|Year : 2021 | Volume
| Issue : 2 | Page : 84-90
Factors associated with the use of outcome measures among physiotherapists working in neurorehabilitation units in tertiary hospitals of North-Western Nigeria
Fatima Sada Sani1, Rufai Yusuf Ahmad2
1 Department of Physiotherapy, Barau Dikko Specialist Hospital, Kaduna, Kaduna State, Nigeria
2 Department of Physiotherapy, Bayero University, Kano, Nigeria
|Date of Submission||27-Oct-2020|
|Date of Decision||07-Jan-2021|
|Date of Acceptance||05-Apr-2021|
|Date of Web Publication||10-Dec-2021|
Dr. Rufai Yusuf Ahmad
Department of Physiotherapy, Bayero University, Kano
Source of Support: None, Conflict of Interest: None
Context: The use of standardised outcome measures (SOMs) is an essential part of rehabilitation and is widely endorsed as an excellent practice. Aim: The purpose of this descriptive study was to identify the factors associated with the use of OMs among physiotherapists working in neurorehabilitation units in tertiary hospitals of North-Western Nigeria. Materials and Methods: Physiotherapists managing neurological conditions in North-Western Nigeria were asked to complete a structured self-administered questionnaire that has two sections. Section I comprises items consisting of demographic information and Section II comprises items regarding the knowledge, attitude, use, perceived benefits and factors that hinder the use of SOMs among physiotherapists managing neurological conditions. Results: over 72.9% of the respondents were familiar with OMs; majority (77.1%) had poor attitude even though they had positive perception about the use of OMs. The respondents reported four most crucial factors hindering the use of OMs in neurological physiotherapy practice in tertiary hospitals in North-Western Nigeria, which are unavailability of appropriate tools, lengthy completion time of OMs, inadequate office space and lack of training on how to use OMs. Conclusion: The main findings of this study revealed that majority of the Participants were aware of the use of outcome measures in clinical practice, they perceived it as essential and useful, however, they have poor attitude and seldom make use of the Oms.
Keywords: Neurological conditions, neurorehabilitation, outcome measures, physiotherapists
|How to cite this article:|
Sani FS, Ahmad RY. Factors associated with the use of outcome measures among physiotherapists working in neurorehabilitation units in tertiary hospitals of North-Western Nigeria. Niger J Basic Clin Sci 2021;18:84-90
|How to cite this URL:|
Sani FS, Ahmad RY. Factors associated with the use of outcome measures among physiotherapists working in neurorehabilitation units in tertiary hospitals of North-Western Nigeria. Niger J Basic Clin Sci [serial online] 2021 [cited 2022 Jan 17];18:84-90. Available from: https://www.njbcs.net/text.asp?2021/18/2/84/332193
| Introduction|| |
Millions of people worldwide are affected by neurological disorders. These conditions affect all ages and may affect mobility, balance, strength, flexibility and coordination. Neurologic disorders can affect a wide range of physical, mental and social functioning. They could also lead to significant morbidity in the community.
Neurologic conditions are managed by a neurological team. Physiotherapy is the healthcare profession that promotes wellness, mobility and independent function. University education, clinical and professional training provide physiotherapists with the knowledge and skills needed to help patients with neurological conditions. The practice of physiotherapy has shifted from opinion-based practice relying on individual perception, clinical experience and peer consultation to evidence-based practice (EBP). Standardised outcome assessment is a primary principle of EBP.,
Measurement tools that assess effectiveness of interventions are referred to as outcome measures (OMs). Standardised instruments have been advocated for use by rehabilitation professionals for many years in almost every disease, condition or ailment that receives attention in physiotherapy. The need for physiotherapists to use standardised OMs (SOMs) has been documented worldwide and has been articulated in a number of policy statements, including the Core Standards of Physiotherapy Practice of the World Confederation for Physical Therapy. Not only do physiotherapists require evaluating physiotherapy treatment outcomes as an integral part of professional accountability, but they also need to make sure their diagnostic process is clear, and that they are able to give their patients some information of their prognosis with treatment. As a result, clinical practice guidelines often incorporate specific recommendations for the use of OMs. The extent to which physiotherapists have embraced the routine use of OMs has been reported in only few studies.,,
Despite recent EBP initiatives and the need for accountability that have highlighted the need to use OMs, recent studies show that their use in clinical practice remains limited., Various challenges are associated with the selection and use of OMs. Past studies indicated that barriers include time constraints, difficulty for patients to complete the forms, lack of equipment, lack of knowledge regarding OMs and limited understanding of how to select and apply the best OM.,, Physiotherapists practicing within neurology previously have been reluctant to use OMs mainly because of the challenge to find OMs that include all aspects of the patient's clinical status into reliable parameters.
