Evaluation of Physical Therapy Services in Burn Departments in Governmental Hospitals of Upper Egypt

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1 Med. J. Cairo Univ., Vol. 84, No. 2, December: , Evaluation of Physical Therapy Services in Burn Departments in Governmental s of Upper Egypt SAMAR H. MOHAMMED, M.Sc.*; MOHAMMED M.A. KHALAF, Ph.D.*; FATMA AL-ZAHRAA H. KAMEL, Ph.D.* and MONA A. EL-AWADY, Ph.D.** The Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University* and The Department of Community & Public Health, Faculty of Medicine, Benha University** Abstract Background: The quality of service delivery has become an important focus of attention for every one employed in health care. This has led to improving services delivery and the patient's quality of life. Purpose: To evaluate Physical Therapy services in Burn Departments in Governmental s of Upper Egypt in order to assess areas of weakness as well as areas of strengths to improve the quality of physical therapy services. Methods: Evaluation of physical therapy services was measured by comparing it with European Core Standards of physiotherapy practice. Two tools of European Core Standards of physiotherapy practice were used. Core standards patient record questionnaire and patient feedback questionnaire. Results: There were a statistical significant difference in the levels of performance between the studied hospitals, level of education, years of experience and the marital status of the physical therapists; also there was significant difference in level of performance between married and single physical therapists. As related to patient feedback questionnaire, there was great significance difference of physical therapy services between outpatients and inpatients. Conclusion: Physical therapy services in burn Departments in Governmental s of Upper Egypt need to be improved as it have many areas of weakness. Key Words: Core standards for physiotherapy Egyptian accreditation Physical therapists performance. Introduction PHYSICAL therapy is a vital form of professional patient care that can be applied in most disciplines of medicine. It emphasizes the use of physical therapy approaches in the promotion maintenance and restoration of an individual's physical, psychological and social wellbeing and takes into account Correspondence to: Dr. Samar H. Mohammed, The Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University individual variations in health status [1]. It is the newest and yet the oldest field of medical practice. Physical therapy practice is supported and influenced by evidence of clinical effectiveness and practitioners may work independently or as members of the health care team [2]. There is an urgent need for physical therapy services to identify physical impairments, limitations and disabilities that prevent people from being independent as they can be. They analyze the source of problems, determine ways of overcoming them, and maximize the individual's movement potential. While physical therapists provide treatment, they also promote people health, fitness, and wellness [3]. Quality of physiotherapist practice depends on: Respect the rights and dignity of all individuals, comply with the laws and regulations governing the practice of physiotherapy in the country in which they work, accept responsibility for the exercise of sound judgment, provide an honest, competent and accountable professional service; are committed to providing quality services according to quality policies and objectives defined by their national physiotherapy association [4], provide accurate information to clients, to other agencies and the community about physiotherapy and the services physiotherapists provide and contribute to the planning and development of services which address the health needs of the community [5]. There are several reasons to evaluate employee performance: First: Evaluation plays an integral role in employer's performance management process, it translates the employer's strategic goals, second: The evaluation lets the boss develop a plan for correcting any deficiencies, third: Evaluation 211

