Philosophiae Doctor - PhD / The past decade has seen a growth in Physiotherapy schools offering postgraduate programmes in South Africa. The Republic of South Africa assists other African countries like Kenya, Malawi, Rwanda, Tanzania and Zambia in upgrading the education of diploma-trained physiotherapists (DTPs) to Bacherlor of Science (Honours) (BSc (Hons) and Master's Degrees respectively. The three institutions offering Physiotherapy training in Cape Town make it the largest training locality for Physiotherapy in South Africa. The University of Cape Town (UCT), University of the Western Cape (UWC) and Stellenbosch University are situated within a twenty kilometre radius from each other. These schools have taken a leading role in the postgraduate training of their own PTs, and those from other developing countries. In 2007, for example, about 20% of postgraduate students in Cape Town Physiotherapy schools were from other African countries. The Department of Physiotherapy at UWC in particular has been upgrading DTPs from other African countries to BSc (Hons) and Master's degrees for the last twenty years. However, compared to the wealth of educational literature on other healthcare professions, literature on the evaluation of postgraduate Physiotherapy programmes is scarce. Thus, the aim of this study was to evaluate the outcomes and impact of the UWC postgraduate Physiotherapy BSc (Hons) and Master's programme on clinical practice and research in East and Southern Africa. The dissertation used an explorative and descriptive theory-based evaluation approach using qualitative research methodology. The steps involved in the research process determined the choice and use of the qualitative methodology. The use of qualitative methods was undertaken to provide a comprehensive analysis of the research problem. The study had three main phases. Initially, administrative document reviews and in-depth interviews with UWC postgraduate Master's programme designers (PDs) were conducted to help develop and test the programme theory and measuring instruments (interview guides). Secondly, postgraduates were interviewed to establish and test the implementation process theory, as well as investigate perceived programme outcomes. Then focus group discussions with postgraduate students of UWC, and individual interviews with workplace supervisors of the UWC postgraduates were undertaken to investigate the perceived outcomes and impact of the UWC Master's programme. A variety of methods appropriate for the different steps or stages of the programme were employed, to ensure this evaluation exercise becomes an integrated function in which data are continuously collected and used for decision-making and programme improvement. Multiple types of data were collected to inform each phase. The researcher used purposive sampling technique to constitute the sample. The sampling technique yielded three official documents, three (3) PDs and two (2) implementers, 27 UWC postgraduates, seven (7) workplace supervisors and 30 students of UWC postgraduates. Data was collected via document analyses, in-depth interviews, telephonic in-depth interviews and focus group discussions. Qualitative data analysis occurred concurrently with data collection. Atlas Ti software version 10 was used to assist with data management. The UWC postgraduates reported acquiring knowledge of manual therapy, better management of musculo-skeletal conditions and enhanced clinical reasoning. Participants also reported career growth, pursuit of higher degrees such as PhDs, promotions, job changes from physiotherapy clinicians to educators, involvement in research and the introduction of BSc programmes in their respective countries. The current study demonstrates that the primary objective of the UWC BSc (Hons) and Master's programmes such as increasing access to physiotherapy training in Africa and empowering DTPs with research skills and knowledge of community-based rehabilitation was being realised. However, many postgraduate participants in all countries emphasised the need to include basic sciences, clinical practice and specialisation in the UWC BSc (Hons) and Master's programmes respectively. Furthermore, the participants reported that the programmes did not have much impact on management of conditions other than musculo-skeletal. On the other hand, the employers that participated in the current study identified that the UWC programmes had a positive impact on Physiotherapy education in their respective countries, producing a total of five Physiotherapy degree programmes between the year 2000 and 2014. Kenya, Rwanda, Tanzania and Zambia reported introducing two, one, one and two BSc Physiotherapy programmes respectively. The study also revealed moderate research activity among UWC postgraduates, a challenge most employers attributed to institutional research agendas, high patient work-load and personal strengths of postgraduate students. The students of UWC graduates who participated in the current study reported acquiring new assessment skills for musculo-skeletal conditions, enhanced treatment techniques for musculoskeletal conditions and use of evidence to guide their clinical practice. The participants also reported reduced hospital visits among patients with musculo-skeletal conditions and relatively short treatment durations. However, in all universities but one, students indicated that most lecturers had difficulty applying basic sciences during lectures. The participants also reported a lack of specialist lecturers in areas other than musculo-skeletal. This thesis focused on evaluation of the outcomes and impact of postgraduate BSc (Hons) and Master's programmes in Physiotherapy for DTPs in SADC and East Africa. While the thesis has highlighted many achievements, it has also identified training needs of DTPs that require attention. First, we recommend that the curriculum be reviewed to incorporate clinical practice and more theoretical content in the BSc (Hons) programme and that the UWC special BSc (Hons) programme be considered an RPL project to ensure the visible (documented) and nonvisible (undocumented) knowledge claimed by applicants are subjected to a form of assessment through the UWC RPL process, thus enabling the university to identify the knowledge gap that requires bridging among DTPs seeking admission to the degree programme. Second, we recommend a review of the Master's degree by coursework programme to include more theoretical and clinical practice components that would allow for specialisation. / National Research Foundation (NRF)

