Role of Physiotherapy in Ugandan Neurosurgical Transitional Care (2023-2024)

Background

Neurotrauma related to road traffic injury is a leading cause of admissions to Ugandan hospitals. Evidence-based practice supports appropriately incorporating rehabilitation after hospital discharge to reduce disability, improve functional mobility and reduce readmission rates. However, Uganda is estimated to have only 2.5 physiotherapists per 100,000 persons, with even fewer occupational or speech therapists. Neurosurgical patients have limited contact with these services before discharge. 

In order to improve patient outcomes, it is important to identify rehabilitation services’ roles in discharge planning for the hospital-to-community transition. Existing research identifies roles of providers, patients and caregivers during care transition for patients with traumatic brain injury (TBI). These findings can inform a discharge protocol intervention. However, there is a scarcity of implementation measure data, which are key to optimizing intervention implementation. 

An international approach to determining the role of rehabilitation in discharge planning is necessary to inform the global process of developing transitional care models in emerging health systems. Further, careful cultural tailoring is necessary to improve Ugandan patient outcomes and contribute to national rehabilitation sector strengthening.

Project Description

The long-term goal of this ongoing project is to develop a culturally appropriate protocol for rehabilitation practices in hospital TBI patient discharge processes. Ideally, this protocol will be adopted by key stakeholders in Uganda. The goal of the 2023-2024 project team is to pilot an interdisciplinary referral protocol intervention for TBI patients in Ugandan hospitals, in order to establish the acceptability and feasibility of such an intervention relative to standard care. 

This goal will be met through three steps. First, the team will assess current acceptability of rehabilitation interventions among TBI medical professionals. They will do so through a synthesis of peer-reviewed literature and past projects, as well as a qualitative study of focus groups. Second, the team will assess the feasibility of implementing the intervention in two hospital wards. Finally, the team will assess the reach of the rehabilitation intervention among patients with TBI. 

The second and third steps will be conducted by the team through quasiexperimental research design that ensures effective and respectful engagement with patients and caregivers. 

Anticipated Outputs

Implementation of referral mechanisms; evaluation of impact; application for external funding; abstracts for conference submission; manuscript submissions; development of virtual educational methodology for future large-scale cross-cultural teaching

Student Opportunities

Ideally, this project team will include 2 graduate students and 10 undergraduate students. Continuing team members will elevate to various leadership roles within the team. Some project team members will be from Duke and others will be from Mbarara University of Science and Technology (MUST) in Uganda. Team members will be divided into two subteams, each with 1 graduate student, 2-3 Duke students and 2-3 MUST students.

Applicants should be interested in participation in mixed-methods research, developing manuscript writing and publication skills, and advocating for multidisciplinary healthcare. They also may be considering advanced degrees in physical therapy or neurorehabilitation. Applicable skills include cross-cultural communication, survey development, focus group or interviewing, data collection and analysis, project management, manuscript writing or research statistics.

Majors of undergraduate team members at Duke may include prehealth-based majors, anthropology, global health, data science-related majors and public policy. Undergraduate team members from MUST will ideally be studying physiotherapy. Graduate students may come from a variety of disciplines, including medicine, statistics, global health, public health, epidemiology, physical therapy, sociology, anthropology, biology and social work.

All students will gain experience with Institutional Review Board (IRB) processes, development of a long-term research project, interdisciplinary and mixed-methods research, cross-cultural collaboration, data analysis, manuscript writing and publication, and giving presentations. Team leads will additionally gain mentoring and leadership skills and have the opportunity to participate in a conference. 
Select students will have the opportunity to travel to Kampala and Mbarara, Uganda in Summer 2024.

Timing

Fall 2023 – Summer 2024

  • Fall 2023: Complete lecture series and project development; create team protocols; perform literature review; prepare focus group; present to Duke and MUST faculty
  • Spring 2024: Submit IRB protocol; collect and analyze sample data
  • Summer 2024 (optional): Implement project; evaluate research data; develop manuscripts with cross-cultural collaboration; perform literature review on post-hospital resources

Crediting

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

This Team in the News

Duke Names Fourth Class of Nakayama Scholars

Meet the Winners of the 2024 Bass Connections Student Research Awards
 

See earlier related team, Role of Physiotherapy in Ugandan Neurosurgical Transitional Care (2022-2023).
 

Image: Uganda-006-RH, by BerbeeWalsh Department of Emergency Medicine, licensed under CC BY-NC 2.0

Exterior view of entrance to Mbale Regional Referral Hospital.

Team Leaders

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

/undergraduate Team Members

  • Amy Fulton, Neuroscience (AB)
  • Jasmine Innis, Psychology (BS)
  • Taranjit Saggu, Neuroscience (BS)

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