Gühring, Marelizé2025-10-212024Gühring, Marelizé . (2024). The Role Physiotherapists Play in Neonatal Intensive Care Units in South Africa: A Pilot Study [Master`s dissertation, University of the Witwatersrand, Johannesburg]. WIReDSpace.https://hdl.handle.net/10539/47126A research report submitted in fulfillment of the requirements for the Master of Science in Physiotherapy, in the Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, 2024Background There is uncertainty about the role physiotherapists play in neonatal intensive care units (NICUs) in South Africa. This is a result of a lack of literature together with a lack of competency frameworks and standardised undergraduate training. This led to the study aim to describe the role physiotherapists are playing in NICUs in South Africa. Methodology A quantitative, cross-sectional, self-administered survey was used to conduct the study. A strategically structured questionnaire collected information on the demographics, qualifications and clinical experience, multidisciplinary team (MDT) involvement, physiotherapy treatment and follow-up protocols of 40 qualified physiotherapists currently working in NICUs in South Africa. The questionnaire was distributed on the South African Society of Physiotherapy (SASP) email platform and social media groups on Facebook, LinkedIn and WhatsApp. The link to the questionnaire was available for two months on the SASP website and was distributed a second time on the relevant social media groups. It was unclear how many physiotherapists work in NICUs in South Africa and so a sample size could not be calculated. After two months of distributing the questionnaire, it was decided that 40 participants would supply sufficient data for the study to continue. The data was collected and managed using REDCap tools. The results of the study were analysed into percentages and frequencies and presented in graphs and tables. Results Data from 40 participants were analysed. More female physiotherapists (90%) participated in the study than male physiotherapists (10%). Most of the participants were between 31 and 40 years of age (50%). More than half of the participants were working in Gauteng (57%). The response rate was higher from physiotherapists working in private hospitals (60%) than public hospitals (40%). The participants had various years of experience and postgraduate training with most participants having trained in neurodevelopmental physiotherapy (79%) compared to respiratory physiotherapy (13%). Basic undergraduate education was predominantly the tertiary education (BSc=69%) with minimal specialised training in neonatal physiotherapy iv (MSc=23%, PhD=8%). The participants worked in both respiratory (74.4%) and neurodevelopmental physiotherapy (71.8%). Treatment was initiated after doctor referral (47.4%) or both self-screening and doctor referral (47.4%). The most used respiratory treatment modalities were vibrations (93.8%), suctioning (93.8%) and percussions (78.1%). Lung squeezing (18.8%), ventilatory weaning (21.9%) and participation in extubation (18.8%) had low responses. The most common respiratory conditions treated were consolidations (81.3%), atelectasis (71.9%), respiratory distress syndrome (RDS) (71.9%) with meconium aspiration (59.4%), the inability to wean off ventilators/during extubation (56.3%) and pulmonary interstitial emphysema (PIE) (18.8%) having lower frequencies. Respiratory physiotherapy was mostly performed once per day (42.4%) or twice per day (30.3%) with treatment performed over weekends and public holidays (64.7%). The most common neurodevelopmental conditions treated were prematurity (83.8%), cerebral palsy (83.8%), developmental delay (75.7%) and hypotonia (73%). The most used neurodevelopmental treatment modalities were positioning (89.2%), prevention of secondary complications in musculoskeletal, neuromuscular systems and skin (86.5%) and gross motor development/developmental milestone facilitation (81.1%). Neurodevelopmental physiotherapy was mostly performed once per day (62.2%). Treatment over weekends and public holidays were either always or when necessary (40.5%). Treatment was mostly initiated when the patient was medically stable (80.6%). Participation in a multidisciplinary team (54.3%) was higher compared to never participating in an multidisciplinary team (11.4%). Treatment was mostly performed as a combination of independent and combined sessions (62.9%). Dieticians (94.4%) and speech and language therapists (69.4%) were indicated to be working most often in the NICU with audiologists (48.6%) and occupational therapists (30.6%) less often. Referrals to other health professionals were higher (61.1%) than receiving referrals (41.6%). Family and caregiver support and education was performed by 91.9% of the participants with most performed while the patient was in the unit (77.8%), compared v to before discharge (16.7%) or on request of the family (5.6%). The type of support and education given were physical demonstrations on the patients (88.9%), verbal education (86.1%), general brochures (27.8%), videos and pictures (27.8%) and personalised brochures (25%). Twenty-four (63.2%) participants have follow-up protocols post-discharge with occasional attendance (58.3%), definite attendance (20.8%) or attendance after a reminder (20.8%). Most of the first follow-up sessions were one month after discharge (50%), two weeks after discharge (33.3%), one week after discharge (20.8%) or longer than a month after discharge (20.8%). Follow-up care at other practices were mostly uncertain (64.3%). Discussion and Conclusion Physiotherapists working in NICUs in South Africa have a role in respiratory and neurodevelopmental treatment as well as family and caregiver support and education. For the family members to be actively involved in the decision-making, family and caregiver support and education should always be included in the scope of practice of neonatal physiotherapists. There is also an important role in the multidisciplinary team as well as follow-up care, however, there is still a lack of implementation. Clearly defined roles of all health professionals within the NICU will improve the referral system and ultimately ensure holistic treatment is provided. The lack of a competency framework, additional educational or experience-related requirements and unstandardised undergraduate training programs cause an inconsistency in physiotherapy treatment and results in evidence-based practice to be lacking. It is therefore recommended that in the absence of standardised undergraduate training, competency frameworks should be developed for physiotherapists working in NICUs.en© 2024 University of the Witwatersrand, Johannesburg. All rights reserved. The copyright in this work vests in the University of the Witwatersrand, Johannesburg. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of University of the Witwatersrand, Johannesburg.UCTDPhysiotherapistsDissertationUniversity of the Witwatersrand, JohannesburgSDG-3: Good health and well-being