JMIR Publications

ABSTRACT

Background:

The Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) (ISRCTN49875385) feasibility trial included physical therapists (PTs) completing two days small group face-to-face training to deliver the six week group-based intervention. While the effectiveness of this training program has been established, potential upscaling to a definitive national trial and future implementation is limited by travel, time, and cost constraints for PTs. Therefore, an asynchronous, interactive, web-based E-learning training program (E-SOLAS) underpinned by behavior and learning theories was developed.

Objective:

This study investigated the effectiveness of the E-SOLAS training program on relevant outcomes for effective training and implementation.

Methods:

Thirteen PT’s from across Ireland were trained via E-SOLAS using mixed methods and seven PTs progressed to intervention implementation. The effectiveness of E-SOLAS was evaluated using the Kirkpatrick model at the levels of (1) Reaction: PTs engagement and satisfaction with E-SOLAS training methods and content, (2) Learning: pre to post-training changes in PTs a) confidence and b) knowledge in delivering SOLAS content and self-determination theory (SDT)-based communication strategies, administered via a SurveyMonkey questionnaire and (3) Behavior: Fidelity to delivery of SOLAS content using PT-completed weekly checklists. During implementation, five PTs audio-recorded delivery of one class and the communication between PTs and clients was assessed using the Health Care Climate Questionnaire (HCCQ), the Controlling Coach Behavior Scale (CCBS), and an intervention specific measure (ISM; 7-point Likert scales). A range of implementation outcomes were evaluated during training and delivery (i.e. acceptability, appropriateness, feasibility, fidelity and sustainability of E-SOLAS) using a post-training feedback questionnaire and individual semi-structured telephone interviews.

Results:

(1) Reaction: Post-training, PTs (n=13) were very satisfied with E-SOLAS (median [IQR]; min-max = 5.0 (1.0); 4.0-5.0) and completed training within three to four weeks. (2) Learning: There were significant increases in PTs confidence and knowledge in delivery of all SOLAS intervention components (P<0.05), and PTs confidence in seven of 10 SDT communication strategies (P<0.05), while PTs knowledge of SDT strategies remained high post-training (P>0.05). 3) Behavior: PT’s delivered SOLAS in a needs supportive manner (median [IQR]; min-max; HCCQ = 5.2 (1.3); 3.7-5.8; median CCBS = 6.6 (1.0); 5.6-7.0; median ISM = 4.5 (1.2); 2.8- 4.8). Fidelity scores were high for SOLAS content delivery (total % mean (SD) fidelity score = 93.5% (4.9)). The post-training questionnaire and post-delivery qualitative interviews showed PTs found E-SOLAS acceptable, appropriate, feasible and sustainable within primary care services to support the implementation of the SOLAS intervention.

Conclusions:

This study provides preliminary evidence of the effectiveness, acceptability and feasibility of an e-learning program to train PTs to deliver a group-based self-management complex intervention in primary care settings that is equivalent to face to face training outcomes and would support inclusion of PTs in a definitive trial of SOLAS.