Despite the professional drive to introduce SOMs, there have been few studies to characterise how such measures are used in everyday clinical practice or to evaluate their impact, especially within specific specialties. Previous work has focussed on identifying which measures are used across rehabilitation centres or departments as a whole., Juxtaposing the importance of SOMs as an essential tool for EBP against their reported limited use in clinical practice,, it becomes pertinent that efforts be made to promote their wide adoption and use. Therefore, this study is of great importance in finding the factors associated with the use of OM and the recommendations that will assist in the use of OM in neurorehabilitation units.
| Materials and Methods|| |
The subjects for this study were physiotherapists managing neurological conditions practicing in tertiary hospitals in North-Western Nigeria. They included all physiotherapists working in federal medical centres and those in teaching hospitals in the north-western states of Nigeria which are Jigawa, Kaduna, Kano, Katsina, Kebbi Sokoto and Zamfara. There were 54 physiotherapists in these hospitals as obtained from heads of departments in the hospitals. The participants were recruited using a purposive sampling technique. The study was a descriptive survey, and data were collected using an anonymous, structured self-administered questionnaire developed for the purpose of the study. The questionnaire has two sections. Section I comprises items consisting of demographic information which were gender, highest educational qualification, years of experience and type of work setting, and section II comprises items regarding the knowledge, attitude, use, perceived benefits and factors that hinder the use of SOMs among physiotherapists managing neurological conditions. The questionnaire was sent to four neurology experts who were selected based on their experience and invited to review the questionnaire for face-and-content validity. Specific guidelines used for selection and inclusion of the experts included:
- Experienced neurological physiotherapists among whom were an associate professor and two senior lectures who had not <15 years of experience
- Familiarity with the concept of OMs.
The experts were also requested to identify deficient areas and provide recommendations or suggestions on ways to improve the sentence structure to ensure clarity and the content of the questions to suite the objectives of the study, as well as the favourable and unfavourable response collated indicated that the items on the questionnaire adequately addressed the objectives of the study.
The questionnaire then was pilot tested on physiotherapy master's students in neurology speciality group of Bayero University, Kano. The pilot study process was smooth with good response from the respondents which indicated that the questions could answer the objectives of the study and they were clear and well understood.
Inclusion criteria were all physiotherapists and physiotherapy interns managing neurological conditions in tertiary hospitals in North-Western Nigeria (Federal Medical Centre, Binin Kudu, Ahmadu Bello University Teaching Hospital, Shika, Aminu Kano Teaching Hospital, Kano, Federal Medical Centre, Katsina, Usman Danfodiyo University Teaching Hospital, Sokoto, Federal Medical Centre, Gusau, and Federal Medical Centre, Birnin Kebbi). Physiotherapy assistants were excluded from this study. Every effort was made to ensure anonymity to encourage best response from participants.
A cover letter seeking for permission to carry out the study, ethical approval letter, information sheet and the questionnaire were sent to the heads of departments of the selected departments. The participants were asked to sign the consent form attached to the information sheet and those interested in participating in the study to complete the questionnaire. Reminders were sent after 2 weeks, and completed copies of the questionnaires were retrieved afterwards.
