Saudi Pediatric Physiotherapists Clinical Reasoning and ICF - Essay Example

Saudi Pediatric Physiotherapists’ Clinical Reasoning and ICF (International ification Functioning Disability and Health). Knowledge and Competence regarding Children with Cerebral Palsy. 1. Location of the investigation At what place(s) will the investigation be conducted? Online survey will be distributed among all pediatric physiotherapist members of Saudi Physical Therapy Association (SPTA). If this is not on University of Strathclyde premises, how have you satisfied yourself that adequate Health and Safety arrangements are in place to prevent injury or harm? No obvious risk in the study, the local health and safety measures and use computer will be followed to conduct online survey. 2. Ethical issues Describe the main ethical issues and how you propose to address them: This study will be conducted according to the standards of the University of Strathclyde Research Ethics Committee regulations, and University of Strathclyde (Faculty of Humanities and Social Sciences) Research Governance policies and procedures. 1. Anonymity The survey primarily aims to collate data through an online questionnaire. No personally identifiable data will be requested on the questionnaire to encourage more honest answers. 2. Data Protection The online survey will remind participants about the rationale for the study and how the data will be shared and stored prior to completing the questionnaire. For those who request a hard copy of the questionnaire by email or telephone, a hard copy of the survey, with the study information and consent form will be posted. A reply-paid envelope will be enclosed for return of the completed questionnaire. 3. Informed consent All participants of the study will be provided with an information sheet describing the aims of the study and sufficient details to make an informed decision about their participation in the study and will be reminded of this information at the beginning of the online survey questionnaire. Participants would not be able to submit online questionnaire until clicking the box of agreement to participate in the study. The study pack will include the invitation letter, information sheets and consent form will be submitted for review and approval by the Research Ethics Committee for the study (see Appendix 2, 3, 4) 4. Risk Assessment There is no risk or any harm for being introduced in the study, as participants will only be complete online questionnaire or hard copy questionnaire. However, all the participants will have general instructions before completing online or hard copy survey (see appendix 5) 3. Objectives of investigation (including the academic rationale and justification for the investigation). Please use plain English. Traditional thinking in physiotherapy has often involved belief that child with cerebral palsy should be encouraged to try as much as possible to learn and to do things normally. Physiotherapy intervention have often provided good outcomes only for the body structure and functioning to enhance child functional activities (Franki et al. 2012, Rosenbaum and Stewart 2004). This is similar to what I have been noticing in pediatric physiotherapy in Saudi Arabia. This approach may not identify two important factors, environment around the child and the personal choices of the child when developing treatment plan. The question arises how pediatric physiotherapists enhance child functional activities and his/her social participation. In Saudi Arabia, there has been an increase in the number of children born with cerebral palsy or hereditary diseases resulting from consanguinity (Al-Jadid, 2011). However, most of the existing research has been conducted on the prevalence and incidence of children with CP (Al-Jadid, 2011) and we have no information about the pediatric physiotherapists’ management for children with cerebral palsy. Therefore, my PhD project is going to explain how Saudi pediatric physiotherapist plan treatment for children with cerebral palsy is managed. In this study, three models will be used together to explore how Saudi pediatric physiotherapist develop plan of treatment, the ICF( International Classification Functioning, Disability and Health) model will be used from the health prospective and The Blooms Taxonomy of Educational Objectives and Miller’s Pyramid Assessment will be used from the education prospective. The ICF model use as clinical reasoning tool, clinical reasoning, refers to capacity of physiotherapist to think, understand, take action and take decisions during continuous cyclic process that physiotherapists undertake in their day to day clinical work. These include assessment, identifying problems and setting goals to develop a treatment plan (Edwards et al. 2006; Higgs et al. 2006). The ICF model supports to develop pediatric physiotherapist rational past child body configuration and occupation as main deficiencies to view that places identical worth on stimulating serviceable action and enabling the child’s total involvement in all features of life. The model “gives permission” to report people’s self- assessed aims very broadly. Such goals might comprise, for example, becoming “independently mobile” or being able to “communicate effectively,” instead of concentrating merely on “walking” or “talking ((Rosenbaum &Stewart 