Magister Philosophiae - MPhil / The traditional approach to physiotherapy education is that of an applied science, in which scientific theory and therapeutic skills are taught in a classroom, and then implemented in a clinical setting. Many difficulties were demonstrated by students during the clinical practice component of the undergraduate course at the University of the Western Cape (UWC). This raised the question of whether current strategies of clinical education were effective in facilitating the development of the clinical skills deemed necessary for professional practice. Furthermore, it appeared to me that the teaching strategies which I employed did little to integrate classroom teaching with clinical practice. During 1993 and 1994 I initiated two cycles of workshops as an action research project, in collaboration with students and colleagues at UWC. The purpose of the workshops was for me to investigate my practice as a clinical educator, whereby I hoped to understand more fully, and therefore enhance, my teaching practice. The study revealed that clinical education is a complex and dynamic process strongly influenced by many factors. Personal perceptions of the educator's role in clinical teaching and learning, as well as the interaction with, and expections of those participating in clinical education, shape teaching practice. The concept of a positive learning environment was explored, and it was found that collaboration_with students and classroom democracy has a significant impact on student motivation. The effect of a variety of reading and writing tasks, co-operative learning and structured group discussion are some of the teaching strategies that were implemented, and positively evaluated by students and colleagues. Ethical considerations relating to the role of the patient during clinical practice and clinical education developed as an important aspect of the workshops. The conflict which can arise between the related roles of clinical educator and clinician, evolved as a professional dilemma. It is suggested that the process of clinical education requires further investigation. Educational change and innovation proved to be a difficult personal, and co-operative, process. Unique responses by different groups of individuals to similar situations or strategies make this issue more complex. In order to practice more competently, it would be appropriate that the clinical education process be thoroughly investigated in order to be more fully understood by physiotherapy educators, rather than be taken for granted. Action research proved to be an effective and flexible vehicle for investigating, and responding to, the dynamic teaching process. The action research study documented in this thesis, being similar in effect to the therapeutic process, would serve the physiotherapy clinician as effectively as it would the physiotherapy lecturer.

Philosophiae Doctor - PhD / Community Based Rehabilitation (CBR) is used internationally, to address the lack of access of People with Disabilities (PwD) to rehabilitation services. Physiotherapy is one of the rehabilitation services offered to PwDs at community level, through CBR. In Sudan, Ahfad University for Women (AUW) offers a Bachelor degree in Physiotherapy, which integrates a CBR module into the curriculum, since 2007. The aim of this current study was to investigate the CBR components of the current physiotherapy curriculum at AUW, to determine whether they should, and could be expanded. The Mix method study design was employed, with a mixed research methodology, containing both qualitative and quantitative approaches for data collection. The components of CBR, present in the current physiotherapy curriculum at AUW were identified, using the constructive alignment framework, and content analysis for data analysis. The PWD’s needs of rehabilitation services in Sudan were established, using a questionnaire survey among users at various rehabilitation centres in Khartoum State. The CBR components that needed to be adapted in the physiotherapy curriculum at AUW were identified, using focus group discussions and in-depth interviews with AUW physiotherapy students and a CBR expert. Finally, the CBR components were revised and adapted, using a collaborative approach during workshops with AUW staff and clinicians. It was concluded that, in order to address the rehabilitation needs of PwDs, the CBR module needed to include additional components, to align the course content, teaching and learning techniques, as well as assessment tasks, with the intended learning outcomes of physiotherapy students. The components in the CBR matrix, such as livelihood and empowerment, were deemed important to provide students with knowledge, skills and competence. Additionally, providing information about assistive devices was deemed vital in rehabilitation. A significant relationship (P<0.05) was observed between the provision of information on assistive devices, and the maintenance thereof, as well as the benefits to users, respectively. Ultimately, commencing CBR placements in the fourth year, as is currently the norm, was deemed too late; therefore, it was suggested that community visits in the first and second years of physiotherapy studies, be included in the CBR course curriculum.