The data collected in this study were analysed using both descriptive and inferential statistics; all statistical analyses were performed using Statistical Package for the Social Sciences (SPSS Program for Windows, version 20.0 SPSS Inc., Chicago, IL, USA); for the descriptive aspect, participants' socio-demographic characteristics were summarised using frequencies and percentages, and the results were displayed in the form of tables, bar graphs and pie charts. Regarding the inferential statistics, Pearson's correlation coefficient was used to determine the relationship between the level of knowledge, perception, attitude and frequency of application of OMs among the respondents.
| Results|| |
There were 53 physiotherapists practicing in neurorehabilitation units in seven tertiary hospitals in North-Western Nigeria, and the questionnaires were distributed to all. Forty-nine questionnaires were retrieved giving a response rate of 92.5%. One of the retrieved questionnaires was invalid due to non-response to most of the questions asked in the questionnaire; as such, the analysis was carried out with 48 questionnaires.
Majority of the participants had age range of 26–34 years (66.7%) and had a bachelor's degree only (83.7%). Most of the participants had <10 years of experience (79%). Many of the participants worked in both inpatient and outpatient units in both teaching hospitals (80.8%) and federal medical centres (86.4%). The demographic characteristics and hospital setting information are shown in [Table 1].
With regard to level of knowledge, it could be seen that out of the 48 respondents, 25% had very high level of knowledge of neurological OMs, while 72.9% had high level of knowledge of the OMs. Only 2.1% had low level of knowledge of the OMs as shown in [Figure 1].
|Figure 1: Respondents level of knowledge of neurological outcome measures|
Click here to view
Perception on the use of outcome measures
More than half of the respondents (56.3%) believed that the OMs were most useful for outpatient cases only, 31.3% believed that the OMs were most useful for inpatient cases only and 12.5% believed that the OMs were most useful for both in- and outpatient cases. This is shown in [Figure 2].
|Figure 2: Distribution of respondents' perceptions of cases where outcome measures is most useful|
Click here to view
Attitude towards standard practice on the use of outcome measures
Most of the respondents (77.1%) had poor attitude towards standard practice on the use of OMs, while 12.5% had good attitude. The remaining 10.4% were indifferent about their attitude.
[Figure 3] depicts the distribution of respondents' attitude towards standard practice on the use of OMs.
|Figure 3: Distribution of respondent's attitude towards standard practice on use of outcome measures|
Click here to view
Out of the 48 respondents, 43 of them that constituted the majority (89.6%) made use of the OMs, while 10.4% did not make use of the OMs. [Figure 4] depicts the distribution of respondents' status on usage/non-usage of OMs during practice.
|Figure 4: Respondents' status on usage/non-usage of outcome measures during practice|
Click here to view
Out of the 43 respondents who made use of the OMs, 11.6% applied them frequently while 88.4% applied the OMs less frequently. From the analysis above, it could be concluded that the frequency of application of neurological OMs by majority of the respondents (i.e. 88.4%) who use the OMs is low. This low frequency of usage was identified to be present in both hospital settings and both genders. [Figure 5] depicts the distribution of respondents' frequency of application of the neurological OMs.
|Figure 5: Respondents frequency of application of neurological outcome measures|
Click here to view
Factors hindering the use of outcome measure
The four most crucial factors hindering the use of OMs in neurological physiotherapy practice in tertiary hospitals in North-Western Nigeria are unavailability of appropriate tools, lengthy completion time of OMs, lack of resources such as funding, office space and lack of training on how to use OMs. The major crucial factors hindering the use of OMs are depicted in [Figure 6].
A positive but weak relationship (i.e. r = 0.082) between the respondents' level of knowledge and frequency of application of OMs which is not significant (ρ = 0.596 > 0.05) is shown in [Table 2] The relationship between the respondents' level of knowledge of OMs and their perception of the cases in which the use of the OMs is most useful was found to be also weak but positive (i.e. r = 0.193) and it is also not significant (ρ = 0.210 > 0.05). The relationship between the respondents' level of knowledge of OMs and their attitude towards standard practice for the use of OMs was also found to be weak but positive (i.e. r = 0.053) and it is also not significant (ρ = 0.730 > 0.05).
