Project aimed to advance clinicians’ application of IGA using an educational intervention in readiness for a definitive trial. Secondary aims were to develop the core elements of complex intervention and to evaluate intervention feasibility.
Project implemented a phased approach and followed the Medical Research Council framework for development and delivery of complex interventions.
Phase1 focused on the development of educational intervention informed by a scoping review of how gait analysis influences management of ambulant CYPwCP across the medical and allied health professions; a qualitative study using semi-structured interviews exploring clinicians’ gait-related decision-making in CYPwCP and prerequisites to confident expert practice; and a national questionnaire of current status of gait analysis access, training and practice of UK paediatric physiotherapists.
Phase2 included a feasibility RCT with outcomes of recruitment, retention and completion rate, alongside secondary measures of confidence, knowledge, skill acquisition, and practice change.
Phase1 results informed the intervention's design and delivery of the study, and showed that clinicians experience multiple difficulties in gaining expertise and confidence in using IGA. Reported barriers are multifactorial, related to access for in-role decision-making, limited training opportunities and inability to translate training into clinical practice. The national questionnaire study on gait analysis knowledge and application amongst paediatric physiotherapists in the UK confirmed this and showed that clinicians’ confidence increases with knowledge (χ2(3)=15.99, p=0.001) and gait related in-role practice (χ2(4)=64.69, p0.001). Scoping review showed that clinician-centred factors such as training and exposure to IGA influence engagement with IGA-derived recommendations and may therefore impact on patient outcomes.
The feasibility RCT study in Phase2 met all feasibility criteria, recruiting over target, with 95% retention, 75% completion rate and no fidelity errors reflecting excellent protocol adherence. Secondary outcome measures showed large effect sizes for interaction between intervention and assessment time points on knowledge rating (F(2,78)=23.364, p0.0001, partial η2=0.375), observed case study results (F(2,78)=17.765, p0.0001, partial η2=0.313) and confidence rating (F(2,78)=8.997, p0.0001, partial η2=0.187); and medium effect size on knowledge test results F(2,78)=3.542, p=0.034, partial η2=0.083. Intervention group reported increased engagement with equipment, gait-related assessment and treatment.
The intervention is feasible and ready for a full trial. It showed promising indications of efficacy in terms of increased self-rated confidence and knowledge at each follow-up in the intervention group. The intervention group reported practice change after receiving intervention.
The research conducted in this project shifts the emphasis from IGA as a tool and focusses on clinicians’ educational needs embedded in the context of their practice. Findings can be a valuable resource to develop practice competencies, training pathways and feed into standard operating procedures relating to management of CYPwCP. Findings can support educational providers in facilitating knowledge transfer for clinicians seeking professional development opportunities.
Gait Analysis
Neurodisability
