ETD Collection

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Author: search.filters.author.Shead, Dorothy Agnes

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    Dissecting the gross anatomy curriculum and pedagogy for South African physiotherapy students
    (2019) Shead, Dorothy Agnes
    Physiotherapists require sound and detailed gross anatomical knowledge to prepare them for safe and competent clinical practice. In South Africa physiotherapy (PT) practitioners are autonomous and provide first line care for patients. In this role they can diagnose a patient’s condition and treat to restore optimal function within the boundaries of their scope of practice. Undergraduate students in this country receive gross anatomy education in the first and/or second year of their PT course. The significance of this research lies in the fact that it addresses the need for a comprehensive perspective on a unified national approach to a gross anatomy curriculum for undergraduate PT students in South Africa. It also identifies the pedagogies best suited for the delivery of such a curriculum to this student body. Studies included in this thesis document facts relating to gross anatomy education for the undergraduate PT student body globally, information from national PT student gross anatomy coordinators and qualified South African physiotherapists and consider the relevance of the relationship between the learning styles of undergraduate PT students and the teaching styles of their gross anatomy lecturers. In South Africa there are eight Health Science Faculties that offer an anatomical grounding to undergraduate PT students as part of baccalaureate courses. They are widely distributed throughout the country. Gross anatomy programmes vary widely in curriculum design and pedagogy used. This thesis brought together global and national perspectives on the topic in order to formulate a unified national approach to gross anatomy education for South African undergraduate PT students. The thesis consisted of four studies that were grouped into Phase 1 (Studies 1 and 2) and Phase 2 (Studies 3 and 4). Four original papers resulted from the findings of Studies 1, 2 and 4. Paper 1 (Appendix 1) of this thesis is a protocol document developed to guide the scoping review process in Study 1. The preparation of the Joanna Briggs institute protocol and charting template ensured that the scoping review that was subsequently carried out followed a systematic, verifiable methodology. Paper 2 (Chapter 3), a scoping review, systematically sourced published or unpublished literature in all languages prior to 20 March 2018, to ascertain the gross anatomical education afforded to undergraduate PT students in the global context. The collation of 1241 sourced documents identified 51 eligible papers for inclusion. Papers were charted into eight categories according to the main focus of the intervention undertaken. Mean sample sizes varied from (216.9 ± 241.3) in the inter-professional category to (55.3 ±30.4) in the ethical, professional and psychological matters category. Overall 26 study samples (51.0%) had input from PT students or PT professionals exclusively in the sample. Key findings emphasised: the relevance of gross anatomy in PT education and how inter-professional education and clinical input in the form of case-base learning factored into this scenario; the increase in computer-assisted learning; the beneficial use of team-based learning and peer teaching; enhancement of professional behaviours during dissection and improved student attitudes to ethics and perceptions of the dignity of human life. These findings were used to compare the global gross anatomy situation with the findings of the national gross anatomy survey undertaken in Paper 3 (Chapter 4). Paper 3 (Chapter 4), a 42-question peer-reviewed online survey established gross anatomy curriculum and pedagogy content for South African undergraduate PT students at all eight relevant Health Science faculties in South Africa. Seven coordinators from six (75%) of the universities responded. Collected data showed that staff qualifications and experience varied widely and high to average staff to student ratios existed between faculties. Total number of weeks in courses per year was 27.6 (± 5.7) varying widely between institutions. Calculable direct contact anatomy hours ranged between 100 and 308 with a mean of 207.6 (±78.1). With the exception of one faculty this is high in comparison to global standards as reported in Paper 2. The main difference noticed between the pedagogy in use globally and locally was that computer-assisted learning was used liberally in the global setting but due to budget constraints only half of the responding faculties used it in South Africa. The findings highlighted disparity between national programmes and therefore confirmed the significance of the study in relation to the identification and formulation of a unified curriculum for the country. The third study (Chapter 5) established what South African physiotherapists in different service delivery spheres, in the Gauteng Province of South Africa, perceived as necessary content for a gross anatomy curriculum and pedagogy for South African PT students. This study used a qualitative grounded theory approach and was conducted using focus group discussions. The sample was PT lecturers, at the University of the Witwatersrand (WITS) and physiotherapists in public hospitals and private practices in Gauteng. Theoretical saturation dictated number of participants and focus groups. Data collection and analysis were simultaneous. Data analysis was inductive to establish themes. Reliability and strength of research factors were implemented. Five focus groups were held (n=32). Overall average age of participants was 29.9 (± 7.8) years and physiotherapy experience was 7.4 (± 7.7) years. The public sector particpants had the lowest mean age of 