2004). The Blooms Taxonomy of Educational Objectives is used to distinguish what types of ICF knowledge that pediatric physiotherapists have. While, Miller’s Pyramid of Assessment is used to understand the levels ICF clinical knowledge and how they are implemented in clinical practice (Ramani and Leinster, 2008) The impetus of this planned research is to understand how pediatric physiotherapist in Saudi Arabia develop plan of treatment for children with cerebral palsy. The research will be conducted by distributing a national survey to identify current Saudi pediatric physiotherapists’ clinical reasoning, their types of ICF knowledge and to predict pediatric physiotherapist behaviour of applying environmental and personal factors in physiotherapist plan of treatment for children with cerebral palsy. The survey will map the aforementioned subjects by answering the following four research questions: 1. To what extent do Saudi pediatric physiotherapists use the ICF as clinical reasoning tool? 2. To what extent do pediatric physiotherapist attitude toward behaviour, subjective norm, perceived behaviour control influence pediatric physiotherapists intention to apply environment and personal factors in treatment plan for children with cerebral palsy? 3. To what extent do level of ICF knowledge, intention and attitude toward behaviour, influence Saudi pediatric physiotherapist’s clinical reasoning? 4. Participants Please detail the nature of the participants: All Pediatric Physiotherapist members of SPTA will be listed on the members’ profiles with an email address will be invited to participate in the study. Please detail any inclusion/exclusion criteria and any further screening procedures to be used: Inclusion criteria: Qualified pediatric physiotherapists employed in Kingdom of Saudi Arabia. Exclusion criteria i) Non pediatric physiotherapists. ii) Other health and social care professionals 5. Method of recruitment Describe the method of recruitment (see section B4 of the Code of Practice), providing information on any payments, expenses or other incentives. A confirmation letter to support the student (HD) undertaking this study and explanation of the study will be obtained from University of Strathclyde and then will be sent to the President of the Saudi Physical Therapy Association (SPTA). Dr. Sami Saleh Ahamed AL-Abdulwahab Saudi Council for Health Specialties and King Saud University, Faculty of Applied Medical Sciences, Rehabilitation Sciences Department, Riyadh, Saudi Arabia. PO 10219 Riyadh 11433 Saudi Arabia Tel: 4355370 Fax: 4355883 Mobile: 050542553 E-mail: swahab@ksu.edu.sa This will enable (HD) to have access to all pediatric physiotherapist members of SPTA listed on SPTA member profiles with an email address which will be comprised of the pool of potential participants and to create Electronic mail distribution lists and also to enable online survey link to be placed on SPTA website. Survey distribution will be managed by SPTA service. An email message will be sent to all members in the list. Outlined details of the purpose of study and information regarding participations, confidentiality and short and simple URL link to the online survey will be sent (see attachment). One week later, the participants will receive the same e-mail as a reminder. A second reminder will be sent two weeks after the first. 6. Participant consent Please state the groups from whom consent/assent will be sought (please refer to the Guidance Document). The PIS and Consent Form(s) to be used should be attached to this application form. The Qualtics online survey will retell partakers about the justification for the study and how the statistics will be pooled and stockpiled prior to finalizing the questionnaire. Partakers could not submit online questionnaire until ticking in the box of covenant to partake in the study. For those who demand a hard copy of the questionnaire by email or telephone, a hard copy of the survey, with the study data, approval form will be posted. A reply-paid cover will be enclosed for posting the survey. Partakers will be informed that any data they deliver will be kept secret. No identifiable data will be included in any report arising from the study. They can pull out from the study at any time during accomplishment of the online survey, by not pressing the SUBMIT button. Data will not then be acquiesced. Any data they have agreed to acquiesce up to the time of pulling out will be used. Completion and return of the online or hard copy of the survey will be measured as assent. This is because we are seeking to retain secrecy of data as far as possible and conclusion of an agreement form would recognize the partaker. 7. Methodology Investigations governed by the Code of Practice which involve any of the types of projects listed in B1 (a) must be submitted to the University Ethics Committee rather than DEC/SEC for approval. Are any of the categories mentioned in the Code of Practice Section B1 (a) (project considerations) applicable in this investigation? 