Role of Physiotherapy in Ugandan Neurosurgical Transitional Care (2021-2022)

Background

Duke Global Neurosurgery and Neurology (DGNN) and Ugandan healthcare partners have utilized health systems strengthening to expand neurosurgical capacity in Uganda. Postoperative patients often require rehabilitation services to optimize function, manage disability, educate caregivers and reduce adverse events. Therefore, improving neurosurgical capacity demands rehabilitation sector strengthening. 

With these rehabilitation needs, a key area for early collaboration is transitional care. Postoperative functional impairments correlate with adverse events such as falls, leading to readmission. Preventing readmission is critical as wards can be overcrowded with high estimated neurosurgical case deficits. 

Utilizing physiotherapy in transitional care can reduce readmission rates as much as 25 percent for surgical patients through discharge planning and patient education. An international approach to determine physiotherapy’s role in discharge planning and patient education/follow-up will inform global transitional care models, and with careful cultural tailoring will improve Ugandan patient outcomes and contribute to national rehabilitation sector strengthening.

Project Description

This project team will describe current care transitions for Ugandan neurosurgical patients and the role of physiotherapy in these transitions. The team will use a mixed-methods approach consisting of survey implementation and semistructured interviews. 

Team members will describe the current discharge practice, such as the roles of healthcare providers in discharge, factors for discharge and care instructions. They will also examine physiotherapy utilization, assessing the perceptions of healthcare providers on the role and scope of physiotherapy in transitional care and existing barriers to physiotherapy. 

The team will then examine patient and caretaker instruction adherence, looking into which safety instructions, home interventions and follow-up referrals are provided, assessing the accuracy of adherence and determining barriers to compliance.

Learn more about this project team by viewing the team's video.

Anticipated Outputs

Data to inform further development and testing of educational interventions for healthcare providers; consultation protocol; intervention to improve access to physiotherapy before and after discharge; conference abstract; journal manuscript

Student Opportunities

Ideally, this project team will include 3 graduate students and 12 undergraduate students. 

Undergraduate students studying prehealth related subjects, cultural anthropology, global health, data science, public policy and physiotherapy are encouraged to apply. Graduate students will likely be from medicine, statistical science, global health, public health and epidemiology. Additionally, students should demonstrate interest in project leadership and experience with research and research statistics.

Interested students should want to explore sociology, anthropology, biology, medicine, health and social work. They should have interest in participation in mixed-methods research, developing manuscript writing and publication skills, advocating multidisciplinary healthcare, pursuing advanced degrees in physiotherapy and neurorehabilitation. 

Students will develop and improve cross-cultural communication, survey development, focus groups or interviewing, data collection or analysis, project management and manuscript writing.

Faculty will collaborate to develop a didactic lecture series presented in a live virtual classroom shared by Ugandan and Duke students covering research methodology, ethical global partnership, health disparities, and various health profession topics. Students will then divide into three subteams to focus on solving the research aims identified above. 

Students will work with a core faculty member assigned to their subteam as well as team contributors to make final decisions on their research methodology and coordinate a full research protocol intended for IRB submission. Graduate students will lead subteams, create meeting agendas, manage documents, facilitate student-only meetings and meet with core faculty for mentorship. Full team meetings will be once a week for 1.5 hours. Breakout teams will meet twice a week for a total of 1.5 hours. Graduate student mentorship will happen one to two times per month for one hour.

A graduate student will be selected to serve as project manager.

Student travel opportunities are to be determined.

Timing

Fall 2021 – Summer 2022

  • Fall 2021: Lecture series; literature review; project identification and development
  • Spring 2022: Completion of project development; lecture series on IRB writing and research statistics; IRB approval; initial project implementation
  • Summer 2022 (optional): Evaluation of project and research data; manuscript writing

Crediting

Academic credit available for fall and spring semesters; summer funding available

 

Image: Mulago National Referral Hospital Physiotherapy Department, by Richard Kasiita, courtesy of Kira Battle

Mulago National Referral Hospital Physiotherapy Department.

Team Leaders

  • Kira Battle, School of Medicine-Neurosurgery
  • Anthony Fuller, School of Medicine-Neurosurgery
  • Damascene Niyonsenga, Mbarara University of Science and Technology (MUST)

/graduate Team Members

  • Shivani Surati, Global Health - MSc

/undergraduate Team Members

  • Hsien-Yao Chee
  • Spandan Goel
  • Hannah Kitakule
  • Nikhita Mahendru, Neuroscience (BS)
  • Vignesh Pirapaharan
  • Peyton Thompson
  • Audra Whithaus, Psychology (AB)
  • Acelo Worku

/yfaculty/staff Team Members

  • Timothy Dunn, Arts & Sciences-Statistical Science
  • Jeffrey Hoder, School of Medicine-Family Medicine and Community Health: Doctor of Physical Therapy
  • Kearsley Stewart, Duke Global Health Institute

/zcommunity Team Members

  • Wilfred Arubaku, Mbarara University of Science and Technology (MUST)
  • Mbarara Regional Referral Hospital (MRRH)
  • Richard Kasiita, Mulago National Referral Hospital (MNRH)
  • Herman Kazibwe, Mbarara University of Science and Technology (MUST)