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Sugavanam T1, Williamson E1, Ali U1, Richmond H1, Hansen Z1, Fordham B1, Lamb SE1
1University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom
Background: The Back Skills Training (BeST) programme is a group Cognitive Behavioural Approach (CBA) for people with persistent low back pain (LBP). It was shown to be clinically and cost-effective in a large clinical trial. To facilitate implementation of the BeST programme, an online course was developed and made available to National Health Service (NHS) clinicians in the United Kingdom.
Purpose: To evaluate an online course to train NHS clinicians to deliver the BeST Programme.
Methods: The online course was available to all NHS clinicians from March 2016 to July 2018. It was hosted by Amazon Web Services and took 10 hours to complete. It used a range of multimedia and learning interactions including videos, case scenarios, and quizzes. The course provided background knowledge, instructions on how to deliver the BeST programme, and downloadable patient materials. Clinicians who registered and provided informed consent participated in this study. Demographic data was collected at registration. Participants completed a knowledge quiz on course content and the Pain Attitude and Belief Scale (PABS) pre and post course. Their confidence and intention to implement the programme was collected on course completion. Actual implementation and barriers to implementation were collected at 4 and 12 months follow-up.
Results: 1300 clinicians registered for the course and 431 (32.4%) completed it. 65% (n=280) of completers were female and the majority were physiotherapists (n=407 (94.4%)) with 10 years or more experience. 229 (53.1%) completers treated more than 20 patients with LBP per month.
343 participants completed the post course evaluation. PABS scores showed a desired shift towards a biopsychosocial model. PABS Biomedical factor score decreased from a mean (SD) of 27.8 (6.2) to 24.0 (4.1) post training. PABS Biopsychosocial factor score increased from 35.8 (4.2) to 37.6 (3.7). Knowledge scores increased from a mean (SD) of 11.7 (3.7) to 12.5 (5.2). On course completion, 69% were confident in their ability to implement the BeST programme, 57% of participants intended to implement it while 20% were unsure and 23% did not intend to implement it.
At the time of abstract submission, 402/431 participants had reached at least one follow-up time point and data was obtained from 145 participants (36.1%). 46/145 (32%) participants reported implementing the BeST programme at follow-up. Post course intensions influenced actual implementation. Of those who intended to implement post training, 46% had implemented it compared to only 17% of those who were unsure/did not intend to implement. Reported barriers included staff capacity, managerial/organisational support, funding, space/logistics and participant drop-out.
Conclusion(s): We have trained over 400 clinicians to deliver the BeST Programme using an online course. Training was effective in encouraging adoption of a biopsychosocial approach for managing LBP. We achieved a modest level of implementation. A limitation was that we did not capture other ways in which the learning experience was integrated into clinical practice.
Implications: We need to further develop and evaluate strategies to maximise implementation of evidence-based interventions. However, the online course was effective for teaching a CBA and we plan to make this available to the global physiotherapy community in 2019.
Keywords: Implementation, Low Back Pain, Cognitive Behavioural Approach
Funding acknowledgements: Funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford. Supported by the Oxford NIHR BRC.
Purpose: To evaluate an online course to train NHS clinicians to deliver the BeST Programme.
Methods: The online course was available to all NHS clinicians from March 2016 to July 2018. It was hosted by Amazon Web Services and took 10 hours to complete. It used a range of multimedia and learning interactions including videos, case scenarios, and quizzes. The course provided background knowledge, instructions on how to deliver the BeST programme, and downloadable patient materials. Clinicians who registered and provided informed consent participated in this study. Demographic data was collected at registration. Participants completed a knowledge quiz on course content and the Pain Attitude and Belief Scale (PABS) pre and post course. Their confidence and intention to implement the programme was collected on course completion. Actual implementation and barriers to implementation were collected at 4 and 12 months follow-up.
Results: 1300 clinicians registered for the course and 431 (32.4%) completed it. 65% (n=280) of completers were female and the majority were physiotherapists (n=407 (94.4%)) with 10 years or more experience. 229 (53.1%) completers treated more than 20 patients with LBP per month.
343 participants completed the post course evaluation. PABS scores showed a desired shift towards a biopsychosocial model. PABS Biomedical factor score decreased from a mean (SD) of 27.8 (6.2) to 24.0 (4.1) post training. PABS Biopsychosocial factor score increased from 35.8 (4.2) to 37.6 (3.7). Knowledge scores increased from a mean (SD) of 11.7 (3.7) to 12.5 (5.2). On course completion, 69% were confident in their ability to implement the BeST programme, 57% of participants intended to implement it while 20% were unsure and 23% did not intend to implement it.
At the time of abstract submission, 402/431 participants had reached at least one follow-up time point and data was obtained from 145 participants (36.1%). 46/145 (32%) participants reported implementing the BeST programme at follow-up. Post course intensions influenced actual implementation. Of those who intended to implement post training, 46% had implemented it compared to only 17% of those who were unsure/did not intend to implement. Reported barriers included staff capacity, managerial/organisational support, funding, space/logistics and participant drop-out.
Conclusion(s): We have trained over 400 clinicians to deliver the BeST Programme using an online course. Training was effective in encouraging adoption of a biopsychosocial approach for managing LBP. We achieved a modest level of implementation. A limitation was that we did not capture other ways in which the learning experience was integrated into clinical practice.
Implications: We need to further develop and evaluate strategies to maximise implementation of evidence-based interventions. However, the online course was effective for teaching a CBA and we plan to make this available to the global physiotherapy community in 2019.
Keywords: Implementation, Low Back Pain, Cognitive Behavioural Approach
Funding acknowledgements: Funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford. Supported by the Oxford NIHR BRC.
Topic: Disability & rehabilitation; Pain & pain management; Education: continuing professional development
Ethics approval required: No
Institution: University of Oxford
Ethics committee: Clinical Trials and Research Governance (CTRG)
Reason not required: University of Oxford CTRG concluded this was an evaluation of impact of a training course and not a research study.
All authors, affiliations and abstracts have been published as submitted.
