Contextualisation of physiotherapy clinical practice guidelines for hospitalised prematurely born infants in South Africa

Abstract

Background: The incidence of premature infant births in South Africa (SA) is estimated at 168 000 per year. Current concern is that premature birth may be associated with lower educational achievement, greater need for social grants in adulthood and lower rates of employment due to the increased risk of disability caused by post-birth complications. Physiotherapists working in neonatal intensive care units (NICUs), high care units (HCUs) or kangaroo mother care (KMC) wards have a unique window of opportunity to influence the infants’ neuromusculoskeletal systems and motor organisation and monitor respiratory function to decrease the risk of impairment. Physiotherapists working in NICUs, HCUs or KMC wards in high-income countries have well-defined clinical practice guidelines (CPGs) to guide the standard of practice, such guidelines are not available in SA. Ethical approval to conduct this study was obtained from the Research Ethics Committee of the Faculty of Health Sciences, University of Pretoria (99/2014).

Purpose: The primary aim of the study was to contextualise a CPG for physiotherapists treating prematurely born infants in NICUs, HCUs or KMC wards.

Methods: An exploratory sequential mixed methods research approach was followed. Phase 1 was qualitative in nature and consisted of focus group discussions / interviews / online survey with consenting multidisciplinary team (MDT) members and parents or caregivers to gain information on the current patient journeys of prematurely born infants in SA. An integrative literature search was undertaken to identify current CPGs for physiotherapists on the management of prematurely born infants in NICUs, HCUs or KMC wards. Phase 2 entailed the compilation of a questionnaire consisting of the statements identified during the focus group discussions / interviews and recommendations from the identified literature. The statements and recommendations were validated in Phase 3 by using a Delphi method (quantitative research approach)

Results: In Phase 1, four possible patient journeys for prematurely born infants in SA were identified. Seven CPGs or position statements were identified and critically appraised by three appraisers using the AGREE II instrument. Three CPGs / position statements were found to be valid for inclusion in this study and permission for inclusion was obtained from the authors of the selected CPGs / position statements. A list of evidence-based recommendations (from the literature) and statements derived from the patient journey that were appropriate for the SA health care context were validated by expert physiotherapists working in clinical and/or academic settings in NICUs, HCUs or KMC wards in SA. The statements were included in the contextualised CPG if they were graded 60% (and above) by participants.

Conclusion: A clinical practice guideline was contextualised for use by physiotherapists working in NICUs, HCUs or KMC wards in SA. It is recommended that future research be undertaken to determine the application of the CPG in physiotherapy practice in SA.

Implication: The implication is that physiotherapy management of prematurely born infants in NICUs, HCUs and KMC wards in SA could potentially be standardised, and may result in the standardisation of infant care while reducing unwarranted health care cost and outcomes.

Key words: Prematurely born infants, physiotherapy, clinical practice guidelines, contextualisation