|ORIGINAL RESEARCH PAPER
|Year : 2013 | Volume
| Issue : 1 | Page : 15-20
Research profile of physiotherapy undergraduates in Nigeria
Ade F Adeniyi, Nelson E Ekechukwu, Lawan Umar, Omoyemi O Ogwumike
Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
|Date of Web Publication||31-May-2013|
Ade F Adeniyi
Department of Physiotherapy, College of Medicine, University of Ibadan
Source of Support: None, Conflict of Interest: None
Objectives: Physiotherapy training in Nigeria is almost 50 years old with no history of appraisal of research projects produced by the physiotherapy students. Physiotherapy students complete research projects in partial fulfilment of the requirements for graduation. An appraisal will reveal areas of strength and weakness in the research requirement for students, potentially leading to better research capacity and promoting evidence-based clinical practice among graduates. This study describes issues related to the study design, scope, statistical analysis and supervision of physiotherapy undergraduates in Nigerian universities. Methods: This retrospective study analysed 864 projects undertaken by Nigerian physiotherapy students between years 2000 and 2010. A maximum of 20 projects per academic year were randomly selected from each of the seven physiotherapy institutions in Nigeria. Data were obtained using a self-designed data retrieval form and analysed using descriptive and inferential statistics. Results: Cross-sectional surveys constituted 47.6% of the research projects with mainly non-probability sampling (57.7%) and lack of objective sample size determination in 91.6% of the projects. Most projects (56.4%) did not report any ethical approval. The particular university attended (χ2 = 109.5, P = 0.0001), type of degree offered (χ2 = 47.24, P = 0.00001) and the academic qualification of supervisors (χ2 = 21.99, P = 0.001) were significantly related to the strength of the research design executed by students. Conclusions: Most research projects carried out by Nigerian physiotherapy students were cross-sectional, characterised by arbitrary sample sizes, and were conducted on human subjects but most without report of ethical approval. Efforts to improve research methodology, documentation and exploration of a wider range of research areas are needed to strengthen this educational experience for students.
Keywords: Physiotherapy education, physiotherapy students, research projects, research supervision
|How to cite this article:|
Adeniyi AF, Ekechukwu NE, Umar L, Ogwumike OO. Research profile of physiotherapy undergraduates in Nigeria. Educ Health 2013;26:15-20
| Introduction|| |
Great value is placed on students' research within universities, exemplified by the prominent role of the dissertation at the end of many programmes including all physiotherapy training institutions in Nigeria. Physiotherapy was first introduced to Nigeria in 1945 by two British Chartered Physiotherapists who commenced physiotherapy training as a diploma programme. The first degree programme began in October 1966 in the University of Ibadan with the graduation of initial students in 1969.  Other universities in Nigeria have since followed with physiotherapy degree programmes, with the second being the University of Lagos in 1977 and the most recent being the Nnamdi Azikiwe University, Nnewi. 
Undergraduate physiotherapy research projects are pre-requisites for a successful academic career and graduating students have carried out research every year for almost 50 years. We noted, however, that students' research activities that lead to research reports had never been appraised in terms of their designs, strengths and weaknesses. This omission is a major gap in helping inform effective research mentorship for physiotherapy students in Nigeria and is the rationale for this study.
| Methods|| |
This study was a cross-sectional survey of undergraduate physiotherapy research projects. A self-designed, close-ended data retrieval form consisting of 15 items was used to obtain data from 864 undergraduate research projects undertaken between years 2000 and 2010. The data retrieval form was produced from a two-stage process. The first stage was the construction of the initial draft by the researchers. Fifteen randomly selected research projects from three universities were reviewed in order to generate the necessary items for the data form. In the second stage, three final-year physiotherapy students and two additional physiotherapy teachers who were not part of the research team were invited to a session where the initial draft was reviewed using the selected 15 projects as guidance. From their input, the form was revised to include contents initially omitted and to remove other contents that were repetitions.
The items on the data retrieval form included type of degree the student was obtaining [Bachelor of Science (B.Sc.), Bachelor of Medical Rehabilitation (BMR) or Bachelor of Physiotherapy (BPT)]. In Nigeria, physiotherapy degree programmes originally offered only B.Sc. and BMR degrees, with the current degree in some universities being the BPT. The research supervisors' highest academic qualifications were also documented: B.Sc., BMR, BPT, Master of Science (M.Sc.), Master of Education (M.Ed.) and Doctor of Philosophy (Ph.D.). Other items on the data form reflected documentation of standard research report contents that should be expected of physiotherapy undergraduates, including documentation of sample size determination, specification of research design, documentation of ethical approval and use of appropriate data analysis techniques. For classifying research designs, eight designs were used: Cross-sectional designs, case reports, case control studies, cohort studies, quasi-experimental, experimental, correlational and longitudinal studies. When a given study reported two research designs, we considered each separately. If the sample size was not calculated, we looked for evidence of any explanation for the sample size applied or assumed it was chosen arbitrarily.