Seit dem Jahr 2001 werden in Deutschland aufgrund von Länder – oder Fachhochschulinitiativen zunehmend Studiengänge für Physiotherapie etabliert, ohne dass es sich jedoch zunächst um einen vom Bund mitgetragenen und somit rechtlich abgesicherten neuen Berufsabschluss handelt. Die rasante Zunahme der Studiengänge geht einher mit einer maximalen Varianz hinsichtlich der Dauer, der Inhalte, der fachlichen Ausrichtung und Organisationsform sowie der Anbindung an unterschiedlichste Fakultäten. Die Studierenden dieser ersten Generation sind somit diejenigen, die mit ihren subjektiven Einstellungen, Wünschen, Ängsten, Erwartungen und Wahrnehmungen über einen neuen Blick verfügen. Sie können als die zentralen ExpertInnen in der Beurteilung eines deutlich Verunsicherung schaffenden Professionalisierungsprozess betrachtet werden. Mit der Einführung dieser neuen Studiengänge (z.T. im Sinne des Bolognaabkommens) werden vor dem Hintergrund der Fragen zur Existenz einer physiotherapeutischen Identität, eines physiotherapeutischen Habitus sowie der professionellen Selbstverortung drei unterschiedliche Forschungsstränge aufgegriffen: 1. Berufswahlmotive, existierende Bilder von Physiotherapie vor und nach der Ausbildung, Beurteilung der fachschulischen Ausbildung, Berufseinstieg 2. Gründe für die Aufnahme des Studiums, Vor- und Nachteile des Studiums, Bewertung des Studiums, Erwartungen an das Outcome, Probleme 3. Einstellung gegenüber Profession, Professionalisierung und Professionalität Methodologisch wurde das Forschungsdesign der ExpertInneninterviews gewählt. Die mit 33 Studierenden der unterschiedlichen Fachhochschulen geführten und vollständig transkribierten Interviews sind dann mittels eines qualitative Forschungsdaten verarbeitenden Softwareprogramms sequenzialisiert und codiert worden, um die Ergebnisse des Antwortverhaltens der Studierenden in eine mögliche Typisierung zu überführen. Um die studentische Binnensicht beruflicher Kulturalität um eine Außenaufsicht zu ergänzen, wurden zwei weitere nicht-studentische, jedoch professionszugehörige ExpertInnen interviewt. / The first university degrees in Physiotherapy have been developing in Germany since 2001, without however, any formal, legislative introduction by government. The rapidly increasing number of these courses vary considerably with regard to duration, contents, staffing and faculty membership. In this process of professionalization the students of this first generation of higher education are of particular interest. They are the “experts”, able to look at the profession from a new and different point of view. Their perception of the profession, their insecurities, wishes, hopes and needs highlight a process which could be described as unstable and confusing. The objective of this research project was to investigate whether a PT identity and a PT professional habitus exist and how the students themselves perceive the status of the profession. Expert interviews with students from different universities were chosen to gather the data which was subsequently analysed and codified using a qualitative research softwear to identify response types. In addition to the 33 students’ interviews portraying an “insider´s view” of the cultural identity, 2 further interviews were carried out with non-student experts in the field to represent an “outsider´s view”. This resulted in the examination of these distinct areas: 1. Career choice, satisfaction with initial PT training course, experiences on entering employment 2. Advantages and disadvantages of studying, satisfaction with the degree course, expectations of the outcome, problems 3. Attitude towards the profession, the status of professionalization and professionalism