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Strike K.1,2, Chan A.3, Lawson W.3,4, Solomon P.1
1McMaster University, School of Rehabilitation Science, Hamilton, Canada, 2Hamilton Health Sciences Corporation, Hamilton, Canada, 3McMaster University, Department of Pediatrics, Hamilton, Canada, 4Mohawk College, Faculty of Health Sciences, Hamilton, Canada
Background: Despite the availability of factor prophylaxis in the developed world, patients with hemophilia continue to experience hemarthrosis. Recent evidence suggests the clinical exam alone is not sensitive to detect small amounts of blood in a joint. As the musculoskeletal experts of the hemophilia team, physiotherapists (PTs) are ideal candidates to improve the sensitivity of the clinical examination by expanding the PT role to include the addition of diagnostic modalities. Point of care ultrasonography (POC-US) is a fast, safe, accessible and inexpensive diagnostic modality that can detect joint structures, muscles, and tendons. POC-US is a user dependent technology and adequate training courses that define the scope of POC-US and include competency assessment/evaluation are required. The McMaster University/Mohawk College POC-US in Hemophilia Care Training Protocol provides PTs with didactic and practical educational modules on the use of POC-US for the assessment and interpretation of acute hemarthrosis.
Purpose: To assess the knowledge base of PTs in POC-US prior to participation in the McMaster University/Mohawk College POC-US course and to determine if there is a relationship between experience in POC-US and success in course examinations.
Methods: Eight PT in hemophilia care from 8 of 25 hemophilia treatment centres in Canada completed the POC-US course. Competencies were tested in a simulated environment and modeled after the Sonography Canada Clinical Skills Assessment Tool and focused on the application of POC-US to hemophilia. Knowledge was assessed using multiple-choice evaluations before and after intervention and a practical examination. Assessments reference a selection of appropriate competencies from the Sonography National Competency Profile developed by Sonography Canada with 70% required for a passing grade. Participants were categorized into groups based on POC-US experience. Descriptive statistics of the mean/standard deviation of the pretest, post-test, practical exam were calculated.
Results: Regardless of POC-US experience, the mean pretest scores for each group were below the 70% threshold. The pretest scores were 59.5% +/- 3.536 for participants who actively use POC-US (n=2), 45.5% +/- 7.778 for participants with some experience in POC-US but who rarely use it (n=2,) and 44.8%, +/- 2.986 for those who had no prior experience in POC-US (n=4,). Regardless of POC-US use, all participants passed the post-test and practical (post groups scores were 84.5% (+/- 0.707), 74.5% (+/- 6.363, and 79.5% (+/- 18.646) and practical scores were (83.5% (+/- 4.95), 85.0 (+/- 2.828), and 79.0 (+/- 12.543) respectively.
Conclusion(s): Without training, not all PTs have the required knowledge of POC-US for use in clinical practice. Completion of the McMaster University/Mohawk College POC-US course appears to improve knowledge and clinical practice of POC-US regardless of previous POC-US experience.
Implications: With appropriate training, PT can be the practitioners of choice to perform POC-US for the musculoskeletal implications of a bleeding disorder. The McMaster University/Mohawk College POC-US course is the first formal certification and training program for POC-US for assessing hemarthrosis. Certification of successful PTs provides a standardized method for assessing competency and performance of POC-US via an accredited academic institution.
Funding acknowledgements: The authors would like to acknowledge and disclose Pfizer Canada as a source of funding support for this project.
Topic: Professional practice: other
Ethics approval: This study received ethics approval from the Hamilton Integrated Research Ethics Board (HiREB) on 19 November 2015.
All authors, affiliations and abstracts have been published as submitted.