0 Yes x No If ‘yes’ please detail: Describe the research methodology and procedure, providing a timeline of activities wherever possible. Please use plain English. Design A cross-sectional survey will be conducted using an online questionnaire and data analysis using quantitative methods. Those participants preferring a hard copy of the questionnaire will be mailed thus. Procedure a) Survey Contents Section 1 Dimension of the pediatric physiotherapist clinical reasoning. The 3 cases scenario was developed based on the ICF model, clinical experience, assistance from Dr. Carin Schroder my second supervisor as she is physiotherapist and three rounds of feedback from Dr. Carin Schorder and Dr. Pauline Adair. The 3 cases scenario presented to ascertain pediatric physiotherapist views on how she/he would manage clinical situation in a child with cerebral palsy. Each case includes same information about age, level of spasticity and level of GMFCS (Gross Motor Functioning Classification system). 3 cases presented to physiotherapy with activities limitation in their walking and walking devices. The ICF domains are used as clinical reasoning tool to identify child problems, assessment and goals setting. However, the main problem is different in each case; physical impairment is in case one, then in case 2 the school environment is used as Barrier and case 3 child interests is used as barrier. Physiotherapist will be asked to choose the plan of treatment preference taking in to account the situation presented .The answer had 5 choices of treatment plans, each choice is focused on one of the ICF domains and the plan of treatment is based on: 1. Child health condition 2. Child physical impalement 3. Practicing physical activities (walking) under PPTs supervision. 4. Practicing physical activities (walking) with consideration to child environment. 5. Practicing physical activities with consideration to child interest. Section 2 has 3 items to understand pediatric physiotherapists work details Section 3 has 6 items to identify how pediatric physiotherapist applies environmental factors and personal factors in her/his management for children with cerebral palsy. Section 4 has 36 items to predict behavior of applying environmental and personal factors in physiotherapy plan of treatment for children with cerebral palsy. 3items to measure intention, 3 items to measure direct attitude, 8 measuring indirect attitude (4 measuring behaviour beliefs and 4 measuring outcomes evaluation); 3 measuring direct subjective norm; 8 measuring indirect subjective norm (4 measuring normative beliefs; 4 measuring motivation to comply); 3 measuring direct perceived behavioural control; 4 measuring indirect perceived behavioural control (2 measuring control belief; 2 measuring control beliefs power). This section was developed Following Theory Planned Behaviour (TPB) manual (Francis et al. 2004) Section 5 has 9 items to identify pediatric physiotherapist clinical background knowledge and her/his levels of ICF knowledge. This section was developed following questionnaire that was distributed in the ICF workshop in Nottwil, Switzerland that I attended and obtained official permission from ICF representative to modify and use the ICF training package. Item 9 of the Bloom Taxonomy of Educational Objectives was followed to identify physiotherapist levels of ICF knowledge (3 measuring factual knowledge, 3 measuring conceptual knowledge, 3 measuring procedural knowledge). Section 6 has 5 items that requests personal and demographic information such as age, gender, qualification, years’ work with children and province of practice in Saudi Arabia. Section 2, 3, 6 was developed to describe population (See attached Appendix 6) b) Qualtrics online survey The tool will be used to deliver online survey is Qualtrics web-based survey which helps in collecting data and to capture survey results. (I’m going to have training workshop in Qualtrics web-based survey). c) Pilot Survey and how face validity will be tested The questionnaire will be piloted with five pediatric physiotherapist from Netherland prior to distribution in order to identify whether any changes to content, phrasing or layout are required (Portney & Watkins, 2009).. These will be selected from the members of the centre where Dr. Carin Schorder (second supervisor) is working and who has volunteered to provide assistance with the pilot study. Selected PPTs will receive the study information pack and a link to the online pilot questionnaire. Once they have completed the questionnaire, they will also be prompted (online) to provide feedback on the study information pack and the survey content and layout. d) Translation Survey After the questionnaire is pilot tested in English version, it will be translated to Arabic version after using method of back-translation to compare the Arabic and English versions (Brislin, 1986) from a professional translator and back translated to make sure that nothing is missing. Items will be presented in the same order as those in the English version. e) Pilot Arabic version The questionnaire Arabic version will be piloted with 5 physiotherapists from all over Saudi Arabia prior to administration and following the previous procedure (c). f) Measures The survey primarily aims to collect data through an online questionnaire, using Qualtrics Online Survey. An electronic transmitting route is selected for the Qualtrics web-centered survey to touch a big number of pediatric physiotherapist affiliates. Attention is given to the speed and competence of data collection and capability to sustain full control over data, thus felicitating more correct data administration (Weber, Yarandi, Rowe, & Weber, 2005). Survey dissemination will be accomplished by a SPTA service that follows customary safety and privacy procedures. The survey will be derived into Arabic and English version as well, as therapist asks for hard copy will be provided to increase response rate. g) The data analysis Analysis will be conducted using SPSSv16. Descriptive statistics will be used to summarise socio-demographic data (e.g. age and gender). Numbers of pediatric physiotherapists having different types of ICF knowledge will be compared across the five provinces of the Saudi Arabia using mean (SD) for continuous variables, median (interquartile range) for ordinal variables and percentages for categorical variables. 