A maximum of 20 projects were randomly selected for each academic year between 2000 and 2010 from each of the seven physiotherapy training institutions in the country. In schools with fewer than 20 projects in a given year, all projects were included. For schools that had more than 20 projects in a given year, 20 projects were selected randomly. After selection for inclusion, projects in hard copies were retrieved from schools' departmental libraries where they were stored. Data were collected from the Physiotherapy Departments of University of Ibadan, Ibadan; Nnamdi Azikiwe University, Nnewi Campus; University of Nigeria, Enugu Campus; Bayero University, Kano; University of Maiduguri, Maiduguri; Obafemi Awolowo University, Ile-Ife and University of Lagos. Through the entire study process, the confidentiality of the students, including their supervisors and the universities, were protected. Data were analysed using frequencies and percentages and chi-square tests with significance set at P < 0.05. The analyses were carried out using SPSS Version 16 (SPSS Inc., Chicago, IL, USA).
| Results|| |
A total of 864 undergraduate research projects were included and assessed. [Table 1] shows that samples drawn from each university ranged from 16% to 20% of the total sample size for five of the seven schools. Nnamdi Azikiwe University, with only 4.3% of the total, and the University of Maiduguri, with 5.9%, had fewer studies assessed because the physiotherapy training programmes at these two universities were relatively new. Thirty-eight percent of the research projects were for students earning the Bachelor of Science (B.Sc.) degree in physiotherapy. A total of 232 (26.9%) projects were supervised by teachers who have had Doctor of Philosophy (Ph.D.) degrees while 3.4% of the projects were supervised by teachers with bachelor degrees only (B.Sc./BMR). More than half (54.8%) of the students applied non-probability sampling techniques (purposive and convenience) with only a few (12.7%) using probability sampling techniques [Figure 1]. Nearly one-third of the projects (31.5%) did not report any specific sampling method.
|Table 1: Distribution of research projects by institution, degree awarded and supervisor's highest qualifi cation|
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[Table 2] reveals that almost half of the research projects (49%) were non-experimental and 23% did not indicate their research design. A strong majority of the projects (92.5%) collected their data through observation and use of questionnaires, and students conducted most of the studies (56.6%) within their institutions (school or hospital). More than half of the projects (51.6%) were conducted in the areas of orthopaedics, sports and fitness and neurology. Involvement of projects in the areas of paediatrics and obstetrics and gynaecology were lower (8.0%).
|Table 2: Distributions of research type, location and focus, method of data collection and data analysis|
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Over half of the research projects (54.3%) had sample sizes less than 100 and 90.4% of the projects did not report any objective way by which their sample sizes were determined. [Table 2] also shows that almost all (98.9%) of the projects were conducted on human samples, most of which were apparently healthy subjects (60.1%). Most of the research projects ( 88.4%) were conducted on adult participants. Ten projects (1.2%) were conducted on non-human samples.
It was expected that through their research projects candidates should be able to demonstrate evidence of their competence in sample size determinations, knowledge of research design, awareness of the need for ethical approval and use of appropriate data analysis techniques. Overall, 781 (90.4%) did not demonstrate evidence of an objective sample size determination, 199 (23%) did not report their research design and more than half (54.9%) did not report ethical approval for their research projects [Table 3]. Only 32 (3.7%) did not utilise any form of descriptive statistics in their research projects.
|Table 3: Distribution of expected research competencies seen in the projects|
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The research designs reported in the students' projects included case reports, cross-sectional surveys, case control studies, cohort studies, longitudinal studies, experimental and quasi-experimental studies and correlational studies. For ease of presentation, we ranked research designs applied by the students on the commonly accepted level of evidence they provide. From strongest to weakest, study designs have been ranked as systematic reviews and meta-analyses, randomised controlled trials, cohort studies, case-control studies, cross sectional surveys and case reports. ,, For the purpose of this study, we grouped all designs into three groups with increasing strength, from Level I to Level III [Table 4]. Based on research designs that students used, Level I is made up of true experimental studies, Level II is made up of quasi-experimental, cohort and correlational studies and Level III is made up of case reports, case control studies and cross-sectional surveys. A total of 199 (23%) of the studies did not report their design, hence these projects were not involved in this stage of the analysis.
|Table 4: Comparison of distribution of the research projects by institution, degree awarded and supervisor's highest academic qualification|
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We next assessed whether each of three factors might influence the research design executed by the students: The particular university attended, the type of degree offered by the university and the academic qualification of the supervisor. A total of 203 (30.5%) of the 665 projects that reported a research design did not reveal the highest academic qualifications of the supervisors and could not be included in analyses of the academic qualifications. [Table 4] shows that the university attended (χ2 = 109.5, P = 0.00001), the type of degree offered (χ2 = 47.24, P = 0.00001) and the academic qualifications of supervisors (χ2 = 21.99, P = 0.001) were each significantly correlated with the research design executed by students. The highest percentage of research projects that were categorised as Level I were reported by the University of Lagos [63 (49.6%)], in the BPT type of degree programmes [86 (43.2%)] and were mentored by supervisors who had earned M.Sc. [46 (21.8%)] or doctoral degrees [50 (27.8%)].