2 212 Evaluation of Physical Therapy Services in Burn Departments should serve as useful career planning purpose by providing the opportunity to review the employee's career plans in light of her strengths and weakness. And last but not least the evaluation almost always affects the employee's salary raise and promotional decisions [6]. Subjects and Methods The total number of physical therapists in the selected hospitals at the time of the study was 49 enrolled in documentations of patients recording, and a random sample of 225 patients either in patient or outpatient from Burn Departments of Governmental s of Upper Egypt participated in the study. This study was conducted from March 215 till February 216; the physical therapists were classified according to years of experience into 4 groups. Practitioner: From to 5 years of experience after graduation. Third degree: From more than 5 to 11 years of experience after graduation. Second degree: From more than 11 to 17 years of experience after graduation. First degree: More than 17 years of experience after graduation. Selection criteria: A- In respect to hospitals: Six governmental hospitals in Upper Egypt one hospital in Bni Sweef, one hospital in El-Minia, one hospital in Assuit, three hospitals in Sohag. Were selected to represent the sample, namely: In Bni Sweef: Bni Sweef General. In El-Minia: El-Minia General. In Assuit: Assuit General. In Sohag: Akhmim General, Sohag General and Sohag Educational. B- In respect of patients' record and patients' sample: The patients have the following criteria: All patients were of both sexes, age of patients ranged from 18-5 years old, selection of patient's record within the last two years at least. At least, there were 12 visits for each patient, the sample size should be not less than 1 patients' records for each physical therapist, the selection of patients should include both inpatients and out patients, randomized selection of patients record. Equipment and tools: The study included investigations of: (1) Patient record audit, (2) Patient feedback audit. 1- Patient record audit: It measures standards and criteria for which the patient record provides evidence of compliance. The patients record audit sheet consists of: A- Demographic data. B- Patient record audit data. 2- Patient feedback audit: The patient feedback questionnaire measures those standards and criteria where the patient is best placed to judge conformance. Patient feedback audit consists of two main sections: A- Demographic data of the patients. B- Patient feedback questionnaire. Procedure of the study: Formal permissions were obtained from the directors of the hospitals to facilitate data collection. The objectives as well as methodology of the study were explained to the heads of physical therapy departments. Regarding the patient record questionnaire, the demographic characteristic of the studied physical therapists were obtained from the head of each Physical Therapist Department. Ten patient records for each studied physical therapist and those in medical records were reviewed to evaluate whether the physical therapists practice will meet the core standards and criteria of physical therapy practice or not. Scoring system: The possible range of scores on each item is 3-1 with a highest score of 3 reflecting the behavior that is used frequently, 2 reflecting the behavior that is used less frequently, 1 reflecting the behavior that is never used. Statistical procedure: After collecting data, they were coded and transformed into especially designed format to be suitable for computer processing. Data will be analyzed using the statistical package for social sciences. The following statistical measures will be used: 1- Mann-whitney tests to compare two groups. 2- Kruskal-Wallis tests to compare between more than two groups.

3 Samar H. Mohammed, et al Tests of association (chi-square) and z. analysis were performed to determine statistical significance for normal data [7]. Results The obtained data from patient's record audit can be presented and discussed under the following: I- Assessment of physical therapist performance according to patient's record. Number of physical therapists sharing in these studies according to hospitals: Six hospitals in different regions in Upper Egypt, one hospital in Bni Sweef, one hospital in El-Minia, one hospital in Assuit, three hospitals in Sohag. Were selected to represent the sample, namely: Bni Sweef General : There are 8 physical therapists, El-Minia General : There are 8 physical therapists, Assuit General : There are 8 physical therapists, Akhmim General : There are 8 physical therapists, Sohag General : There are 1 physical therapists, Sohag Educational : There are 7 physical therapists. 1- Statistical comparison among different groups of physical therapists according to patients record: Table (1): Difference between groups of physical therapists in their performance among six hospitals. s Number Bni-Sweeef General El-Minia General Assuit General Akhmim General Sohag General Sohag Edu Chisquare Result Total As it shown in Table (1), there was significant difference between groups of physical therapists in their performance among six hospitals Fig. (1): Difference between group of physical therapists in their performance among six hospitals. 2- Difference between B.Sc. and M.Sc. degree of physical therapists and physical therapy service: There was no significant difference between B.Sc. and M.Sc. degree of physical therapists and physical therapy service as in Table (2). Table (2): Difference between B.Sc. and M.Sc. degree of physical therapists and physical therapy service. Total Certificate Number B.Sc. M.Sc. : Significance. N.S. : Non Significance. Z : Mann-Whitney test B.Sc Z Result N.S M.Sc. Fig. (2): Difference between B.Sc. and M.Sc. degree of physical therapists and physical therapy service. 3- Difference between single and married physical therapists and physical therapy service: There was significant difference between single and married physical therapists and physical therapy service; the difference was higher in married physical therapists by (27.76) than the single physical therapists (18.11) as in Table (3).