24.2 (± 2.4) years. Recorded years of experience was highest in the private sector at 12.7 (±7.3). There were more female participants and clinical work areas were diverse in scope of practice. All pedagogies named by participants were in line with the global and national findings (Papers 2 and 3). The suggested anatomy programme content inclusion and exclusion mirrored that suggested in both the global and national perspectives (Papers 2 and 3). The psychological wellbeing of PT students in relation to dissection and coping with ‘anatomy overload’ was raised in the discussions. Seven themes were identified. This study added depth to the overall thesis by incorporating the essential viewpoint of qualified physiotherapists who have the advantage of knowing what is clinically required to ensure effective, professional and competent PT practice post qualification. Paper 4 (Chapter 6) determined the different gross anatomy learning styles utilised by two chronological South African undergraduate PT student cohorts enrolled at WITS and identified the different teaching styles utilised by the gross anatomy instructors, involved in the teaching of those students in the School of Anatomical Sciences at WITS. This study design was cross-sectional and data were collected using the standardised GrashaRiechmann learning style scale (GRLSS) and the Grasha-Riechmann teaching style scale (GRTSS) questionnaires. The key findings from this study offered insight into the type of learning styles PT students use to learn gross anatomy. Student samples were small (Group 1, n=59 and Group 2, n=54) but response rates high (n=39, 66.1% and n= 43, 81.5%) in 2015 and 2016. Mean Likert scores for GRLSS indicated most popular choice for learning style was the Dependent style: 3.81(0.75) for Group 1 and the Independent style: 3.68(0.61) for Group 2. Both gender and age factors influenced the results but no significant differences were recorded in GRLSS scores for the different age groups. Lecturers scored highest in the Expert category of teaching styles. Compatibility between learning and teaching styles was seen in both years when identified GRLSS and GRTSS styles were grouped together into specific cluster categories. One member of staff had ‘accomodated’ to a different teaching style cluster in 2016 more suited to the Independent learning style of student Group 2.These findings may impact on the types of pedagogy chosen to best suit student group learning. However, the increase number of students in anatomy classes as indicated in both the global literature and the national survey and the general diversity of student learning style preference may lead to the conclusion that there is no ‘one size fits all’ strategy that can be implemented to ensure all student learning style needs are met. In conclusion the research strategy undertaken fulfilled the aims and objectives of the project. The addition of a qualitative component in the gathering of the data added a further dimension and depth to the research. Overall there is identification of plausible, beneficial and implementable curricular and pedagogical suggestions that can be presented to relevant tertiary and governmental bodies in order to help facilitate a unified national gross anatomy educational programme for undergraduate PT students in South Africa
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    Hydrotherapy in the management of chronic obstructive pulmonary disease: a qualitative systematic review
    (2011-04-06) Shead, Dorothy Agnes
    Background: Chronic obstructive pulmonary disease (COPD), characterised by progressive airflow limitation which is not fully reversible and associated with pulmonary and systemic inflammatory processes, is largely associated with smoking and is classified as a disease of lifestyle. Other factors related to the incidence of COPD are passive smoking, the inhalation of gases from biomass fuels and the genetic absence of the protease alpha1-antirypsin in some people. COPD is found in all sectors of society and is not dependent on level of income or on the global location of a population. Compounding the incidence of COPD in Africa is the human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) that predisposes patients to the development of COPD. Hydrotherapy has been used since ancient times as a preventative and/or therapeutic form of treatment. Physiotherapists have used hydrotherapy alone or as a useful adjunct to other treatment options for years. Today aquatic therapy is practised in many centres where a multi-disciplinary approach to this form of treatment is offered. There are a number of methodologies of application of the therapy. Among these are Ai Chi, Halliwick, Watsu and Bad Ragaz. The treatment takes place in thermoneutral water between 29 degrees centigrade (oC) and 34oC where use is made of the buoyancy and/or resistance created by the aquatic medium. Musculoskeletal conditions, including pre-operative total hip and knee replacements; osteoarthritis and rheumatoid arthritis can be treated with this modality. Hydrotherapy affords athletes a non-weightbearing rehabilitative environment to enable a quicker recovery and also enables cardiovascular reconditioning to commence sooner than would be afforded by a land-based rehabilitation programme. Many chronic conditions, including cardiac failure, stroke and metabolic disorders have benefited from a hydrotherapy intervention. COPD has been shown to have an inflammatory component. Exercise on land has been shown to have an anti-inflammatory effect in healthy individuals but increased levels of tumour necrosis factor–alpha (TNF-alpha), known to be associated with inflammation, has resulted from moderate intensity land-based exercise in patients with COPD. Aim and objectives of the research: The aim of this study is to systematically review the evidence related to the role of hydrotherapy in the management of