Inclusion of physical therapy services on a short term mobile medical mission team to Nicaragua: a qualitative description study of team members’ observations and recommendations for improvement

Authors

  • Douglas Steele At the time of research Harding University Currently UF Health (JAX) Department of Orthopedic Surgery and Rehabilitation)
  • Candice Beitman University of Indianapolis Retired Associate Professor School of Occupational Therapy

DOI:

https://doi.org/10.15566/cjgh.v2i2.81

Keywords:

Poverty, disability, limited rehabilitation providers, short term medical missions, physical therapy

Abstract

Abstract

Context: Access to physical therapy (PT) services is sorely limited in many developing countries due to the constraints of poverty and regional insufficiency in the number of PT providers.   Opportunities exist for physical therapists to participate in short term mobile medical mission (STMMM) efforts to provide PT services in many of those regions.  However, there is a relative dearth of research regarding the utility of including PT services in STMMM endeavors.

Objective: The aim of this study was to ascertain the impressions and recommendations of medical mission team members regarding the inclusion of PT services during a STMMM trip to underserved areas of Nicaragua.

Methods: This was a qualitative description study conducted in 2014.  Data were derived from interviews with STMMM participants and analyzed using conventional content analysis as described by Hsieh and Shannon.

Results: Emergent themes included evidence of: (1) patient need for and benefit from PT services; (2) team member need for physical therapy services for trip related disorders; and (3) a high prevalence of patient orthopedic disorders related to strenuous activities of daily living.  There were also a number of reported limitations in the delivery of PT services including: (1) language barriers; (2) lack of medical provider familiarity with PT capability; and (3) limited means of providing follow up care.  Respondent recommendations included: (1) addition of more translators; (2) inclusion of additional treatment modalities; (3) utilization of Nicaraguan therapists or health care workers to facilitate patient follow up; and (4) the provision of a comprehensive screening program to improve identification of patients in need of PT services.

Conclusion: This results of this study contributes to the understanding of corollaries associated with the addition of PT services to a STMMM and provides recommendations to improve PT services in that context.  Additional research is needed to evaluate the soundness of participant responses and whether this information is transferable to STMMM efforts in other communities.  Also, further research is needed to establish best PT practices in the STMMM context.

Author Biographies

Douglas Steele, At the time of research Harding University Currently UF Health (JAX) Department of Orthopedic Surgery and Rehabilitation)

Douglas Steele DHS, DPT, MHS, PA-C, PT, CPT

At time of research

Assistant Professor of Allied Health

Currently

Physican Assistant: UF Health Department of Orthopedic Surgery and Rehabiliation

Candice Beitman, University of Indianapolis Retired Associate Professor School of Occupational Therapy

Candice Beitman OT EdD

University of Indianapolis
Retired
Associate Professor
School of Occupational Therapy

References

Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Rahman MH. Poverty and access to health care in developing countries. Ann N Y Acad Sci. 2008;1136:161-171.

Campbell J, Dussault G, Buchan J, Pozo-Martin F, et al. A universal truth: no health without a workforce. Global Health Workforce Alliance and World Health Organization. Global Health Workforce Alliance Website.

http://www.who.int/workforcealliance/knowledge/resources/hrhreport2013/en/

Published November 2013. Accessed January 5, 2014.

Officer A, Posarac A. World report on disability. World Health Organization. World Health Organization Website. http://whqlibdoc.who.int/publications/2011/9789240685215_eng.pdf Published 2011. Accessed March 15, 2013.

Liao H, Lai J, Chai H, Yaung C, Liao W. Supply of physical therapists in member countries of the World Confederation for Physical Therapy. Physiotherapy Theory and Practice. 1997;13:227-234.

Gupta N, Castillo-Laborde C, Landry MD. Health-related rehabilitation services: assessing the global supply of and need for human resources. BMC Health Serv Res. 2011;17:276-287.

World Health Organization. Nicaragua: country cooperation strategy at a glance. World Health Organization Website. https://extranet.who.int/iris/restricted/bitstream/10665/136781/1/ccsbrief_nic_es.pdf

Accessed April 28, 2014. (Currently only available in Spanish)

Dupre AM, Goodgold S. Implementation of a physical therapy needs assessment in Nicaragua. [abstract]. Physical Therapy Online. 2005. American Physical Therapy Association Website.

http://aptaapps.apta.org/Abstracts/abstract.aspx?abnum=QUNQUFBUMDV8UE8tU0ktMTMtVEguSFRNTA Published 2005. Accessed April 28, 2014.

Cano O. Interview, February, 2003. Cited by Jarquin FT. International Disability Monitor. Regional Report of the Americas (Nicaragua). http://www.idrmnet.org/content.cfm?id=5E5A75&m=3 Published 2004. Accessed 5/8/2014.

Spring of hope Uganda. Spring of hope Uganda Website. http://www.springofhope.org.uk/index.html Accessed April 29, 2014.

Global health outreach. Christian Physical Therapists International Website. http://www.cpti.org/mis_opps.html Accessed April 29, 2014.

Health Volunteers Overseas. Physical Therapy. Health Volunteers Overseas Website. http://www.hvousa.org/ourwork/programs/physical-therapy/ Accessed April 29, 2014.

