Development, validation, and testing of a physiotherapist initiated checklist of items for implementing pulmonary rehabilitation in Nigeria

Abstract

Objectives: Pulmonary rehabilitation (PR) program is beneficial to patients with chronic respiratory diseases. However, PR services are limited or non-existent in many resource limited settings of the world, including Nigeria. Equally important, is lack of local guidelines or checklists to support the implementation of these programs. This study was aimed at developing, validating, and testing a physiotherapist initiated checklist of items for implementing of PR in Nigeria. Materials and Methods: A panel of experienced cardiopulmonary physiotherapists was constituted to draw-up and agree on a list of items that they consider necessary for implementing of PR. The resulting items were collated as a checklist of items. The checklist was then locally validated by presenting it to a wider group of respiratory health-care professionals including chest physicians, nurses, occupational therapists, dieticians, and clinical psychologists, practicing within the study area. Each item was rated from strongly agree to strongly disagree on 5-point Likert scale. Thereafter, the performance of the items of the checklist was subjected to testing by assessing whether each item was addressed in the British Thoracic Society (BTS) PR guideline. This was done by rating each item with either a “yes,” “no,” or “not fully” to whether our checklists are included and described in the BTS guideline. Supporting evidence profile was also stated for some items, if applicable. Results: A consensus was reached by the panel of physiotherapists to arrive at a 16-item checklist. Each item was further provided with specific details and/or examples that are relevant for instituting PR in a Nigerian setting. All items on the checklist were considered valid by other respiratory health-care professionals, with a rating consensus agreement of between 80% and 100%. Furthermore, the testing of checklists based on inclusion and description in the BTS guideline showed that six items were addressed fully in the BTS guideline (rated “yes”), six were partially addressed (rated “not fully”), while four were not addressed (rated “no”). Conclusion: A checklist of items for the implementation of PR in Nigeria was successfully developed, validated, and tested. Nevertheless, there may be a need to develop a full guideline before instituting PR in view of the potential disparities with existing/established guidelines.