4 214 Evaluation of Physical Therapy Services in Burn Departments Table (3): Difference between single and married physical therapists and physical therapy service. Marital Number Z Result Total Married Single : Significance. N.S. : Non Significance. Z : Mann-Whitney test. Table (4): Statistical comparison between inpatients and outpatients level responsiveness. Patient Number Z Inpatient Out patient Total : Significance. N.S. : Non Significance. Z : Mann-Whitney test Married Single Fig. (3): Difference between single and married physical therapists and physical therapy service. II- Evaluation of physical therapy service scores of each core standards and its criteria: 1- Statistical comparison between criteria scores of each core standards for each physical therapist in the six hospitals: Statistical analysis revealed that there was significant difference in the levels of physical therapy service between the studied hospitals, the physical therapy service was at higher level in Sohag Educational more than other hospitals, next is Assuit General, next is Sohag General, next is Bni Sweef General, next is El-Minia General, next is Akhmim General. III- Assessment of patients responsiveness according to their demographic characteristics: A- Statistical comparison between inpatients and outpatients level responsiveness: As presented in the table. 225 patients participated in this study: The inpatients were 75 patients with the average value of their total scores while the number of outpatients was 15 patients there is significant effect between the inpatients and outpatients Inpatient Number Outpatient Fig. (4): The average between inpatients and outpatients responsiveness. B- Statistical comparison between patient's age and their level of responsiveness: There was significant difference of patient's age and their level of responsiveness according to the patient's feedback questionnaire as shown in the table, this significance is appear highly in interval age by (145.58). Table (5): Average of patient's responsiveness with different age groups. Patients age Less 25y More 56y Chi- Square Total : Significance. N.S.: Non Significance. C- Statistical comparison between patient's education and their level of responsiveness: There was significant difference between patient's level of education and their level of responsiveness according to the patients feedback questionnaire this significant is highly in patients with high level of education by (155.63) as shown in Table (5).

5 Samar H. Mohammed, et al. 215 Table (6): Statistical comparison between patients education and their level of responsiveness. Level of education No.of patients Chi- Square Low education Middle education High education Total Significant : Significance. N.S.: Non Significance. Discussion Findings from the current study revealed that there is no significant difference in the levels of performance between the studied hospitals: It may be the result of lack of an adequate regulatory system and inadequate human resources in governmental hospitals of Upper Egypt [8]. The result of this study found that there is no significant difference also in the levels of performance in regard to physical therapists gender. However Standing and Baume [8] reported that; most of the low category workers in the health sector are women and they need childcare support in order to reduce absenteeism. While Bruce et al., [9] reported that; previous research showed that experienced and expert female physical therapists value compassion and caring in clinical practice. In regard to the level of education, there was no significant difference in physical therapist s level of performance. The findings from our nominal data indicated that there is no record of high performance, in regard to B.Sc. physical therapists, some of them might be involved in some training courses and/or lifelong learning and they can be classified as expertise, this agree with what Resink and Jensin [1] identified as therapists classified as experts were not distinguished by years of experience, but they are differed in academic and work experience, while M.Sc. physical therapists were involved in doctoral studies so they must have the advantage of diminishing their work hours like other scientific workers. As the result of this, they are overloaded by their work and their studies and don't have the adequate time to complete the patients records [11]. Regarding the marital status of the physical therapists; results revealed that there was significant difference in levels of performance between married and single physical therapists. Married physical therapists were high in their performance, regarding degree of physical therapists there was no statistical significant difference between the four degree of physical therapists. The results of the current study indicated that; the increase in the years of experience of physical therapists in governmental hospitals failed to improve the level of performance. This result did support our hypothesis which expected that there was no significant difference between the number of years of experience (physical therapists degrees) and the physical therapists performance as Romanello [12] expected. Findings of physical therapists total performance scores according to years of experience (physical therapists degree) indicated that 1 st degree physical therapists have higher mean rank (32.21) then the 2nd degree of physical therapist with mean rank (28.11). These findings revealed that the increase of experience years of physical therapists working in Upper Egypt Governmental s may have led them to increase their motivation and job satisfaction due to many reasons; some of them are related to the local working conditions, organizational and management support, team working, communication and autonomy over work, and factors such as appreciation and recognition, obtaining knowledge, skills and attitudes [13]. The current study is consistent to research of Boxall [13] which indicated that: Performance, motivation and job satisfaction are closely related to each other: Motivated staff is more likely to be satisfied with their jobs and therefore remain in their posts and perform well. Dieleman and Harnmeijer [14] reported that: De motivation and dissatisfaction with work lead to poor attitudes from the providers towards their work and their patients. In report of WHO [15] inadequate knowledge, skills and inappropriate attitudes can all form obstacles for a good health care. These obstacles affect the treatment and diagnosis, while practitioner third degree physical therapists were low in their total performance scores, this may be due to their lack of experience, and most of practitioner physical therapists didn't prefer the activity of patients recording, may be because they have been poorly trained or haven't yet met their professional socialization, inadequate training in interviewing patients and recording details and leak in understanding of the need for accurate data collection [16]. Among the findings of physical therapists total performance scores according to their level of

