Agoriwo Mary W, Joseph Conran, Franzén Erika, Unger Marianne
Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana.
J Eval Clin Pract. 2025 Apr;31(3):e14169. doi: 10.1111/jep.14169. Epub 2024 Oct 13.
The structure, process and outcome (SPO) framework has been used to establish that improved structures of care influences an enhanced process of stroke care resulting in improved outcome. Although, both stroke and Parkinson's disease (PD) are neurological conditions that require prolonged period of care and rehabilitation, the SPO framework has not yet been used to describe the existing structures and processes of PD care and rehabilitation in Ghana.
To describe the current structures and processes of PD rehabilitation across the three healthcare levels (primary, secondary and tertiary) in the southern sector of Ghana.
An online cross-sectional descriptive survey design was used via REDCap. Fifty-two therapists, including department heads, physiotherapists, occupational therapists and speech and language therapists from seven healthcare facilities were purposefully sampled and invited to complete the survey on structures and processes of PD rehabilitation. Descriptive statistical analysis was performed with SPSS v29.0. Comparative analysis was performed using Pearson's chi-square and Kruskal-Wallis test (H-test) as appropriate. Statistical significance was set at p < 0.05.
Forty-nine (94.2%) responses were received and four incomplete responses were excluded from analysis. Structure of rehabilitation: Most of the participants were physiotherapists (n = 36/45; 80.0%) and tertiary level professionals (n = 31/45; 68.9%). Only physiotherapy service was available across all the healthcare levels. Persons with PD were mostly referred for rehabilitation at Hoehn and Yahr stage III as reported by 55.6% (n = 20/36) of the therapists. Process of rehabilitation: Most therapists treated persons with PD two times weekly (n = 19/33; 57.6%) and on individual basis (n = 29/33; 87.9%). Only 9 (27.2%) and 7 (21.2%) therapists often used clinical guidelines or outcome measures respectively in managing PD and 93.9% of the therapists had no local protocols.
The structures and processes needed for PD rehabilitation exist but differ across the healthcare levels and among therapists. Physiotherapy was the most common rehabilitation service available at all levels of healthcare.
结构、过程和结果（SPO）框架已被用于证实，改善护理结构会影响中风护理过程的强化，从而带来更好的结果。尽管中风和帕金森病（PD）都是需要长期护理和康复的神经系统疾病，但SPO框架尚未被用于描述加纳PD护理和康复的现有结构和过程。
描述加纳南部三个医疗保健级别（初级、二级和三级）的PD康复的当前结构和过程。
通过REDCap采用在线横断面描述性调查设计。从七个医疗保健机构中，有目的地抽取了52名治疗师，包括部门负责人、物理治疗师、职业治疗师以及言语和语言治疗师，并邀请他们完成关于PD康复结构和过程的调查。使用SPSS v29.0进行描述性统计分析。根据情况，使用Pearson卡方检验和Kruskal-Wallis检验（H检验）进行比较分析。设定统计学显著性为p < 0.05。
收到49份（94.2%）回复，4份不完整回复被排除在分析之外。康复结构：大多数参与者是物理治疗师（n = 36/45；80.0%）和三级医疗保健级别专业人员（n = 31/45；68.9%）。所有医疗保健级别都仅提供物理治疗服务。如55.6%（n = 20/36）的治疗师所报告，PD患者大多在霍恩和亚尔分期III时被转介进行康复。康复过程：大多数治疗师每周为PD患者治疗两次（n = 19/33；57.6%），且是单独治疗（n = 29/33；87.9%）。只有9名（27.2%）和7名（21.2%）治疗师在管理PD时经常使用临床指南或结果测量指标，并且9*3.9%的治疗师没有本地方案。
PD康复所需的结构和过程是存在的，但在不同医疗保健级别和治疗师之间存在差异。物理治疗是各级医疗保健中最常见的康复服务。
