Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents related literature and studies that have a significant bearing on the
present study. These served as the basis and support for the researcher's conduct of the
research and the explanation of the results. This includes synthesis of the state-of-the-art, Gap
Bridge of the study, theoretical and conceptual framework, paradigm, and definition of terms

Related Literature

World Health Organization (2021) stated that COVID-19 is an infectious disease caused by the
SARS-CoV-2 Virus. The vast majority contaminated with the infection will encounter gentle to
direct respiratory ailment and recuperate without requiring unique treatment. Notwithstanding,
some will turn out to be genuinely sick and require clinical consideration. More seasoned
individuals and hidden ailments like cardiovascular sickness, diabetes, persistent respiratory
infection, or disease are bound

Facal, Wilson, Hooi, Sciortino, and Adnrieu (2021) published an article about the current state of
Southeast Asian nations on the impact of Covid-19. In Southeast Asia, the pandemic's
numerous social and social components have become dark. The voices of humanities and
sociology specialists and surprisingly general wellbeing experts appear to be. The effects of
social distancing and closures grab hold, and social and economic opportunity contract much
further. Self-help networks alone are then insufficient. In Indonesia, as in other Southeast Asian
nations, meaningful government mediation is required promptly to empower the helpless
populace to overcome this emergency.

Mendoza (2021) issued an article regarding the effects of Covid-19 on the Philippines. First, the
Philippines' financial model itself shows up more powerless against infection episodes. It is
worked around the versatility of individuals, yet the travel industry, administrations, and
settlements that took care of development are generally powerless against pandemic-induced
Lockdowns, and consumer confidence declined.

Bhatia, Get al., (2021) published 2,835, 154 infections and 49,499 coronavirus-related deaths
reported in the Philippines since the pandemic began. As the data suggest, the Philippine
government implemented health policies to prevent the further spread of infection. However, the
public did not readily accept policy implementation; with the severity of the living condition.

Koty (2021) stated that The COVID-19 pandemic has transformed how medical workers from
the Philippines work, both at home and abroad. The pandemic has tossed medical workers'
relocation designs into confusion. However, the pandemic encouraged phenomenal worldwide
interest for medical employees; the crisis at home drove the Philippine government to fix
limitations on work development. As the pandemic continues, medical workers struggle to
accomplish their mandate and meet.
World Confederation of Physical Therapy (2019) stated that Physical therapy is a service
provided by physical therapists to individuals and populations to develop, maintain and restore
maximum movement and functional ability throughout the lifespan. Many people suffer from
different types of disability or condition that affects their movement, in this current situation
where travel restriction is implemented, preventing patients from being mobile in going from one
place to another.

American Physical Therapy Association (2020) advocates that home health care can be
cost-efficient, convenient, and as effective as patients' care in a hospital or skilled nursing
facility. Home health PTs work one-on-one with patients in their environment, making services
entirely relevant to their needs and goals.

Philippine Physical Therapy Association (2020) stated that as a healthcare professional, the
Physical Therapist must advise the patient on the best option/s and give all the necessary
considerations in pursuing home healthcare during the pandemic. Physical Therapists will have
to consider all the implementing policies in traveling to render home-based Physical Therapy
Treatment.

Romero, Guillen, Cordova and Gatarin (2014) provides a comprehensive overview of the
transport governance situation in the Philippines, focusing on Metro Manila. The paper
highlights the complexity and dynamics of transport governance in the country, compounded by
the number of local government units and national agencies involved in the transport sector.
Metro Manila, with its 17 cities and municipalities and a population of 13 million, is a prime
example of the challenges faced in transport governance in the Philippines. The study highlights
the need for coordinated efforts between government agencies and local units to address the
transport issues in the country's largest metropolitan area. Overall, the paper presents an
informative situation on transport governance in the Philippines.

Institute of Health Policy and Development Studies (2005) provides a comprehensive literature
review on the migration of Filipino health workers and its impact on individuals, families,
professions, and the nation. The paper examines why health workers choose to migrate or stay
in the country and the effects of health worker migration on the health system, including working
conditions and service provision. The study also reviews existing migration policies and
practices and discusses the various viewpoints of key stakeholders. Furthermore, the paper…..

(Missing)
​
…..health worker migration and recommends strategies for socially acceptable management of
health worker migration.

