), disturbed sleep 71%(n=56), \nemotional problems 62%(49), mild-severe pain 80%(66), weight maintenance difficulties and \ndiarrhoea were apparent. In the out-patient mining group memory problems, energy and drive \nfunctions 36%(n=18), sleep 24% (n=12) and emotional functions 28% (n=14), seeing 32% (n=17), \nhearing, vestibularproblems 28%(n=14) and pain 55%(n=28), blood pressure and respiratory \nproblems 24%(n=12), weight maintenance 63%(n=32), sexual functions 22%(n=11) and reduced \nproximal muscular power 24%(n=12) were encountered. The in-patient group had high levels of \nactivity limitations and participation restrictions, while the out-patient mining group did not. There \nwas association between the different domains and in the in-patient group gender (p=0.02) and \nmarital status (p=0.01) were likely to influence the activity and participation levels and the \nexperience of the environment. \nThe remaining three studies involved aspects related to informing the curriculum component of this \nthesis. Study 3 audited the universities’ curricular documents to establish what the current \ncurriculum included. Seven of the eight universities that offer physiotherapy training were reviewed \nand their curricula were generally scanty on information regarding HIV/AIDS. When compared to \nthe areas outlined as a result of the literature review, the study of the patients and focus groups with clinicians and academic staff, revealed some gaps, in particular; the types of conditionsand \nthe influence of HIV on other body systems which are pertinent to the clinical reasoning process for \nthe physiotherapist: The philosophy of care and approach to management and the physiotherapists’ \nrole in HIV prevention, treatment and care were evident gaps. \nStudy 4 sought to develop a framework of HIV content for a physiotherapy curriculum. This was \ndone by integrating the results found so far and verifying and enriching this data by gaining \nclinicians’ and academics’ insights and perceptions around HIV, based on their clinical and \neducational experience. Focus group discussions were conducted and a qualitative approach was \nundertaken for data analysis. A framework for curricula content emerged from this exercise. \nIn study 5 the framework of HIV content was used to develop a questionnaire that was sent out in \nthe Delphi survey to academic staff with the aim to test the level of consensus. Eighty three \ncomponents of the curriculum under four outcome areas (Appendix 7.2) were sent to 68 academic \nstaff who were identified. Of the 68 academic staff, 58 were available and 47 responded and \nconsented to participate. All but two topics obtained consensus set at 80% and the remaining two \nobtained consensus in the second round. \nThe final chapter discusses the results of these studies and illustrates how these results on HIV \naffect and can be applied to the physiotherapy curriculum, when applied to the UNAIDS \nmainstreaming criteria. Applying the mainstreaming principles to the process of including HIV \ncontent into the curriculum, ensures that the process is not done in a piece meal fashion but \nencompasses all important facets which were identified. The programme, if systematically \nimplemented, could result in a coordinated outcome accounting for all the important facets. \nA conceptual framework is drawn from the results of this thesis illustrating the three levels of \ncurriculum taxonomy: At the micro level, through the body systems, the meso level through the role \nof physiotherapy, dealing with internal and external domains and teaching approaches. The macro \nlevel is accounted for by the facilitatory activities such as advocacy among clinicians and \nacademics and forming strategic partnerships at all levels.
Author: Hellen Myezwa
Language: English
Subfield: Rehabilitation
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W32953649