Role of Physiotherapy in Ugandan Neurosurgical Transitional Care (2022-2023)

Background

Neurotrauma related to road traffic injury is a leading cause of admission to Ugandan hospitals. These patients often experience physical and cognitive impairments that require incorporating rehabilitation after hospital discharge – a crucial practice to reduce disability, improve functional mobility and reduce readmission rates. Thus, careful coordination of rehabilitation services during the hospital to community transition is crucial to quality patient care. Transitional care utilizes discharge practice to serve this connection.

A transitional care model must fit a society’s culture and resources. In Uganda, rehabilitation is an emerging healthcare service. The accessibility of rehabilitation services after the transition to community represents a knowledge gap. The extent of availability and accommodation of outpatient rehabilitation as well as the patient barriers to seeking, reaching and engaging in these services is unknown.

An international approach to determine rehabilitation’s role in discharge planning for neurosurgical patients will inform the development of transitional care models in emerging health systems. Further, cultural tailoring will improve Ugandan patient outcomes and contribute to strengthening the national rehabilitation sector.

Project Description

This project team aims to examine current and emerging post-hospital rehabilitation resources for traumatic brain injury (TBI) or new spinal cord injury (SCI) patients from stakeholder groups and identify patient/caregiver barriers and facilitators to accessing these resources. Long-term, this project contributes to a multiyear goal to develop a culturally appropriate protocol for rehabilitation involvement in hospital discharge planning of TBI and SCI patients, to be adopted as recommended practice by key national stakeholders in Uganda.

Conducting a situational analysis, team members will synthesize information from peer-reviewed literature and public data that maps post-hospital rehabilitation resources. The team will complete key stakeholder interviews to further identify emerging resources. Team members will collaborate on cultural adaptation of tools, tailoring research plans and methods to resource availability, and explore the effect of variations in health care systems on research implementation. 

Through qualitative design, the team will select a methodology for engaging with TBI/SCI patients and caregiver populations. 

All team members will engage with international collaborators and take part in the development of an international research team. 

Anticipated Outputs

Data for developing/testing and further research; referral protocol from hospital to post-hospital rehabilitation resources; abstract for submission to conferences; manuscript for submission to relevant global health and physiotherapy journals

Student Opportunities

Ideally, this team will be comprised of 1-2 Duke graduate students, 1 Ugandan graduate student, 4 Duke undergraduate students and 4 Ugandan undergraduate students. Interested undergraduate students will most likely have a background in cultural anthropology, global health, public policy and related fields in health and data science. Graduate students will most likely pursue similar fields in addition to statistical science and epidemiology. Students with skills in cross-cultural communication, geospatial mapping, interviewing, data collection or analysis, project management and manuscript writing are preferred. Students with interests in mixed-methods or qualitative research, developing manuscript writing and publication skills, pursuing advanced degrees in physical therapy, neurorehabilitation, international collaboration and learning about rehabilitation sector strengthening are encouraged to apply. 

All students will have the opportunity to develop and practice cross-cultural collaboration skill sets and understand ethical issues surrounding global health. Students will have exposure to differing health care systems. Graduate students will gain leadership skills for managing a project team of undergraduate students with faculty mentorship. Team members will gain knowledge in mixed-methods research, IRB preparation, capacity building in long-term research projects, data analysis, manuscript writing, presentation skills, and disseminating post-project observations alongside sustainable cross-cultural collaboration.

Team members will form two subteams, with a graduate student paired with several undergraduate students for each subteam. Graduate students will be responsible facilitating student meetings, managing team documents and coordinating support needs. There will be a full team meeting once per week as well as a student-led subteam meeting once per week. Graduate students will have a mentorship meeting with team leaders once per month.

Graduate students will receive leadership training to prepare as subteam leaders, and new team members will also have an orientation to become familiar with the team’s research. Team members are expected to complete two reflection exercises in each semester. Team members are expected to complete two reflection exercises in each semester. 

Student travel opportunities to Kampala and possibly Mbarara, Uganda, in Summer 2023 are to be determined.

Timing

Summer 2022 – Summer 2023

  • Summer 2022 (optional): Preparation meetings for subteam leaders and new members
  • Fall 2022: Workshop on team charter and norms creation; didactic lecture series; review of previous data analysis; data synthesis of post-hospital resources; project design
  • Spring 2023: IRB application; mock data collection and analysis
  • Summer 2023 (optional): Project implementation and evaluation; initial manuscript development

Crediting

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

See earlier related team, Role of Physiotherapy in Ugandan Neurosurgical Transitional Care (2021-2022).

 

Image: Traffic in Kampala, by flöschen, licensed under CC BY 2.0

Traffic in Kampala.

Team Leaders

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

/yfaculty/staff Team Members

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