University of the Philippines Population Institute (2020) discusses the impact of the COVID-19
outbreak in the Philippines; it highlights the need to hire more health workers to address the
increasing number of COVID-19 cases and protect those in the line of duty. The analysis draws
information from the latest census data of 2015 and projections on health professionals in the
country. It also utilizes the 2018 National Migration Survey (NMS), and the 2018 Occupation
Wages Survey (OWS), which covers establishments employing at least 20 workers nationwide.
The review aims to guide policy formulation in human resources for health (HRH), crucial in the
current fight against the pandemic. It highlights the urgent need to address the country's health
workforce gap and provide valuable information for policymakers, which is essential in
managing the current crisis.

The Philippine Statistics Authority (2022) conducts the Occupational Wages Survey (OWS)
every two years to monitor wage rates for various occupations in different industries. The 2020
Ows covered establishments with 20 or more workers and monitored 190 industry-specific
occupations using the 2012 Philippine Standard Occupation Classification (PSOC). The survey
generates wage statistics that inform wage and salary administration policies, wage
determination, and collective bargaining negotiations. It also measures wage bargaining
differences across occupations and industries and wage differentials and inequality in low-wage
and high-wage occupations. The 2020 OWS is recognized as a critical statistical activity that
generates essential data for government and private sector decision-making. The survey
includes data on occupational wage rates, median basic pay, and median allowance of
time-rated workers on a full-time basis, covering the pay period that includes 31 August 2020,
the wage data collected from the Ows is internationally comparable, using the current standard
codes for industries and occupations.

Related Studies

Ozili and Arun (2020) conducted a study regarding the global spillover of covid-19. Statistical
data was gathered and analyzed on the impact of the pandemic on the major sectors of the
global economy. The study shows that increasing the number of Lockdown days, and monetary
and travel restrictions imposed significant risks to the general development of the economy.
They concluded that social distancing and lockdown restrictions triggered the global recession
of the year 2020.

On the other hand, Olivia, Gibson, and Nasrudin (2020) presented a study on the impact of
covid-19 on the Indonesian economy. The researchers compared the global data and the
current status of the Indonesian Covid-19 response. The pandemic hit a major weakness of the
Indonesian health care system as it was already a fragile state. Health care quality was affected
by the growing number of patients was affected as Indonesia became the country with the
highest covid-19 positive in the region. The macroeconomic impact was also analyzed, which
has significantly disrupted the Indonesian economy, prompting the government to issue stimulus
packages to soften the economic impact of the pandemic. potential stated also Researchers
long-term implications such as food supplies, immunization drawbacks, and long-term economic
effects. ​
​
Douglas, Katikireddi, Taulbot, McKee, and McCartney (2020) discussed their study of the
broader health effects of Coivd-19 and ways to mitigate its impact. The research emphasized
the identification of several groups to be more vulnerable to the effects of social distancing
policies. Social isolation due to quarantine can induce psychological harm that can lead to
long-term effects. Community restrictions and isolation policies may control the spread of the
covid-19. However, broader health effects may arise that need to be addressed.

Chong, Li, and Yip (2020) investigated the effects of covid-19 on the ASEAN countries. They
mentioned in their paper that the Philippines experienced the most significant decline in
economic growth in terms of GDP among the ASEAN countries. In the analysis, unemployment
made a significant impact on the Philippine recession, in which the country's economic trade
became sluggish. ​
​
Haw, Uy, Sy, and Abrigo (2020) conducted descriptive research on the Philippines'
Epidemiological profile and transmission dynamics of covid-19. Data was collected in
coordination with the Epidemiological Bureau of the Department of Health through the records
made by the Epidemiological Surveillance Unit (ESUS). This outline of the initial three months of
the COVID-19 episode in the Philippines gives an exceptional viewpoint on the transmission of
COVID-19 in a wellbeing framework with restrictions in reconnaissance, testing, and
administration conveyance.

