Camp P1,2, Ben Ari O3, Dechman G4, Black A5, Chung F6, Dajee P7, Ellis A8, Hoens A1, Jones R9, Kirkham A2, Parappilly B10, Singh C8, Sweeney P9, Woo E7
1University of British Columbia, Faculty of Medicine, Physical Therapy, Vancouver, Canada, 2University of British Columbia, Centre for Heart Lung Innovation, Vancouver, Canada, 3University of British Columbia, Physical Therapy, Vancouver, Canada, 4Dalhousie University, Physiotherapy, Halifax, Canada, 5Providence Health Care, Providence Health Care Research Institute, Vancouver, Canada, 6Burnaby General Hospital, Physiotherapy, Burnaby, Canada, 7Providence Health Care, Physiotherapy, Vancouver, Canada, 8Fraser Health Authority, Physiotherapy, Surrey, Canada, 9Vancouver Coastal Health, Physiotherapy, Vancouver, Canada, 10Providence Health Care, Nursing, Vancouver, Canada

Background: Mobility and exercise are important for individuals hospitalized with an acute exacerbation of COPD (AECOPD) yet there are few guidelines for mobility and exercise prescription for these patients. This is especially important for newly-graduated physiotherapists (PT) who report that cardiorespiratory practice is intimidating. AECOPD-Mob is a clinical decision-making tool for safe and effective exercise prescription for hospitalized patients with AECOPD but this tool has not been implemented and evaluated in clinical practice.

Purpose: The purpose of this study was to investigate the usability of knowledge translation (KT) approaches to implementing AECOPD-Mob by newly-graduated acute care physiotherapists.

Methods: Newly-graduated (within 3 years) or new-to-AECOPD PTs from five hospitals in Canada were recruited and completed a questionnaire which assessed years of practice, confidence in treating patients with AECOPD, and barriers to KT. Each participant received the original paper AECOPD-Mob tool, and also participated in three additional ways to receive the AECOPD-Mob information: 1) a smartphone app, which included a clinical decision-making tree and pictures of exercises; 2) a web-based, video-enhanced learning module, which included patient scenarios; and 3) a didactic group inservice delivered by an expert PT. Participants were then encouraged to use the tool formats in clinical practice. At 3 weeks and 3 months, the participants completed a questionnaire and attended focus groups to discuss the usability of the different formats of the AECOPD-Mob tool.

Results: 17 PTs participated in the study (100% women; 80% 30 years of age; 95% graduated from PT program within 5 years). Only 15% reported being very confident in mobilizing hospitalized patients with AECOPD. The main barrier to KT was difficulty in finding the time to review the published literature. Regarding the different formats of the AECOPD-Mob information, the paper-based tool was considered the most comprehensive and provided the quickest access to information. The learning module and the inservice were seen as having different strengths - the learning module could be accessed anytime, while the inservice allowed discussion between colleagues and with the clinical PT expert. The smartphone was seen as problematic for bedside use, due to the impressions of smartphone use in the clinical setting and infection control. Although all the PTs had used all the formats at three weeks, the paper was the only format used consistently at three months. The paper version was considered the best format for PTs to provide the evidence-based rationale for mobilization to the health care team.

Conclusion(s): Newly-graduated physiotherapists working with AECOPD patients in acute care hospitals report the lack of time being the main barrier to KT. A paper-based version of the AECOPD-Mob tool was the best format for use in clinical practice. Smartphones were not feasible for bedside use, and both the learning module and the smartphone app were not used again within 3 months of the study.

Implications: Although mobile and web-based technology advances may support knowledge translation, simple paper-based formats of clinical decision-making tools may be the most feasible for ongoing acute care clinical use and to facilitate communication between team members.

Keywords: acute exacerbation of COPD, knowledge translation, clinical decision-making

Funding acknowledgements: This project was funded by the Providence Health Care Research Institute.

Topic: Cardiorespiratory; Education: continuing professional development; Education: methods of teaching & learning

Ethics approval required: Yes
Institution: University of British Columbia
Ethics committee: Providence Health Care Research Ethics Board
Ethics number: H15-01582

All authors, affiliations and abstracts have been published as submitted.

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