EHealth to empower patients with musculoskeletal pain in rural Australia (EMPoweR) a randomised clinical trial: study protocol.

BACKGROUND: Low back pain (LBP) and knee osteoarthritis (OA) are major contributors to disability worldwide. These conditions result in a significant burden at both individual and societal levels. Engagement in regular physical activity and exercise programs are known to improve physical function in both chronic LBP and knee OA populations. For people residing in rural areas, musculoskeletal conditions are often more frequent and disabling compared to urban populations, which could be the result of reduced access to appropriate health services and resources in rural settings. EHealth is an innovative solution to help provide equitable access to treatment for people with musculoskeletal pain living in rural settings. METHODS/DESIGN: We will conduct a randomised clinical trial investigating the effects of an eHealth intervention compared to usual care, for people with chronic non-specific LBP or knee OA in rural Australia. We will recruit 156 participants with non-specific chronic LBP or knee OA. Following the completion of baseline questionnaires, participants will be randomly allocated to either the eHealth intervention group, involving a tailored physical activity and progressive resistance exercise program remotely delivered by a physiotherapist (n = 78), or usual care (n = 78) involving referral to a range of care practices in the community. Outcomes will be measured at baseline, 3 and 6 months post-randomisation. The primary outcome will be physical function assessed by the Patient-Specific Functional Scale (PSFS). Secondary outcomes include pain intensity, physical activity levels, activity limitations, quality of life, pain coping. We will also collect process evaluation data such as recruitment rate, attendance and adherence, follow-up rate, participants' opinions and any barriers encountered throughout the trial. DISCUSSION: The findings from this trial will establish the effectiveness of eHealth-delivered interventions that are known to be beneficial for people with LBP and knee OA when delivered in person. As a result, this trial will help to inform health care policy and clinical practice in Australia and beyond for those living in non-urban areas. TRIAL REGISTRATION: This study was prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12618001494224 ) registered 09.05.2018.

A Delphi study to establish consensus on an educational package of musculoskeletal clinical prediction rules for physiotherapy clinical educators.

BACKGROUND: Clinical prediction rules (CPRs) are evidence-based tools to aid clinical decision-making, and there are many that are relevant for physiotherapists, especially in the musculoskeletal field. However, a lack of awareness and understanding by physiotherapy clinical educators could limit students' exposure to these potentially valuable tools. An educational package tailored for clinical educators could help them recognise the value of CPRs and implement them in clinical practice with students. OBJECTIVES: To determine consensus on the essential content and optimal delivery of an educational package on musculoskeletal CPRs for physiotherapy clinical educators. DESIGN: An online survey of physiotherapy experts who have published on CPRs, using a Delphi approach. METHOD: Sixteen experts were recruited for a two-round reactive Delphi study in which they rated previously identified elements, as well as suggesting new items for an educational package. FINDINGS: A pre-defined consensus of ≥70% identified that the content of an educational package should cover fundamental aspects of CPRs including why, when and how to use them clinically, and their limitations. Information on the evidence-base of different types of CPRs, with specific examples, was also identified as important. Online delivery was recommended via self-directed learning and webinars, along with electronic versions of actual CPRs. A self-assessment component was also supported. CONCLUSIONS: An educational package on musculoskeletal CPRs for clinical educators was supported with key elements outlined by an international panel of experts. IMPLICATIONS: Improving clinical educators' knowledge of CPRs may lead to physiotherapy students having a greater understanding and ability to use CPRs.

The preferences of physiotherapy clinical educators on a learning package for teaching musculoskeletal clinical prediction rules - A qualitative study.