Dy and Rabajante (2020) made a study on Covid-19 infection risk among health care workers.
Results show a direct relationship between the increased exposure to the Covid patient and the
increased risk of infection by medical frontliners. Decreasing the infection risks faced by health
workers each day, combined with predominant wellbeing, prosperity, and government
assistance rehearse, will bring about a robust medical care staff that can persevere through a
significant stretch of the fight during this COVID-19 pandemic. ​
​
Tino, Sacdalan. Abarquez, and Uson (2020) conducted a study…..​

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…..significantly prevent infection spread in a treatment area, such as foot traffic management.
The systematic treatment protocol can help manage infection without affecting the quality of
treatment given to patients.

Wittmeier, Parsons, Webber, Askin, and Salonga (2020) conducted a study on how Physical
Therapists will play a role in the current covid-19 pandemic. Physical Therapists play significant
part a in reaction endeavors identified with significant occasions affecting wellbeing and health,
including the COVID-19 pandemic. The proof introduced inside this audit can be utilized to
illuminate office-based and territorial arranging…..

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…..endeavors during the current COVID-19 pandemic and overall readiness arranging: Fast
and convenient sharing of proof and experience is fundamental to guarantee that active
recuperation offices are prepared to react to the fullest extent of work during a pandemic.
Falvey, Krafft, and Kornetti (2020) studied the crucial roles in-home and community-based
physical Therapy. Many proofs support home and community-based Physical Therapists as
fundamental health care providers during the COVID-19 pandemic. For some patients, support
from physical therapist intercessions lessens the hazard of hospitalization. It permits them to
stay at home instead of requiring nursing home level consideration-both fundamental general
wellbeing objectives during a viral pandemic that is at the present overwhelming medical facility
and nursing home limit.

Palacio-Ceña et al. (2021) explore future challenges for Physical Therapists during and after the
covid-19 pandemic. Data analysis categorizes Organizational, challenges ICU management,
three into themes: and Patient management. Researchers concluded that telerehabilitation
would play a significant role in future treatment options in mitigating physical therapy treatment
challenges in the pandemic.

Marcus, Quimson and Short (2014) explores the views and experiences of key informants from
Filipino organizations regarding Filipino nurse migration to Australia. The study uses
focus-group interviews to gather qualitative data, and a thematic analysis approach is used to
analyze the data. The study finds that health workforce migration has both positive and
negative…..​

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…..consequences. On the positive side, emigration offers opportunities for individual to nurses
achieve economic, professional, lifestyle, and social benefits. On the negative side, senior and
experienced nurses leaving the country lead to a misdistribution of health workers, negatively
affecting rural health outcomes in developing countries.

Labrague, Pettite, and Leocadio (2019) presents a study that describes the transition
experiences of newly graduated Filipino nurses during their initial clinical placement process.
The study used a qualitative phenomenological approach, and data were analyzed using
Coliazzi's methodological framework. The findings revealed four distinct themes: experiencing
transition shock, feeling pressured, learning excitement, and needing support. The study
highlights that new nurses' transition to a professional nursing role is a challenging and stressful
experience. Support from academic and nursing administration team members can facilitate a
smooth transition and integration of new nurses into the nursing workforce.

Pinto (2017) focuses on stress and burnout in health professionals. The review highlights the
prevalence of stress and burnout among health professionals and its negative consequences on
their quality of life and patient care. It identifies occupational stress as a result of work
complications caused by physical, social, or psychological stressors, Burnout syndrome is
characterized by emotional exhaustion, lack of professional accomplishment, and
depersonalization. The study also identifies coping mechanisms to mitigate the effects of stress. ​
​
Falguera Et. Al, (2920) explores the relationship between the nurse practice environment and
work outcomes in the Philippines. A cross-sectional survey involving 549 hospital nurses was
conducted in 2018. The results suggest that a favorable work environment can significantly
reduce job burnout and job stress and improve the quality of patient care. Furthermore, a
favorable nurse practice environment may engage a better nurse workforce in the country and
reduce migration. The study recommends that managers develop suitable nurse practice
environments to improve professional work outcomes and quality patient care.

Van wee and Witlax (2021) explores the potential long-term impacts of the COVID-19 pandemic
on activity-travel behavior, drawing from theories and concepts from various disciplines. The
study suggests that lasting effects are expected and that the peak demand for car and oublic
transport may be lower than pre-pandemic levels. However, the overall impact on total travel
time is likely limited. The paper highlights the need for further research on the role of attitude
changes, the formation of new habitual behavior, social norms and practices, well-being effects,
and the role of Information and Communication Technologies (ICT). The findings of this study
have implications for transportation infrastructure planning decisions.