|Table 2: Relationship between respondents' level of knowledge, perception, attitude and frequency of application of outcome measures|
Click here to view
[Table 2] also shows a weak but negative relationship (i.e. r = −0.125) between the respondents' frequency of application of OMs and their perception of the ICF domains in which the use of the OMs is most useful. This is also not significant (ρ = 0.416 > 0.05). Furthermore, it could be seen that that there is also a weak but positive relationship (i.e. r = 0.192) between the respondents' frequency of application of OMs and their attitude towards standard practice for the use of OMs. This is also not significant (ρ = 0.211 > 0.05). Finally, [Table 2] shows that the relationship between the respondents' perception of the ICF domains in which the use of the OMs is most useful and their attitude towards standard practice for the use of OMs is weak but negative (i.e. r = −0.142). This is also not significant (ρ = 0.359 > 0.05).
| Discussion|| |
This study addressed the factors associated with the use of OMs among physiotherapists managing neurological patients in tertiary hospitals in North-Western Nigeria. 88.7% of the respondents had bachelor's degree. This agrees with Akinpelu and Eluchie's findings in a study that identified the familiarity with knowledge and general utilisation of SOMs among physiotherapists in various specialisations in Nigeria. They indicated that majority (81.4%) of their respondents had bachelor's degree. There is no postgraduate clinical programme for physiotherapists in Nigeria and most hospitals regard MSc and PhD as academic programmes that do not have relevance to clinical practice. Thus, obtaining formal release from employers for postgraduate studies is difficult for physiotherapists practicing in clinical settings in Nigeria.
Majority (80.8%) of the respondents also reported working in all hospital settings, i.e., both inpatients and outpatient. This also shows that they have a heavy workload in their practice, thereby not being able to create the required time in patients' assessment using OMs. Majority of respondents were fresh graduates with <5 years' experience and therefore need more supervision by their senior colleagues to change their attitude towards the use of OMs in clinical practice. It also indicates the need to persuade more physiotherapists in North-Western Nigeria to undertake postgraduate courses of study and advocacy to influence formal release of physiotherapists by hospitals for postgraduate programmes.
Another major finding indicated that respondents participated in continuous professional development activities, meaning that they were also updating their knowledge and clinical career. However, majority (about 50%) reported attending once annually, which is not adequate to ensure good clinical practice. Participation in continuous professional development activities should be encouraged, especially relating to the use of OMs.
The results of the survey indicated that most physiotherapists in this study were familiar with OMs. Majority (72.9%) of the respondents had high-level knowledge of OMs, which is in agreement with previous studies.,, This disagrees with Akinpelu and Eluchie's findings which reported that most physiotherapists in Nigeria were not familiar with most of the listed SOMs presented in their study. This is probably due to the fact that the study of Akinpelu and Eluchie was carried out about 10 years ago, when familiarity and usage of the OMs in Nigeria were low.
Surprisingly, even though the knowledge of OMs as shown in this study is high, the frequency of use in clinical practice was low (88.4%). A large proportion of the respondents reported the use OMs but not often. This implies low frequency of outcome assessment and EBP among physiotherapists in the study population. This is in agreement with Jette et al.'s findings that 'despite more than a decade of development and testing of measures appropriate for various conditions and practice settings, the physical therapy profession appears to have some distance to go in implementing standardised outcome measurement routinely in most clinical settings'.
Majority (77.1%) of the physiotherapists managing neurological conditions in the tertiary hospitals in North-Western Nigeria had poor attitude towards standard practice on the use of OMs, and they believed that OMs were most useful for outpatient cases only.
Among the listed barriers in the study questionnaire, majority of the respondents indicated that the major barriers hindering the usage were unavailability of appropriate tools, lengthy completion time of OMs and lack of resources such as funding, office space and lack of training on how to use the OMs. The availability of OMs, relevant resources and training for their usage are the responsibility of hospital managements with recommendations from staff and heads of departments. These responsibilities may not have been taken by the relevant stakeholders. The small number of physiotherapists in the study settings compared to very large number of neurological patients seen, the pressure to treat many patients daily and lack of use of clinical practice guidelines may have caused the complaint for lengthy completion time of OMs.
