Role of Rehabilitation in Ugandan Neurosurgical Transitional Care (2024-2025)

Background

Traumatic brain injury from road traffic accidents is a leading cause of Ugandan hospital admissions. Stroke is the second largest cause of disability-adjusted life years in middle age and older adults. Evidence-based practices support incorporating neurorehabilitation in hospital discharge planning to improve functional mobility and reduce disability and readmission rates.

Uganda is estimated to have only 2.5 physiotherapists per 100,000 persons, with even fewer neuropsychologists, occupational therapists and speech therapists. Ugandan patients have limited contact with these services before discharge. Identifying rehabilitation service roles in discharge planning for the hospital to community transition is a key opportunity to improve patient outcomes.

While Ugandan medical and rehabilitation providers perceive multidisciplinary care as necessary within a discharge planning protocol, they report severe limitations in workforce, time and documentation. International protocols are not fully suitable in this setting, and there is a paucity of research on the appropriateness and usability of any discharge planning protocol to meet Uganda's healthcare system's needs. 

International partnerships create collaborative growth while tailoring solutions for local practice. This ongoing project and international partnership investigates rehabilitation's role in discharge planning to inform the global process of developing and tailoring transitional care models in emerging health systems.

Project Description

The project team will work to develop a culturally appropriate protocol for rehabilitation involvement in hospital neurologic patient discharge planning to be adopted as recommended practice by key Ugandan stakeholders. Building on the work of previous teams, the 2024-2025 team will revise and expand a discharge planning protocol to meet needs of multiple providers and users relative to pilot implementation.

Team members will define implementation measures (e.g., acceptability, feasibility, adoption, reach) of a pilot protocol with physiotherapists. The project team will extend the protocol to include other vital neurorehabilitation services such as occupational or speech therapy and neuropsychology. The team will utilize brain injury and stroke support groups as community engagement partners. Team members will use a mixed-method design to assess appropriateness and usability of the revised and expanded protocol to inform further development and meet needs of target users.

Focus groups with previous patients and caregivers will inform health concerns and usability. Findings will be reported to a team of support group-based healthcare providers, prior patients and caregivers. 

Anticipated Outputs

Discharge planning protocol; outreach presentations; data for grant applications; conference abstracts; peer-reviewed manuscript

Student Opportunities

Ideally, this project team will include 2-4 graduate students and 6-10 undergraduate students with majors and interests in heath, cultural anthropology, global health, data science, public policy, physiotherapy, medicine, statistics, epidemiology, physical therapy, sociology, biology and/or social work. Students with skills in cross-cultural communication, qualitative methodologies, data collection and analysis, project management and/or manuscript writing will be preferred. All students should be excited to learn about research implementation, developing manuscript skills, conversing about equitable global partnerships and advocating multidisciplinary healthcare. 

Team members will develop and practice cross-cultural collaboration. Students will gain experience in ethical issues surrounding global health, long-term research project organization and development, data analysis, manuscript writing, academic presentation and research dissemination. The team will be exposed to differing healthcare systems, research methodologies, neurorehabilitation professions and applications of multidisciplinary care in health settings.

All students will participate in lessons on professionalism in international research and reflection exercises to develop problem-solving strategies in cross-cultural exchange. Students will guide an Appreciative Inquiry Workshop to produce goals and approaches of international student teams. 

The team will break into subteams that meet once per week in addition to weekly full-team meetings. The team will hold monthly mentorship meetings between faculty and student team leaders.

In optional summer components, students will participate in an orientation, perform literature review, analyze data and contribute to manuscript writing. Selected students will travel to Kampala and Mbarara, Uganda and have the opportunity to travel to Tokyo, Japan for World Physiotherapy Congress in May 2025.

Timing

Summer 2024 – Summer 2025

  • Summer 2024 (optional): Host orientation meetings; perform literature review
  • Fall 2024: Consult support group and experts; synthesize data from prior projects; seek IRB approval; present to faculty
  • Spring 2025: Collect, clean and analyze data; travel to Tokyo, Japan for conference
  • Summer 2025 (optional): Clean and analyze data; evaluate project; write manuscript; report to hospital; travel to Kampala and Mbarara, Uganda

Crediting

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

See earlier related team Role of Physiotherapy in Ugandan Neurosurgical Transitional Care (2023-2024).

 

Image: Kampala, Uganda, by Carlos Felipe Pardo, licensed under CC BY 2.0

Image: _DSC1644.jpg (Kampala, Uganda), by Carlos Felipe Pardo, licensed under CC BY 2.0

Team Leaders

  • Kira Battle Bullock, School of Medicine-Neurosurgery
  • Michael Haglund, Duke Global Health Institute|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
  • Bradley Kolls, School of Medicine-Neurology
  • Kearsley Stewart, Duke Global Health Institute

/zcommunity Team Members

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