6 216 Evaluation of Physical Therapy Services in Burn Departments education in the current study, statistically significant difference was found between the various levels of education (B.Sc. and M.Sc.) and physical therapists total performance scores. Through the current study and during analyzing each core standard and its criteria; core standard 2 'informed consent' (criteria 2.1), core standard 11 'transfer of care discharge' (criteria 11.2, 11.3, 11.4) and core standard 16 'patient and physiotherapist safety' in regard to core standard 2 (informed consent) world confederation for physical therapy [6] : Expects that: Physical therapists would ensure the appropriate consent has been given before any physical therapy was undertaken. A competent adult should be provided with adequate, intelligible information about the proposed therapy: Description of the intervention, treatment to be provided, a clear explanation of the risks which may be associated with the therapy, expected benefits from the therapy, anticipated time frames, anticipated costs and reasonable alternatives to the recommended therapy [17]. Conclusion: Physical therapy service in Burn Departments in Governmental s of Upper Egypt have strength points which are: - Continuous workshops and training courses every month for the physical therapists. - Longitudinal continuity of the physical therapist treatment (the patient seen by the same physical therapists all the course of treatment). - Medical record is the first priority for physical therapist who was working in some hospitals. While there were weak points which are: - Defect in workshops and training courses. - The medical record was not be the first priority for physical therapists working in some of the selected hospitals and have many defects and not covers all the points of assessment, diagnosis and treatment according to the ideal patient record of the Egyptian Health Ministry. - There was no longitudinal continuity of the physical therapist treatment (the patient seen by more than one physical therapist, which has bad effect on the course of the treatment). - Physical Therapy Departments in some hospitals have no in patients' medical record, and patients can make discharge before complete treatment course and without physical therapists permission. References 1- World Confederation for Physical Therapy: "Policy statement: Standards of physical therapist practice." London, UK: WCPT, The Chartered Society of Physiotherapy: "Guidance on Manual Handling in Physiotherapy." London, UK: CSP, World Confederation for Physical Therapy: "Policy statement: Ethical responsibilities of physical therapists and WCPT members." London, UK: WCPT, LAURA MAE DOUGLASS: "The Effective Nurse: Leader and Manager." 5 th edition, London, Mosby Company, 261-4, European Region of World Confederation for Physical Therapy: "European Region World Confederation for Physical Therapy Glossary of Terms." Brussels, Belgium: ER-WCPT, World Confederation for Physical Therapy: "Declaration of Principles and position Statements." Kensington Charity Centre. London. United Kingdom: 7-17, 21, Updated WAYNE W. DANIEL and CHAD L. CROSS: "Biostatistics. A foundation for analysis in the health science."tenth Edition, January 9, STANDING H. and BAUME E.: Equity, Equal Opportunities, Gender And Organization Performance. In: Eerrinho P., Poz M.R., eds. Towards A Global Health Workforce Strategy. Antwerp, ITG Press: 31-26, BRUCE H., FIELD G. and ANDERSON A.: ing of Caring to 7 Novice Physical Therapists during Their First Year of Clinical practice. Phys. Ther., 88 (1): , RESNISK L. and JENSEN G.: Using Clinical Outcomes to Explore the Theory of Expert Practice in Physical Therapy. Pher., 83 (12): , O'NEIL M., RUBERTONE P. and AUGESTA M.: Community Experiential Learning Opportunities in the Drexel University Professional Doctor of Physical Therapy Program. Journal of Physical Therapy Educational (Fall 27). Pro Quest Information and Learning Company, ROMANELLO M.: Ethic Of Care In Physical Therapy Practice And Education: Challenges And Opportunities. Journal Of Physical Therapy Education. Pro Quest Information And Learning Company, BOXALL L.: Human Recourses Strategy And Competitive Advantage In The Service Sector. Human Resources Management Journal, 13 (3): 5-2, DIELEMAN M. and HARNMEIJER J.: Improving Health Worker Performance: In Search Of Promising Practices. Kit-Royal Tropical Institute The Netherlands. WHO, MATINEZ J. and MARTINEAU T.: Assesing quality, outcome and performancemanagement. Genava, World Health Organization, 211.

7 Samar H. Mohammed, et al LEEMRIJSE C.J., SWINKELS I.C.S. and VEENHOF C.: "Direct Access to Physical Therapy in the Netherlands: Results From the First Year in Community-Based Physical Therapy." Physical Therapy. August, 88 (8): , Chartered Society of Physiotherapy. Learning and development principles for CSP accreditation of qualifying programmes in physiotherapy. London: The Chartered Society of Physiotherapy, 21.