patients with COPD. The research objectives of this study are: to determine, from the literature, whether water temperature and depth of immersion influences cardiopulmonary function in patients with COPD; to determine, from the literature, whether hydrotherapy increases endurance, function and quality of life (QoL) in patients with COPD and to determine, from the literature, whether the anti-inflammatory effects of water-based exercise in patients with COPD have been documented. Method: The study design is a qualitative systematic review. A search was made for relevant journal articles in the PUBMED, SCOPUS, CINAHL, MEDLINE, SPORTSDiscus and Cochrane review databases. Google scholar was perused in order to find any grey literature pertaining to the population under review. The review of the literature was from 1996 until 2009. This protracted period of 13 years was needed to insure that all leading articles on the subject under review were included in the review. There were too few articles available from 2000 onwards to produce a valid review of the topic. The words and/or phrases used in the search were: hydrotherapy, Halliwick, Ai Chi, Watsu, Bad Ragaz, chronic obstructive pulmonary disease (COPD), pulmonary rehabilitation, emphysema, chronic bronchitis and the anti-inflammatory effects of exercise. Articles in the form of systematic reviews, randomised controlled trials, clinical trials and case studies pertaining to adult patients with non-acute, non-terminal COPD and the use of hydrotherapy were included in this review. No articles based on animal studies were included. No articles on Kneipp therapy were included as hydrotherapy in this format does not include the immersion of the patient in water. The LOW (Lewis, Olds and Williams, 2007) critical appraisal tool was used to evaluate the articles included in the systematic review. Results: Thirty-seven studies were sourced and nine studies were included in the qualitative systematic review. A total of 35 outcomes measures were reported within the nine included studies. They were of a varied nature and therefore were grouped into the following categories: cardiovascular; pulmonary; muscle strength/weakness; endurance and power, QoL and activities of daily living (ADL). Beneficial results were found in relation to heart rate (HR) with a regime of upper limb exercises performed in water. Following an upper body and upper limb 15 minute land-based exercise programme and subsequent 10-15 minute rest period on land, systolic blood pressure (SBP) was decreased by 14mmHg and diastolic blood pressure (DBP) by 6 mmHg (compared to resting land values) when patients with COPD were immersed in 32 oC water. Ejection fraction (EF) improved significantly at the end of a two month breathing exercise programme in water. A water-based intervention period of 120 minutes (20 minutes, six days/week for two months) decreased left ventricular end –diastolic (LVd) and left ventricular end-systolic (LVs) dimensions (p<0.01). Exhaling into water, during an aquatic breathing exercise regimen lasting 30 minutes/day, six days/week for two months, was demonstrated to significantly increase percentage predicted forced expiratory volume in one second (FEV1%). Arterial concentration of carbon dioxide (PaCO2) levels were decreased significantly due to the breathing exercise with exhalation into water regimens and during the breathing out into water intervention for 20 minute /day for six days the arterial concentration of oxygen (PaO2) levels were increased. Peak flow (PF) was improved in all the breathing programmes where the patient exhaled into water. Improvement in respiratory rate (RR) and oxygen saturation (SaO2) were seen, in patients with COPD, who performed weight -resisted upper limb exercises in water once a week with a twice weekly pulmonary rehabilitation programme (PRP) on land as opposed to a land-based PRP three times per week. Two of the included studies recorded improvement in the incremental shuttle walk test (ISWT) following exercise in water and one noted a greater improvement in the endurance shuttle walk test (ESWT) than in the ISWT after hydrotherapy. Maximal dynamic flexion showed marked improvement after an aquatic programme. Physical and cardiopulmonary improvements, including reduced levels of dyspnoea in some instances, were reported and these were linked to increased levels of physical conditioning, better QoL and improved ability to undertake ADL in the patients with COPD. Conclusion: Breathing exercises, where the patients exhale into the water, appear to have a beneficial effect on pulmonary outcomes particularly when the programme is of a duration of120 minutes per week or more and the exercise is performed on six days / week. The physical exercise hydrotherapy programmes address some of the muscular weaknesses resulting from the systemic effects of COPD. Both the cardiopulmonary benefits and physical benefits seem to result in a general improvement in the QoL of the patients and their greater ability to perform ADL. Social interaction and psychological well-being seem to be factors related to increased compliance in hydrotherapy exercise programmes when compared to compliance in land-based programmes. No information was retrieved from the included studies relating to the anti-inflammatory effects of hydrotherapy exercise programmes. No randomised controlled trials were sourced on the subject under review. The overall evidence was of variable quality, with three studies above average, two average and four below average, according to the LOW critical appraisal tool. From the results obtained in the review it became apparent that there is an urgent need for a number of randomised controlled trials to investigate the role of breathing exercises in combination with physical exercise programmes of hydrotherapy in the management of COPD so that this form of therapy can be utilised to its full capacity.