Short term missions.com. Short term missions.com Website. http://www.shorttermmissions.com/trips/8117/?STM=096bb91a9b4b2cce37c3070c193996d6 Accessed April 29, 2014.

Standing with Hope. Standing With Hope Website.

http://www.standingwithhope.com/outreaches/prosthetics/participate-trip/

Accessed January 7, 2015.

Bajkiewicz C. Evaluating short-term missions: how can we improve? J Christ Nurs. 2009;26:110-114.

Ketter P. PT helps Nicaraguans recover from hurricane. PT Bulletin. 1999;14:3.

Nixon S, Cleaver S, Stevens M, Hard J, Landry M. The Role of Physical Therapists in Natural Disasters: What Can We Learn from the Earthquake in Haiti? Physiother Can. 2010; 62:167–168.

Faanes E. Experiences of Physical Therapists who Participate in Disaster Relief Work in Haiti [Doctor of Physical Therapy Research Paper]. Saint Paul, MN: St. Catherine University Sophia. St. Catherine University Sophia Website.

http://sophia.stkate.edu/cgi/viewcontent.cgi?article=1013&context=dpt_papers

Published 2012. Accessed March 20, 2013.

Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23:334-340.

Sequeira M, Espinoza H, Amador JJ, Domingo G, Quintanilla M, de los Santos T. The Nicaraguan Health System. Seattle, Washington: PATH; 2011.

http://www.path.org/publications/files/TS-nicaragua-health-system-rpt.pdf Published 2011. Accessed June 3, 2014.

Nicholls D. Qualitative research: Part three-Methods. Int J Ther Rehabil. 2009;6:638-647.

McLellen E, Macqueen K, Neidig J. Beyond the Qualitative Interview: Data Preparation and Transcription. Field Methods. 2003;15:63-84.

Hsiu-Fang H. Shannon S. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277-1288.

Mays N, Pope C. Rigour and qualitative research. BMJ. 1995;311(6997):109-112.

Koch T. Establishing rigour in qualitative research: The decision trail. Journal of Advanced Nursing.1993;19: 976-986.

Seale C, Silverman D. Ensuring rigour in qualitative research. European Journal of Public Health. 1997;7:379-384.

Golafshani N. Understanding reliability and validity in qualitative research

The Qualitative Report. 2003;8:597-607.

http://www.nova.edu/ssss/QR/QR8-4/golafshani.pdf Accessed May 30, 2014.

Tobin GA, Begley C.M. Methodological rigour within a qualitative framework Journal of Advanced Nursing. 2004;48:388-396.

Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage Publications; 1985.

Trochim M.K. Qualitative validity. Research Methods Knowledge Base website.

http://www.socialresearchmethods.net/kb/qualval.php

Revised October 20, 2006. Accessed June 3, 2014.

Flores G. The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review Med Care Res Rev 2005;62;255-299. DOI: 10.1177/1077558705275416

Jack K, McLeanb SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review. Man Ther. 2010;15: 220–228.

Sluijs E.M., Kok G.J., van der Zee J. Correlates of exercise compliance in physical therapy. Physical Therapy. 1993;73:771–782.

Picorelli AM, Pereira DS, Felício DC, et al. Adherence of older women with strength training and aerobic exercise. Clin Interv Aging. 2014;9:323-331. doi: 10.2147/CIA.S54644.

Medina-Mirapeix F, Escolar-Reina P, Gascón-Cánovas JJ. et al. Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study. BMC Musculoskelet Disord. 2009 ;10:155. doi: 10.1186/1471-2474-10-155.

Härkäpää K, Järvikoski A, Mellin G, Hurri H. A controlled study on the outcome of inpatient and outpatient treatment of low back pain. Scand J Rehabil Med. 1989;21:81-89.

Ice R. Long-term compliance. Phys Ther. 1985;65:1832-1839.

Martin JE, Dubbert PM. Exercise applications and promotion in behavioral medicine: current status and future directions. J Consult Clin Psychol. 1982;50:1004-1017.

Jette AM. Improving patient cooperation with arthritis treatment regimens. Arthritis Rheum.1982;25:447-453.

Stanton PE, Fox FK, Frangos KM, Hoover DH, Spilecki GM. Assessment of resident physicians' knowledge of physical therapy. Phys Ther. 1985;65:27-30.

Uili RM, Shepard KF, Savinar E. Physician knowledge and utilization of physical therapy procedures Phys Ther. 1984;64:1523-1530.

Harrison FG1, Kisicki DS. How knowledgeable are physician assistants and nurse practitioners about physical therapy? J Allied Health. 2006;35:227-339.

Grissom M. Disorders of childhood growth and development: screening and evaluation of the child who misses developmental milestones. FP Essent. 2013 410:32-44.

Downloads

Published

2015-11-05

How to Cite

Steele, D., & Beitman, C. (2015). Inclusion of physical therapy services on a short term mobile medical mission team to Nicaragua: a qualitative description study of team members’ observations and recommendations for improvement. Christian Journal for Global Health, 2(2), 39–51. https://doi.org/10.15566/cjgh.v2i2.81