Williamson E1, Srikesavan C1, Adams J2, Eldridge L1, Thompson J1, Lamb S1
1University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom, 2University of Southampton, Health Sciences, Southampton, United Kingdom
Background: The Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH) is a 12-week exercise programme for people with hand problems due to rheumatoid arthritis (RA). It is delivered in six sessions by a hand therapist. The SARAH programme was tested in a large trial and is clinically and cost-effective.
To facilitate the implementation of the SARAH programme into the National Health Service (NHS) in the United Kingdom, we developed a free online training (iSARAH) for NHS physiotherapists and occupational therapists. iSARAH was launched in April 2017.
Purpose: To evaluate the iSARAH training
Methods: Demographic information was collected at registration. Post-training data was collected from therapists who completed the training using an online questionnaire. Data included satisfaction, confidence, implementation intentions and potential barriers to implementation.
Therapists were followed up at six months using an online questionnaire. Data included implementation, perceived usefulness, and intentions to continue using the programme. We conducted telephone interviews with therapists, who had both implemented and not implemented the programme, to further understand the implementation process.
Results: As of 29 August 2018, 806 therapists had registered with iSARAH and 445 therapists had completed it. Seventy percent of completers were occupational therapists and 30% were physiotherapists. The majority were females (89%) with graduate-level education (68%).
Following the training, 376 therapists (84%) reported being confident to deliver the programme. 379 therapists (85%) intended to implement it. Satisfaction with the training was high. 404 therapists (91%) reported being very or extremely satisfied with the training. Potential barriers to implementation were lack of time, not seeing patients with RA, and lack of exercise equipment.
274 therapists had reached the 6-month time point and were contacted for follow up. 77 (28%) therapists provided follow up data. Of the responders, 50 therapists (65%) had implemented the programme to between 1 and 15 patients per month. The majority of therapists delivered the programme in 3-4 sessions. They found the programme clinically useful, rated patient satisfaction as high, and would continue to use the programme. Reasons for not implementing were lack of appropriate patients, heavy caseload, or providing alternative exercise programmes.
Analysis of the interviews found that barriers were similar to those reported previously. Facilitators included a positive attitude by therapists and patients (e.g. expectations of benefit), rheumatology staff endorsement and that the programme was clear and easy to follow. Aspects of the clinical interaction helped patients to engage with the programme including spending time teaching the exercises, education about RA and the importance of exercises, and providing motivation when patients had difficulty exercising. Therapists recommended digital applications of the programme and translation into other languages to increase accessibility.
Data collection is ongoing and results will be updated for WCPT 2019.
Conclusion(s): NHS therapists were successfully trained to deliver an evidence-based hand exercise programme for patients with RA using an online programme. It can be used to facilitate implementation of the SARAH programme.
Implications: The iSARAH training is an effective training tool for physiotherapists and we hope to make it widely available.
Keywords: Online training, Rheumatoid Arthritis, Implementation
Funding acknowledgements: Funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford. Supported by the Oxford NIHR BRC.
To facilitate the implementation of the SARAH programme into the National Health Service (NHS) in the United Kingdom, we developed a free online training (iSARAH) for NHS physiotherapists and occupational therapists. iSARAH was launched in April 2017.
Purpose: To evaluate the iSARAH training
Methods: Demographic information was collected at registration. Post-training data was collected from therapists who completed the training using an online questionnaire. Data included satisfaction, confidence, implementation intentions and potential barriers to implementation.
Therapists were followed up at six months using an online questionnaire. Data included implementation, perceived usefulness, and intentions to continue using the programme. We conducted telephone interviews with therapists, who had both implemented and not implemented the programme, to further understand the implementation process.
Results: As of 29 August 2018, 806 therapists had registered with iSARAH and 445 therapists had completed it. Seventy percent of completers were occupational therapists and 30% were physiotherapists. The majority were females (89%) with graduate-level education (68%).
Following the training, 376 therapists (84%) reported being confident to deliver the programme. 379 therapists (85%) intended to implement it. Satisfaction with the training was high. 404 therapists (91%) reported being very or extremely satisfied with the training. Potential barriers to implementation were lack of time, not seeing patients with RA, and lack of exercise equipment.
274 therapists had reached the 6-month time point and were contacted for follow up. 77 (28%) therapists provided follow up data. Of the responders, 50 therapists (65%) had implemented the programme to between 1 and 15 patients per month. The majority of therapists delivered the programme in 3-4 sessions. They found the programme clinically useful, rated patient satisfaction as high, and would continue to use the programme. Reasons for not implementing were lack of appropriate patients, heavy caseload, or providing alternative exercise programmes.
Analysis of the interviews found that barriers were similar to those reported previously. Facilitators included a positive attitude by therapists and patients (e.g. expectations of benefit), rheumatology staff endorsement and that the programme was clear and easy to follow. Aspects of the clinical interaction helped patients to engage with the programme including spending time teaching the exercises, education about RA and the importance of exercises, and providing motivation when patients had difficulty exercising. Therapists recommended digital applications of the programme and translation into other languages to increase accessibility.
Data collection is ongoing and results will be updated for WCPT 2019.
Conclusion(s): NHS therapists were successfully trained to deliver an evidence-based hand exercise programme for patients with RA using an online programme. It can be used to facilitate implementation of the SARAH programme.
Implications: The iSARAH training is an effective training tool for physiotherapists and we hope to make it widely available.
Keywords: Online training, Rheumatoid Arthritis, Implementation
Funding acknowledgements: Funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford. Supported by the Oxford NIHR BRC.
Topic: Rheumatology; Education: continuing professional development; Disability & rehabilitation
Ethics approval required: No
Institution: University of Oxford
Ethics committee: Clinical Trials and Research Governance (CTRG)
Reason not required: The University of Oxford CTRG concluded that ethical approval was not required as it was a training course evaluation rather than a research study.
All authors, affiliations and abstracts have been published as submitted.