BACKGROUND: There is a growing number of clinical prediction rules (CPRs) relevant to physiotherapy, particularly in the musculoskeletal area, but many students are not learning about them due to lack of awareness or understanding by clinical educators. An educational package specifically designed for physiotherapy clinical educators would aid their understanding of CPRs and ability to utilise them clinically, and also to be able to teach them to students. OBJECTIVES: To determine the desired content and preferred methods of delivery of an educational package for clinical educators on musculoskeletal CPRs. DESIGN: A qualitative descriptive approach using semi-structured group and individual interviews with clinical educators. METHOD: Educators working in the clinical area of musculoskeletal physiotherapy who had an awareness of or interest in CPRs were recruited and interviewed on their views regarding the content and delivery of an educational package on musculoskeletal CPRs. Audio files were transcribed and analysed using framework analysis to explore and develop themes and subthemes. FINDINGS: Content of an educational package should include general information on CPRs to improve familiarity and understanding, including a brief description, purpose, stages of development, application, limitations, and Information to dispel common myths and misunderstandings, as well as some specific examples of commonly-used CPRs. The package should be available in multiple formats to allow for different learning styles, both online via video, webinars, and podcasts, and face-to-face in practical sessions. CONCLUSIONS: Clinical educators would find an educational package useful in assisting them to learn about musculoskeletal CPRs and to teach them to students.

Physiotherapy students' perceptions and experiences of clinical prediction rules.

OBJECTIVES: Clinical reasoning can be difficult to teach to pre-professional physiotherapy students due to their lack of clinical experience. It may be that tools such as clinical prediction rules (CPRs) could aid the process, but there has been little investigation into their use in physiotherapy clinical education. This study aimed to determine the perceptions and experiences of physiotherapy students regarding CPRs, and whether they are learning about CPRs on clinical placement. DESIGN: Cross-sectional survey using a paper-based questionnaire. PARTICIPANTS: Final year pre-professional physiotherapy students (n=371, response rate 77%) from five universities across five states of Australia. RESULTS: Sixty percent of respondents had not heard of CPRs, and a further 19% had not clinically used CPRs. Only 21% reported using CPRs, and of these nearly three-quarters were rarely, if ever, learning about CPRs in the clinical setting. However most of those who used CPRs (78%) believed CPRs assisted in the development of clinical reasoning skills and none (0%) was opposed to the teaching of CPRs to students. The CPRs most commonly recognised and used by students were those for determining the need for an X-ray following injuries to the ankle and foot (67%), and for identifying deep venous thrombosis (63%). CONCLUSIONS: The large majority of students in this sample knew little, if anything, about CPRs and few had learned about, experienced or practiced them on clinical placement. However, students who were aware of CPRs found them helpful for their clinical reasoning and were in favour of learning more about them.

Physiotherapy clinical educators' perceptions and experiences of clinical prediction rules.

OBJECTIVES: Clinical prediction rules (CPRs) are widely used in medicine, but their application to physiotherapy practice is more recent and less widespread, and their implementation in physiotherapy clinical education has not been investigated. This study aimed to determine the experiences and perceptions of physiotherapy clinical educators regarding CPRs, and whether they are teaching CPRs to students on clinical placement. DESIGN: Cross-sectional observational survey using a modified Dillman method. PARTICIPANTS: Clinical educators (n=211, response rate 81%) supervising physiotherapy students from 10 universities across 5 states and territories in Australia. RESULTS: Half (48%) of respondents had never heard of CPRs, and a further 25% had never used CPRs. Only 27% reported using CPRs, and of these half (51%) were rarely if ever teaching CPRs to students in the clinical setting. However most respondents (81%) believed CPRs assisted in the development of clinical reasoning skills and few (9%) were opposed to teaching CPRs to students. Users of CPRs were more likely to be male (p<0.001), have post-professional qualifications (p=0.020), work in private practice (p<0.001), and work in the area of musculoskeletal physiotherapy (p<0.001) compared with non-users. The CPRs most commonly known, used and taught were the Ottawa Ankle Rule, the Ottawa Knee Rule, and Wells' Rule for Deep Vein Thrombosis. CONCLUSIONS: Students are unlikely to be learning about CPRs on clinical placement, as few clinical educators use them. Clinical educators will require training in CPRs and assistance in teaching them if students are to better learn about implementing CPRs in physiotherapy clinical practice.