Using mixed methods evaluation to assess the feasibility of online clinical training in evidence based interventions: a case study of cognitive behavioural treatment for low back pain.
BACKGROUND
Cognitive behavioural (CB) approaches are effective in the management of non-specific low back pain (LBP). We developed the CB Back Skills Training programme (BeST) and previously provided evidence of clinical and cost effectiveness in a large pragmatic trial. However, practice change is challenged by a lack of treatment guidance and training for clinicians. We aimed to explore the feasibility and acceptability of an online programme (iBeST) for providing training in a CB approach.


METHODS
This mixed methods study comprised an individually randomised controlled trial of 35 physiotherapists and an interview study of 8 physiotherapists. Participants were recruited from 8 National Health Service departments in England and allocated by a computer generated randomisation list to receive iBeST (n = 16) or a face-to-face workshop (n = 19). Knowledge (of a CB approach), clinical skills (unblinded assessment of CB skills in practice), self-efficacy (reported confidence in using new skills), attitudes (towards LBP management), and satisfaction were assessed after training. Engagement with iBeST was assessed with user analytics. Interviews explored acceptability and experiences with iBeST. Data sets were analysed independently and jointly interpreted.


RESULTS
Fifteen (94 %) participants in the iBeST group and 16 (84 %) participants in the workshop group provided data immediately after training. We observed similar scores on knowledge (MD (95 % CI): 0.97 (-1.33, 3.26)), and self-efficacy to deliver the majority of the programme (MD (95 % CI) 0.25 (-1.7; 0.7)). However, the workshop group showed greater reduction in biomedical attitudes to LBP management (MD (95 % CI): -7.43 (-10.97, -3.89)). Clinical skills were assessed in 5 (33 %) iBeST participants and 7 (38 %) workshop participants within 6 months of training and were similar between groups (MD (95 % CI): 0.17(-0.2; 0.54)). Interviews highlighted that while initially sceptical, participants found iBeST acceptable. A number of strategies were identified to enhance future versions of iBeST such as including more skills practice.


CONCLUSIONS
Combined quantitative and qualitative data indicated that online training was an acceptable and promising method for providing training in an evidence based complex intervention. With future enhancement, the potential reach of this training method may facilitate evidence-based practice through large scale upskilling of the workforce.


BACKGROUND
Current Controlled Trials ISRCTN82203145 (registered prospectively on 03.09.2012).
Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. h.richmond@warwick.ac.uk.|Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK. h.richmond@warwick.ac.uk.
Helen
H
Richmond
The George Institute for Global Health, University of Oxford, Oxford, UK.
Amanda M
AM
Hall
Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Zara
Z
Hansen
Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Esther
E
Williamson
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
David
D
Davies
Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Sarah E
SE
Lamb
D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D015928:Cognitive Behavioral Therapy / Q000193:education*; D003194:Computer-Assisted Instruction / Q000379:methods*; D003362:Cost-Benefit Analysis; D055317:Evidence-Based Practice / Q000193:education*; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000193:education* / Q000592:standards; D016730:Program Development; D015397:Program Evaluation; D055815:Young Adult
Cognitive behavioural; Dissemination; E-learning; Evidence-based practice; Implementation; Low back pain; Mixed methods; Online training; Physiotherapy; Psychological