Richmond, Helen, Hall, Amanda M., Hansen, Zara, Williamson, Esther M., Davies, D. A. and Lamb, S. E. (Sallie E.) (2016) 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. BMC Medical Education, 16 (1). pp. 1-12. doi:10.1186/s12909-016-0683-4

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Abstract

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.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Medical personnel -- In-service training, Cognitive therapy, Therapeutics, Physiological
Journal or Publication Title:	BMC Medical Education
Publisher:	BioMed Central Ltd.
ISSN:	1472-6920
Official Date:	18 June 2016
Dates:	Date Event 18 June 2016 Published 17 June 2016 Available 7 June 2016 Accepted 15 January 2016 Submitted
Date of first compliant deposit:	27 September 2016
Volume:	16
Number:	1
Number of Pages:	12
Page Range:	pp. 1-12
DOI:	10.1186/s12909-016-0683-4
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	West Midlands Strategic Health Authority, National Institute for Health Research (Great Britain) (NIHR), Collaborations for Leadership in Applied Health Research and Care (CLAHRC)

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