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. 2021 Dec 1;7(4):e30378.
doi: 10.2196/30378.

An e-Learning Program for Physiotherapists to Manage Knee Osteoarthritis Via Telehealth During the COVID-19 Pandemic: Real-World Evaluation Study Using Registration and Survey Data

Ana Elisa Serafim Jorge  1 , Kim Louise Bennell  2 , Alexander Jared Kimp  2 , Penny Kate Campbell  2 , Rana Shane Hinman  2
Affiliations

An e-Learning Program for Physiotherapists to Manage Knee Osteoarthritis Via Telehealth During the COVID-19 Pandemic: Real-World Evaluation Study Using Registration and Survey Data

Ana Elisa Serafim Jorge et al. JMIR Med Educ. .

Abstract

Background: The COVID-19 pandemic necessitated clinicians to transition to telehealth, often with little preparation or training. The Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis (PEAK) e-learning modules were developed to upskill physiotherapists in management of knee osteoarthritis (OA) via telehealth and in-person. In the research setting, the e-learning modules are perceived by physiotherapists as effective when they are part of a comprehensive training program for a clinical trial. However, the effectiveness of the modules on their own in a real-world setting is unknown.

Objective: This study aims to evaluate the reach, effectiveness, adoption, and implementation of PEAK e-learning modules.

Methods: This longitudinal study was informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Participants were clinicians, researchers, educators, and health care students who registered for access to the modules between April 1 and November 30, 2020. Reach was evaluated by outcomes (countries, referral sources, and attrition) extracted from registration data and embedded within precourse surveys in the Learning Management System (LMS). Effectiveness was evaluated by outcomes (confidence with videoconferencing; likelihood of using education, strengthening exercise, and physical activity in a treatment plan for knee OA; usefulness of modules) measured using a 10-point numeric rating scale (NRS; score range from 1=not confident or likely or useful at all to 10=extremely confident or likely or useful) in pre- and postcourse (on completion) surveys in the LMS. Adoption and implementation were evaluated by demographic and professional characteristics and outcomes related to the use of learning and usefulness of program elements (measured via a 4-point Likert scale, from not at all useful to extremely useful) in a survey administered 4 months after module completion.

Results: Broad reach was achieved, with 6720 people from 97 countries registering for access. Among registrants, there were high levels of attrition, with 36.65% (2463/6720) commencing the program and precourse survey and 19.61% (1318/6720) completing all modules and the postcourse survey. The program was effective. Learners who completed the modules demonstrated increased confidence with videoconferencing (mean change 3.1, 95% CI 3.0-3.3 NRS units) and increased likelihood of using education, strengthening and physical activity in a knee OA treatment plan, compared to precourse. Adoption and implementation of learning (n=149 respondents) occurred at 4 months. More than half of the respondents used their learning to structure in-person consultations with patients (80/142, 56.3%) and patient information booklets in their clinical practice (75/142, 52.8%).

Conclusions: Findings provide evidence of the reach and effectiveness of an asynchronous self-directed e-learning program in a real-world setting among physiotherapists. The e-learning modules offer clinicians an accessible educational course to learn about best-practice knee OA management, including telehealth delivery via videoconferencing. Attrition across the e-learning program highlights the challenges of keeping learners engaged in self-directed web-based learning.

Keywords: e-learning; education; evaluation; exercise; implementation; knee; osteoarthritis; pain; physiotherapy; professional development; rehabilitation; telehealth.

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Conflict of interest statement

Conflicts of Interest: KLB receives consulting fees from Wolters Kluwer for UptoDate knee osteoarthritis clinical guidelines. The Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis (PEAK) e-learning modules are now hosted for free on the FutureLearn (The Open University and SEEK Ltd) platform; however, the University of Melbourne will receive a share of any revenue arising from sales of course upgrades.

Figures

Figure 1
Figure 1
Users since program launch. Pipeline depicting the number of people who registered for access, activated their Learning Management System (LMS) account, and completed the various modules of the e-learning program. Percentages are calculated as a proportion of those who requested registration. OA: osteoarthritis.
Figure 2
Figure 2
Distribution of confidence scores with videoconferencing consultations for participants (n=1299) who answered this question pre- and postcourse (where scores of 1=not confident at all and 10=extremely confident).
Figure 3
Figure 3
Distribution of confidence scores with videoconferencing consultations specifically for management of knee osteoarthritis for participants (n=1299) who answered this question pre- and postcourse (where scores of 1=not confident at all and 10=extremely confident).
Figure 4
Figure 4
Distribution of scores (n=1299) regarding likelihood to use education in a treatment plan for patients with knee osteoarthritis (where scores of 1=not at all likely and 10=extremely likely).
Figure 5
Figure 5
Distribution of scores (n=1299) regarding likelihood to use strengthening exercise in a treatment plan for patients with knee osteoarthritis (where scores of 1=not at all likely and 10=extremely likely).
Figure 6
Figure 6
Distribution of scores (n=1299) regarding likelihood to use physical activity in a treatment plan for patients with knee osteoarthritis (where scores of 1=not at all likely and 10=extremely likely).
Figure 7
Figure 7
Perceptions of 4-month survey respondents about usefulness of learnings.
Figure 8
Figure 8
Strategies used by respondents (n=142) at 4 months to incorporate learnings into usual practice.
See this image and copyright information in PMC

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References

    1. Safiri S, Kolahi A, Smith E, Hill C, Bettampadi D, Mansournia MA, Hoy D, Ashrafi-Asgarabad A, Sepidarkish M, Almasi-Hashiani A, Collins G, Kaufman J, Qorbani M, Moradi-Lakeh M, Woolf AD, Guillemin F, March L, Cross M. Global, regional and national burden of osteoarthritis 1990-2017: a systematic analysis of the Global Burden of Disease Study 2017. Ann Rheum Dis. 2020 May 12;79(6):819–28. doi: 10.1136/annrheumdis-2019-216515.annrheumdis-2019-216515 - DOI - PubMed
    1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1789–858. doi: 10.1016/S0140-6736(18)32279-7. https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(18)32279-7 S0140-6736(18)32279-7 - DOI - PMC - PubMed
    1. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SM, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019 Nov;27(11):1578–89. doi: 10.1016/j.joca.2019.06.011. https://linkinghub.elsevier.com/retrieve/pii/S1063-4584(19)31116-1 S1063-4584(19)31116-1 - DOI - PubMed
    1. Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG, Doherty M, Geenen R, Hammond A, Kjeken I, Lohmander LS, Lund H, Mallen CD, Nava T, Oliver S, Pavelka K, Pitsillidou I, da Silva JA, de la Torre J, Zanoli G, Vliet Vlieland TP, European League Against Rheumatism (EULAR) EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013 Jul;72(7):1125–35. doi: 10.1136/annrheumdis-2012-202745. https://ard.bmj.com/lookup/pmidlookup?view=long&pmid=23595142 annrheumdis-2012-202745 - DOI - PubMed
    1. National Clinical Guideline Centre Osteoarthritis: Care and Management in Adults. 2014. [2021-11-29]. https://www.ncbi.nlm.nih.gov/books/NBK248069/pdf/Bookshelf_NBK248069.pdf .