| Discussion|| |
This study was conducted to characterise the research projects of undergraduate physiotherapy students in Nigerian universities completed between 2000 and 2010. We found that some projects were supervised by teachers with bachelor's degrees only. This may reflect a manpower problem affecting developing countries generally, where it is often difficult to find more highly qualified faculty to lead training institutions. But also in Nigeria, the first Ph.D. degrees in physiotherapy were awarded in 2001, thus there are few advanced degree holders who have graduated as of yet. In this respect, it may be a positive finding that more than two-thirds of all projects were supervised by individuals with masters or doctoral degrees.
The reasons why randomised sampling was carried out in only one of ten projects is not known, but it may be because other sampling methods are more convenient and less technical, and implementing randomisation can prove difficult in practice. At least three types of problems can occur in randomisation: (1) wrong choice of randomisation method, (2) design and programming errors in implementing the method and (3) human error during the conduct of the trial.  Nevertheless, recent empirical evidence supports the importance of randomisation in controlled trials.  Without randomisation, treatment comparisons may be prejudiced, whether consciously or not, by selection of participants of a particular kind to receive a particular treatment.  The low level of randomisation may also be due to the nature of some research studies in physiotherapy whereby randomisation is impracticable because of the small number of available patient categories or because of the stages or phases involved in the research projects. It was also disappointing to note that nearly one-third of the projects did not report any type of sampling method.
That most of the studies reported a sample size less than 100 in itself may not be the problem but it is a problem that more than 9 out of 10 projects did not document a scientific or objective means of arriving at their sample sizes. This problem may not be peculiar to research projects carried out by students alone. A previous study by Charles et al. reported that out of 215 selected published articles by researchers, presumably most fully trained, 10 (5%) did not report a sample size calculation and 92 (43%) did not report all of the required parameters for their calculation. A major implication for not having a justifiable sample size is that the conclusions drawn from these studies may not be applicable to the broader population and thus should not influence clinical practice. 
There are two possible reasons why so few reports included mention of ethical approval. Either the research students did not obtain ethical approval or perhaps they did obtain approval but did not note it in their report. Either way this is a problem, as ethical review and approval are important competencies for student researchers to demonstrate, especially for studies carried out with human subjects, as were 99% of these student reports. , To the best of our knowledge, all institutions included in this evaluation had some form of ethical review committee in place, thus it is surprising that most reports did not include mention of ethics approval. At the very least, studies should state that they adhered to the principles of the Declaration of Helsinki. 
More than one-third of the research projects carried out by these students was cross-sectional, constituting the most common research design used by the students. This may not be surprising in view of the educational level of the students, the availability of resources and relative simplicity with which cross-sectional surveys are conducted. Typically, the students had only a short time available to conduct their research to earn their degrees, and it is not unexpected that most would favour a simpler and quicker design. The common choice of research topics in orthopaedics, neurology and sports may be because of the ready availability of facilities and patients for these conditions, or perhaps reflects the influence of supervisors. The university attended, the degree offered by the university and the academic qualification of the supervisor significantly correlated with the strength of the research design undertaken by the students. The reasons for this cannot be explained with these data. It is, however, noticed that stronger research designs were seen for projects conducted in the older universities, by students from degrees operating the newer curricula with longer years of physiotherapy training and by projects with supervisors with higher degrees.
A major limitation of this study is our inability to know why students' projects were as we found them to be. A future project could involve interviews where information on why projects were designed and reported as they were could be sought directly from the students and their teachers. Another limitation was that literature on similar studies was generally not available, making comparison across institutions and countries difficult. However, we believe that the outcomes of this study will form part of a possible intellectual discourse on how to improve research capacity of physiotherapy students.
| Conclusion and Implications|| |
This study finds a number of problems in the research education of physiotherapy students in Nigeria. It highlights some weaknesses in undergraduate physiotherapy research projects. This study can serve as a basis for further study, which could include interviews with students and faculty to better understand the choices they make in student research projects. The outcomes of this study could be used to help guide faculty members in identifying which types and areas of research are heavily subscribed and which types and areas are not, leading to a possible reorientation of students' research into priority types and areas. Study outcomes may also help stimulate a more informed instruction in research methodology for physiotherapy students based on weaknesses observed in the research projects of past students.
| Acknowledgement|| |
The authors are sincerely grateful to the Head of Departments of Physiotherapy in the universities where data for this study were collected.
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[Table 1], [Table 2], [Table 3], [Table 4]
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