Dataset Information

Physiotherapists' awareness of risk of bone demineralisation and falls in people living with HIV: a qualitative study.

ABSTRACT:

Background

Recent research has indicated a seemingly increased propensity for both falls and accelerated bone loss in people living with HIV (PLWH). Physiotherapists play a crucial role in optimising function and quality of life of PLWH through prevention of falls and reducing the harm that results.

Aim

This study aimed to explore physiotherapists' awareness of falls risk and accelerated bone demineralisation in PLWH and their perceptions of current falls prevention strategies in the care of PLWH in selected regions of sub-Saharan Africa.

Method

An exploratory descriptive qualitative research method was employed to explore physiotherapists' perceptions and experiences regarding bone health and falls in PLWH. In-depth semi-structured telephonic interviews were used to collect data from 21 physiotherapists working in primary HIV care. Transcribed interview data were coded in Atlas.ti.8® and analysed using inductive thematic analysis.

Results

The primary study revealed a lack of awareness by physiotherapists of falls risk and bone demineralisation in PLWH. As such, physiotherapists did not link falls or fractures to HIV or antiretroviral therapy (ART) when they did observe such events during their general patient assessments. However, in retrospect, some physiotherapists were able to recognise risk factors linked to falls in those with HIV. Current services for falls prevention, as perceived by the physiotherapists, were sub-optimal.

Conclusion

Physiotherapists may need to be more aware of the potential risk of falls and bone demineralisation in PLWH and routinely assess for these phenomena in both older and younger PLWH.

SUBMITTER: Charumbira MY

PROVIDER: S-EPMC8045224 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Publications

Physiotherapists' awareness of risk of bone demineralisation and falls in people living with HIV: a qualitative study.

Charumbira Maria Y MY Berner Karina K Louw Quinette Q

BMC health services research 20210413 1

<h4>Background</h4>Recent research has indicated a seemingly increased propensity for both falls and accelerated bone loss in people living with HIV (PLWH). Physiotherapists play a crucial role in optimising function and quality of life of PLWH through prevention of falls and reducing the harm that results.<h4>Aim</h4>This study aimed to explore physiotherapists' awareness of falls risk and accelerated bone demineralisation in PLWH and their perceptions of current falls prevention strategies in ...[more]

PMID: 33849529

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Project description:ObjectivesRecent research has indicated seemingly increased propensity for falls and accelerated bone demineralisation in people living with HIV (PLWH). We aim to map out the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH.MethodsA scoping review was done following Arksey & O'Malley's methodological framework and recommendations from Joanna Briggs Institute. Four databases were searched until October 2019 for peer-reviewed studies available in English reporting on the definition, prevalence, assessment, risk factors and interventions for falls in PLWH as well as information on bone demineralisation linked to falls in PLWH. Narrative reviews were excluded. Two reviewers independently performed the extraction using a predesigned Excel sheet. A descriptive analysis of extracted information was done.ResultsFourteen studies on falls in older PLWH were identified, with all but one study conducted in high-income countries. Prevalence of falls in PLWH ranged from 12% to 41%. Variable assessment tools/tests were used to assess potential risk factors, but it remains to be determined which are more predictive and appropriate for use among PLWH. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age-matched and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH.ConclusionMore research is needed on falls in younger cohorts of PLWH and in sub-Saharan Africa where HIV is most prevalent and more robust clades exist. More studies need to report on data in seronegative controls to determine risk factors unique to PLWH. More intervention studies targeted at falls prevention and promotion of bone health are required. Quality clinical practice guidelines highlighting validated assessment tools and outcome measures need to be developed.

Project description:AimThe overarching aim of this study was to explore patients' falls risk awareness in hospitals using section A of the validated Self Awareness of Falls Risk Measure (SAFRM).DesignDescriptive cross-sectional study design.SettingThree rural/regional hospitals in the State of Victoria, Australia.MethodsUsing a purposive sampling strategy, patients were eligible to participate if aged ≥ 40 years, English-speaking, and have ambulatory capacity prior to hospital admission. Participants were excluded from the study if they returned a Standardised Mini-Mental State Examination (SMMSE) score < 18. Falls risk awareness data was collected from both patient and health professionals using section A of the SAFRM. Patient demographic data was collected from patient medical records.ResultsA total of 77 patients (72.9 years ±11.2) and 58 health professionals were recruited. Patients had a significant difference in falls risk awareness when compared to their clinician (z = -2.08, p = 0.038). Regression analyses showed that patients were more likely to overestimate their falls risk if they used anticoagulant medication and if their highest education level was less than or equal year 11. An exploratory factor analysis (EFA) revealed a three-factor solution from section A of the SAFRM, which were labelled Physical Activity Awareness, Cognitive Awareness and Balance Awareness.ConclusionsThere was a significant difference in patients' falls risk awareness compared to a health professional. The independent associations of variables with falls risk awareness, such as age, education level and medication use, further our understanding of the differences in falls risk awareness. The findings also establish that the 15-item section A SAFRM is a reliable and feasible falls risk perception measure for use in hospitals, with future research recommended to evaluate the proposed three-factor model with the addition of tailored hospital falls education.Implications for the profession and/or patient careThe findings from this study establish a significant difference in patients' falls risk awareness compared to their health professional. Section A of the SAFRM is a reliable tool for nurses and other health professionals to establish the presence of a falls risk disparity. The ability to empirically measure this disparity and to determine an under- or overestimation of falls risk is a useful addition to clinical practice. The SAFRM facilitates a person-centred approach to falls prevention by providing opportunities for the clinician to collaborate with the patient and tailor fall prevention strategies.ImpactProblem: Inpatient falls in hospital settings.Main findingsThere was a significant difference in patients' falls risk awareness compared to a health professional. Section A of the Self-Awareness of Falls Risk measure is a reliable and feasible tool to identify under- or overestimation of falls risk perception in hospitals. Patients were more likely to overestimate their falls risk if they used anticoagulant medication and if their highest education level was less than year 11. The findings for a three factor-model Physical Activity Awareness, Cognitive Awareness and Balance Awareness could inform future hospital falls education.ImpactRegistered nurses, health professionals, inpatients. Reporting Method: STROBE checklist for cross-sectional studies. Patient or Public Contribution: This study involved the collection of data from patient participants and registered nurses.