1. To what extent do Saudi pediatric physiotherapists use the ICF as clinical reasoning tool? One Way- Factorial ANOVA will be used to examine ability of pediatric physiotherapist to decide treatment plan of child with CP in difference situation. When the main problems of the child either physical impairment, or environmental impairment or child dislikes to practice physical activities limitation (Walking). 2. To what extent do pediatric physiotherapist attitude toward behaviour, subjective norm, perceived behaviour control influence pediatric physiotherapists intention to apply environment and personal factors in treatment plan for children with cerebral palsy? Logistic regression will be used to examine effects of attitude toward behaviour, subjective norm, perceived behaviour control on intention to apply environment and personal factors in treatment plan for children with cerebral palsy. 3. To what extent do level of ICF knowledge, intention, and attitude toward behaviour influence Saudi pediatric physiotherapist’s clinical reasoning? Logistic regression will be used to examine effects of level of the ICF knowledge, intention, and attitude toward behaviour on Saudi pediatric physiotherapist’s clinical reasoning 8. Data collection, storage and security How and where are data handled? Please specify whether it will be fully anonymous (i.e. the identity unknown even to the researchers) or pseudo-anonymised (i.e. the raw data is anonymised and given a code name, with the key for code names being stored in a separate location from the raw data) - if neither please justify. Primarily, survey data will be collected via online questionnaires. Hard copy of the questionnaires will be issued on request to those without online access. Information about study participants will be kept confidential and managed according to the requirements of the Data Protection Act (1998).The Research Governance Framework for Health & Social Care, Ethics Committee Approval and University of Strathclyde Research Governance Procedures. 1. Identifiable participant data will not be obtained through the online survey. 2. Identifiable data obtained through telephone, email or reply forms (such as name and work address) will be accessed and used by the research study team only. This will enable questionnaires to be mailed out to participants correctly. 3. Each study participant will be assigned a unique participant number. A master list of participant numbers and corresponding names of province will be maintained on the database which will be securely stored on the Qualtrics Online Survey. A database (names, addresses and telephone numbers) of those participants requesting additional study packs will be maintained. Progress through the study will be tracked in order to ensure timely mailing of questionnaires and reminders. This will be password protected on a secure file storage area on the Qualtrics main server. This will only be accessible by researchers team directly engaged upon the project. 4. The Principal Investigator is the Custodian of the data. 5. Research participants will not be able to revoke their authorization for the use of their information as personal information will not be identifiable once the completed questionnaire is submitted. 6. Participants will not be identifiable in any future publication. Explain how and where it will be stored, who has access to it, how long it will be stored and whether it will be securely destroyed after use: Participant will be identified by numbers only in statistical records and on questionnaires. Data analysis (SPSS) files will only identify participants’ survey ID. Paper versions of the questionnaires will be stored in separate locked cabinets in PhD office of the University. 9. Potential risks or hazards Describe the potential risks and hazards associated with the investigation: There is no risk or any harm being introduced in the study, as participants will only be completing online- questionnaire or hard copy of the questionnaire. However, all the participants will have general instructions before completing online or hard copy survey. 10. How will the outcomes of the study be disseminated (e.g. will you seek to publish the results and, if relevant, how will you protect the identities of your participants in the said dissemination)? On completion of the study, I will submit abstracts for review to World Congress of Physical Therapy (WCPT) and at the Annual Meeting of European Academy of childhood disability (EACD). I will submit an article/s for review in peer-reviewed Physical therapy or Rehabilitation journals. Read More