Physiotherapists had good knowledge, poor attitude and low frequency of application of OMs in clinical practice in North-Western Nigeria. This implies that there is still room for improvement in acquiring more in-depth knowledge, correcting the poor attitude and low frequency of application of OMs, and if this can be achieved, more physiotherapists will be able to practice appropriately using EBP. However, this cannot be achieved in a short period of time but can be reinforced through further education and training activities. The main limitation of this study is depending on reported, rather than observed behaviours, and hence, respondents' social desirability bias may be present.
| Conclusion|| |
This study showed that majority of the respondents had a high knowledge of the OMs and have recognised their importance in clinical decision-making and in providing the most appropriate care for their patients. Despite all these, they do not make use of the OMs regularly in their day-to-day practice. The most crucial factors reported hindering the use of OMs were unavailability of appropriate tools, lengthy completion time of the OMs, lack of resources (funding, availability of office space) and lack of training on how to use the OMs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. Prevalence of Mental Disorders, Global Health Estimates 2014 Summary. Geneva: World Health Organization; 2014.
MacDonald BK, Cockerell OC, Sander JW, Shorvon SD. The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain 2000;123 (Pt 4):665-76.
Law M, MacDermid J. Evidence-based Rehabilitation: A Guide to Practice.2008(2nd
ed): Slack incorporated 6900 Grove Road Thorofare, NJ 08086 USA.
McGlynn M, Cott CA. Weighing the evidence: Clinical decision making in neurological physical therapy. Physiother Can 2007;59:241-52.
Swinkels RA, van Peppen RP, Wittink H, Custers JW, Beurskens AJ. Current use and barriers and facilitators for implementation of standardised measures in physical therapy in the Netherlands. BMC Musculoskelet Disord 2011;12:106.
Chesson R, Macleo M, Massie S. Outcome measures used in therapy departments in Scotland. Physiotherapy 1996;82:673-9.
Kay TM, Huijbregts M. Physical rehabilitation outcome measures: A guide to enhanced clinical decision making. Physiother Can 2003;55:53.
Mayo N, Cole B, Dowler J, Gowland C, Finch E. Use of outcome measurement in physiotherapy: Survey of current practice. Can J Rehabil 1993;7:81-2.
Jette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of standardized outcome measures in physical therapist practice: Perceptions and applications. Phys Ther 2009;89:125-35.
Van Peppen RP, Maissan FJ, Van Genderen FR, Van Dolder R, Van Meeteren NL. Outcome measures in physiotherapy management of patients with stroke: A survey into self-reported use, and barriers to and facilitators for use. Physiother Res Int 2008;13:255-70.
Huijbregts MP, Myers AM, Kay TM, Gavin TS. Systematic outcome measurement in clinical practice: Challenges experienced by physiotherapists. Physiother Can 2002;54:25-36.
Bentley J. A physiotherapy perspective on the dilemmas of outcome measurement in severe and complex brain injury rehabilitation. Physiotherapy 2001;87:593-9.
Skinner A, Turner-Stokes L. The use of standardized outcome measures in rehabilitation centres in the UK. Clin Rehabil 2006;20:609-15.
Copeland JM, Taylor WJ, Dean SG. Factors influencing the use of outcome measures for patients with low back pain: A survey of New Zealand physical therapists. Phys Ther 2008;88:1492-505.
Akinpelu AO, Eluchie NC. Familiarity with, knowledge, and utilization of standardized outcome measures among physiotherapists in Nigeria. Physiother Theory Pract 2006;22:61-72.
Haigh R, Tennant A, Biering-Sørensen F, Grimby G, Marincek C, Phillips S, et al
. The use of outcome measures in physical medicine and rehabilitation within Europe. J Rehabil Med 2001;33:273-8.
Stokes EK, O'Neill D. Use of outcome measures in physiotherapy practice in Ireland from 1998 to 2003 and comparison to Canadian trends. Physiother Can 2008;60:109-16.
Turner-Stokes L, Turner-Stokes T. The use of standardized outcome measures in rehabilitation centres in the UK. Clin Rehabil 1997;11:306-13.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2]