Project description:BackgroundPeople living with HIV (PLWH) have low levels of physical activity. Using the social ecological model to understand perceptions, facilitators and barriers of physical activity in this population is of importance for developing contextualised interventions to improve physical activity in PLWH.MethodThis was a qualitative sub-study conducted between august and November 2019 as part of a cohort study on diabetes and associated complications in HIV infected in Mwanza, Tanzania. Sixteen in-depth interviews and three focus groups with nine participants in each were conducted. The interviews and focus groups were audio recorded, transcribed and translated into English. The social ecological model was considered during the coding and interpretation of the results. Transcripts were discussed, coded and analyzed using deductive content analysis.ResultsForty-three PLWH aged 23-61 years participated in this study. The findings showed that most PLWH perceived physical activity as beneficial to their health. However, their perceptions of physical activity were rooted within existing gender stereotypes and roles in the community. Running and playing football were perceived as activities for men while household chores activities were for women. Further, men were perceived to do more physical activity than women. For women, household chores and income-generating activities were perceived as sufficient physical activity. Social support and engagement of family members and friends in physical activity were reported as facilitators of physical activity. Reported barriers of physical activity were lack of time, money, availability of physical activity facilities and social support groups, and poor information on physical activity from health care providers in HIV clinics. Human-immunodeficiency virus (HIV) HIV infection was not perceived by PLWH as a barrier for doing physical activity but most family members did not support them to do physical activity, fearing that it might worsen their condition.ConclusionThe findings demonstrated differing perceptions, facilitators and barriers of physical activity among PLWH. Interventions addressing awareness, gender stereotypes and roles related to physical activity from individual to community level are needed. Supportive environment and infrastructures are needed to improve physical activity levels in PLWH in Tanzania.

Project description:ObjectivesTo explore experiences of physiotherapists working with adults living with Long COVID in Canada.DesignCross-sectional descriptive qualitative study involving online semi-structured interviews.ParticipantsWe recruited physiotherapists in Canada who self-identified as having clinically treated one or more adults living with Long COVID in the past year.Data collectionUsing an interview guide, we inquired about physiotherapists' knowledge of Long COVID, assessment and treatment experiences, perspectives on physiotherapists' roles, contextual and implementation factors influencing rehabilitative outcomes, and their recommendations for Long COVID rehabilitation. Interviews were audio-recorded, transcribed verbatim and analysed using a group-based thematic analytical approach. We administered a demographic questionnaire to describe sample characteristics.Results13 physiotherapists from five provinces participated; most were women (n=8; 62%) and practised in urban settings (n=11; 85%). Participants reported variable amounts of knowledge of existing guidelines and experiences working with adults living with Long COVID in the past year. Physiotherapists characterised their experiences working with adults living with Long COVID as a dynamic process involving: (1) a disruption to the profession (encountering a new patient population and pivoting to new models of care delivery), followed by (2) a cyclical process of learning curves and evolving roles of physiotherapists working with persons living with Long COVID (navigating uncertainty, keeping up with rapidly emerging evidence, trial and error, adapting mindset and rehabilitative approaches and growing prominence of roles as advocate and collaborator). Participants recommended the need for education and training, active and open-minded listening with patients, interdisciplinary models of care, and organisational- and system-level improvements to foster access to care.ConclusionsPhysiotherapists' experiences involved a disruption to the profession followed by a dynamic process of learning curves and evolving roles in Long COVID rehabilitation. Not all participants demonstrated an in-depth understanding of existing Long COVID rehabilitation guidelines. Results may help inform physiotherapy education in Long COVID rehabilitation.

Dataset Information

Physiotherapists' awareness of risk of bone demineralisation and falls in people living with HIV: a qualitative study.

Background

Aim

Method

Results

Conclusion

Publications

Physiotherapists' awareness of risk of bone demineralisation and falls in people living with HIV: a qualitative study.

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