Richmond Helen, Hall Amanda M, Hansen Zara, Williamson Esther, Davies David, Lamb Sarah E
Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
BMC Med Educ. 2016 Jun 18;16:163. doi: 10.1186/s12909-016-0683-4.
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.
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.
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.
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.
Current Controlled Trials ISRCTN82203145 (registered prospectively on 03.09.2012).
认知行为（CB）方法在非特异性下腰痛（LBP）的管理中有效。我们开发了CB背部技能培训计划（BeST），并在之前的一项大型实用试验中提供了临床和成本效益的证据。然而，由于缺乏针对临床医生的治疗指导和培训，实践变革面临挑战。我们旨在探索一个在线计划（iBeST）提供CB方法培训的可行性和可接受性。
这项混合方法研究包括对35名物理治疗师的个体随机对照试验和对8名物理治疗师的访谈研究。参与者从英格兰的8个国民健康服务部门招募，并通过计算机生成的随机分配列表进行分配，以接受iBeST（n = 16）或面对面研讨会（n = 19）。在培训后评估（对CB方法的）知识、临床技能（在实践中对CB技能的非盲评估）、自我效能感（报告使用新技能的信心）、态度（对LBP管理）和满意度。通过用户分析评估对iBeST的参与度。访谈探讨了对iBeST的可接受性和体验。数据集进行独立分析并共同解读。
iBeST组的15名（94%）参与者和研讨会组的16名（84%）参与者在培训后立即提供了数据。我们观察到在知识方面得分相似（MD（95%CI）：0.97（-1.33，3.26）），并且在实施该计划的大部分内容方面自我效能感相似（MD（95%CI）0.25（-1.7；0.7））。然而，研讨会组在对LBP管理的生物医学态度方面有更大程度的降低（MD（95%CI）：-7.43（-10.97，-3.89））。在培训后的6个月内，对5名（33%）iBeST参与者和7名（38%）研讨会参与者的临床技能进行了评估，两组之间相似（MD（95%CI）：0.17（-0.2；0.54））。访谈强调，尽管最初持怀疑态度，但参与者认为iBeST是可以接受的。确定了一些策略来改进iBeST的未来版本，例如增加更多技能练习。
定量和定性数据相结合表明，在线培训是提供基于证据的复杂干预培训的一种可接受且有前景的方法。随着未来的改进，这种培训方法的潜在覆盖范围可能通过大规模提升劳动力技能来促进循证实践。
当前受控试验ISRCTN82203145（于2012年9月3日前瞻性注册）。