Tabler et al (2014) examines how patients' experiences at primary care clinics affect their
perceptions of their relationship with their primary care provider (PCP). The study uses a
mixed-methods approach, including focus group interviews, a patient experience survey, and
medical records analysis, to explore the role of patient experience in interpersonal continuity of
care. Results show that patients' experiences, such as wait times and effective provider
communication, positively influenced their perceptions of the patient-provider relationship. The
study highlights the importance of considering patient experiences in assessing interpersonal
continuity of care…..

(Missing)

…..two-phase mixed methods approach. The first phase involved the administration of the
Maslach Burnout Inventory-Human Services Survey, and the second phase involved a focus
group discussion and a series of in-depth interviews. The results indicated that several
conditions influenced burnout for Filipino occupational therapists, including age, marital status,
years of practice, and work hours. The study suggests that the pressure from societal and
personal expectations can lead to burnout and decreased creativity in practice among Filipino
occupational therapists.

Collado (2019) examines the public health sector in the geographically isolated and
disadvantaged area of Jomalig Island, Quezon Province, Philippines. Key informant interviews
were conducted with health professionals and village health workers, and the World Health
Organization's tracer checklist was administered. Results showed deficiencies in facilities,
offered services, and health staff. Mortality and morbidity rates were not alarming, but
hypertension and diarrhea were common. Difficulties of the island's public health sector include
better budgetary allocation, equipment, and additional training for the village health workers.
The study recommends emergency boats per village, health education campaigns, stand-by
generators for health centers, and a radio communication system to mitigate the negative
impacts of living in GIDA communities.

Synthesis of the State of the Art

The present study is comparable to Wittmeier et al. (2020), Falvey et al. (2020), and
Palacios-Ceas et al. (2021) since it aimed to propose new programs and techniques for
managing Physical Therapy Treatment during the Covid-19 epidemic. This study examined
Home Health Physical Therapists in the U.S. Previous studies evaluated international data,
while the current study focused on Physical Therapy problems in the Bicol Region. ​
​
The Covid-19 pandemic impacts healthcare workers and medical procedures. The present
study is comparable to theirs because it assesses how covid-19 influences Physical Therapy
Treatment. The study emphasized physical therapists (Dy et al., 2020). As well as how
environmental factors affect the practice of home health physical therapy practice in the Bicol
Region (Van Wee & Witlax, 2021).

The current study evaluated the status quo of the study setting, which is the emphasis of Haw et
al., Douglas et al., and Chono et al. (2020). The present study focused on PTs in Bicol's status
quo, which is also comparable to the studies of Marcus et al., Labrague et al., and Calledo,
which focus on the challenges of the practice of health workers.

Ozili and Arun (2020) and Olivia et al. (2020) described the global epidemic. The prior study
stresses how the global recession affects the healthcare system and Physical Therapy
treatment.

Pinto (2017), Falguera (2020), and Delos Reyes (2018) discussed how different factors could
affect the psychological well-being of health workers. This study has taken an interest in the
mental health status of home health practitioners.

This chapter’s research provided broad insights and concrete perspectives on the current study.
All the information acquired will help researchers connect and break the continuity between the
prior and current study, which is the pandemic’s consequences for home health physical
therapy.

Gap-Bridge by the Study

After considering all the relevant literature and research, it became evident that the studies
mentioned previously focused on the broader impacts of the COVID-19 pandemic on society.
These studies were conducted nationally or globally and included more diverse groups of
healthcare professionals. However, no single study has explicitly targeted healthcare providers
in the Philippines or the Bicol Region. Furthermore, the challenges physical therapists
encounter in home health physical therapy practice due to the COVID-19 outbreak and their
strategies to address these issues have yet to be adequately explored in descriptive studies.
The objective of the present study is to fill this research gap.​
​
Theoretical Framework

The study is anchored on the approach of Social Cognitive theory.

The Social Cognitive Theory (SCT) is widely used in Public Health. Albert Bandura develops it
as a cognitive formulation of social learning theory. Human behavior is a three-way dynamic
reciprocal model in which Cognitive factors, Environmental influences, and behavioral factors
continually interact. SCT emphasizes the unique manner in which individuals acquire and
sustain behavior and the social environment in which the behavior is performed. Many models
of behavior utilized in public health do not account for the maintenance of behavior, focusing
instead on behavior initiation.

This is problematic as the fundamental objective of public health is behavior maintenance, not
only behavior initiation. SCT seeks to explain how individuals regulate their behavior through
control and reinforcement to accomplish goal-directed behavior that can be maintained over
time.​
​

Reciprocal Determinism: This is SCT's central concept. It refers to the dynamic and reciprocal
relationship between the Physical Therapist (individual with a set of acquired experiences),
environment (Coivd-19 influence), and behavior (responses to stimuli to achieve and defeat
challenges).

Behavioral Capability: It refers to the Physical Therapist's ability through essential Home
Health Physical Therapy knowledge and skills.

Observational learning: refers to learning from others' successes or mistakes.

Reinforcement: refers to the internal or external responses to a person's behavior that

Self-efficacy: This refers to a Physical Therapist's confidence level in their ability to deal with
challenges and problems brought by the pandemic.

In summary, this theory presents the general implications of Challenges and Strategies affecting
the practice of Home health Physical therapists during the Covid-19 pandemic. Furthermore, it
will serve as a cornerstone in strengthening the idea that the status quo of this pandemic may
influence the careers of home health physical therapists. The researcher believes that this
model will effectively present the prevailing theory of the present study, considering that it is a
widely used model around the globe to provide successful health intervention to patients and
people alike.

Conceptual Framework

The study's conceptual framework describes all procedures involved in this study of the effects
of the covid-19 pandemic as the independent variable and challenges of home health PT
practice in Camarines Sur, as the dependent variable.

The paradigm gives us the "Input" of the study that is necessary for building the foundation of
the study. It consists of the legal basis, Theories on which the study is anchored, previous data
related to the study, research methodologies, and relevant research and statistical
instruments-followed by the "Process," which will gather, analyze, and interpret data. Lastly, the
"Output" of the study Identification of the challenges of Physical Therapist, proposed solutions
and proposed updated guidelines for in-home health PT practice.

INPUT: The legal basis of the study is how physical therapists must perform their duty as stated
by the government. On the other hand, a theory is the system of ideas or explanations where
the challenges and strategies affect physical therapists. The questionnaire will be the research
instrument to gather data on the Challenges experienced by the participants, broken down into
five key points: Public Policy, Transportation, Income and Expense, PT treatment Practice,
Patient and family relationships, and psychosocial well-being. Furthermore, the strategies that
gave solutions to those challenges.​
​
PROCESS: The Process of the study will focus on the data gathering from the respondents;
interpret and analyze the gathered data from the online questionnaire; identify the correlation of
the variables while discussing the profile of the respondents, the extent of challenges, and
strategies of home health physical therapy practice during covid-19. And lastly, drawing of
conclusions and formulation of recommendation.

Output: The output of this study will be proposing an action plan to enhance the home physical
therapy practice among physical therapists during a health crisis.

Definition of Terms

To better understand this study, the researcher deemed it necessary to define the following
terms.

COVID 19 Pandemic is an infectious disease that gravely affects every sector of society,
including the Economy, Government, health care, and social interaction.
Physical Therapy is movement experts who improve quality of life through prescribed exercise
and patient education.

Physical Therapists are professionals to practice physical therapy.

Home Health Physical Therapy Practice is a branch of Physical Therapy that specializes in
giving Physical therapy services in the patient’s homes in the Bicol region.

Extent of Challenges is the degree of difficulties experienced by Physical therapists in giving

Extent of Strategies is the degree of solutions/modifications made by a physical therapist to

Public policy and protocols are the rules and regulations made by the government agency or
private institution to prevent/minimize the spread of the Covid-19 Virus.

Transportation- these are private or public vehicles used by the Physical therapist to reach the
patient's destination.

Income and Expenses- these are the financial earnings and cost of performing home physical
therapy.

Physical therapy treatment procedures- are individualized programs and processes

Patient and family relationships- this is the connection and behavior between patient and
family toward their physical therapist.

Psychosocial well-being is a physical therapist's mental health experience during the covid-19
pandemic.

Action Plan- this is the proposed strategy/programs based on the results of the study that will
help physical therapists during a health crisis