Department of Physiotherapy, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK.
Health Education England (HEE), Leeds, UK.
BMC Med Educ. 2023 Feb 2;23(1):85. doi: 10.1186/s12909-022-03861-2.
Deficiency in the provision and quality of treatment specification by rehabilitation clinicians impairs the ability to differentiate effective from ineffective elements of treatment. The standardised language of the rehabilitation treatment specification system (RTSS) has been proposed as a countermeasure. To date, there is no evidence of its use in clinical practice and what effect it may have. This study aimed to assess the ability of a pilot teaching programme to embed the RTSS into the clinical practice of an inpatient oncology physiotherapy team. The objectives were to evaluate the teaching programme's effect on; participants' familiarity and perceived benefit of the RTSS, its uptake, participants' clinical reasoning, and their feelings and attitudes towards adopting the RTSS. This study provides an evaluation of the pilot teaching programme which will subsequently inform a larger iteration in an ongoing Health Education England (HEE) project aiming to disseminate and embed the RTSS into physiotherapy practice to improve physiotherapists' treatment specification.
A 6-week, multi-modal RTSS pilot teaching programme based upon socio-constructivist theory was delivered to 10 inpatient oncology physiotherapists at a large urban UK trust in 2021. Self-reported measures and clinical case note audits were assessed before and after the RTSS teaching programme to evaluate its effect on RTSS familiarity and perceived benefit, uptake, and clinical reasoning. A post-teaching focus group was undertaken. It was qualitatively analysed using an inductive, independent thematic approach to evaluate clinicians' reflection and adoption.
Ten participants (8F, 29.4(±3.5) years) with variable clinical experience completed the RTSS teaching programme (six 1-hour lecture/case-based-learning sessions weekly) with 85% mean attendance. Nine yielded complete data for analyses, and 7 participated in the focus group. There was significant improvements in self-reported familiarity and confidence using the RTSS. Furthermore, there was a significant effect of the teaching on self-reported clinical reasoning overall and specifically in knowledge and theory application. But this was not reflected in clinicians' uptake of RTSS language, nor in the quality of clinical reasoning emergent in their case notes. Qualitative analyses revealed that while clinicians' conceptual understanding and the relative advantage of using the RTSS in practice was pervasive, they articulated that translating its perceived academic disposition into their clinical practice a challenge.
The RTSS teaching programme was shown to be effective in improving self-reported measures of clinical reasoning, despite clinical uptake of the RTSS remaining low. Future iterations should be tested across physiotherapy specialisms and in a larger sample with consideration of pedagogical and cultural measures to support the clinical diffusion of the RTSS.
康复临床医生在提供和规范治疗方面的不足，会降低治疗中有效与无效元素区分的能力。康复治疗规范系统（RTSS）的标准化语言已被提出作为一种对策。迄今为止，它在临床实践中的应用尚未得到证实，也不清楚其可能产生的影响。本研究旨在评估一个试点教学计划将 RTSS 嵌入住院肿瘤物理治疗团队临床实践的能力。目的是评估该教学计划对以下方面的影响：参与者对 RTSS 的熟悉程度和感知益处、采用率、参与者的临床推理能力，以及他们对采用 RTSS 的感受和态度。本研究对试点教学计划进行了评估，这将为正在进行的英格兰卫生与保健优化署（HEE）项目提供信息，该项目旨在将 RTSS 传播和嵌入物理治疗实践中，以提高物理治疗师的治疗规范能力。
2021 年，在英国一家大型城市信托机构，10 名住院肿瘤物理治疗师接受了为期 6 周的多模式 RTSS 试点教学计划，该计划基于社会建构主义理论。在 RTSS 教学计划之前和之后，使用自我报告的措施和临床病例记录审计来评估其对 RTSS 熟悉程度和感知益处、采用率和临床推理的影响。进行了一次教学后焦点小组。采用独立的归纳主题分析方法对其进行定性分析，以评估临床医生的反思和采用情况。
10 名参与者（8 名女性，29.4(±3.5)岁）具有不同的临床经验，完成了 RTSS 教学计划（每周 6 次 1 小时的讲座/基于案例的学习课程），平均出勤率为 85%。9 名参与者完成了完整的数据分析，7 名参与者参加了焦点小组。自我报告的 RTSS 使用的熟悉度和信心有显著提高。此外，教学对整体自我报告的临床推理，特别是在知识和理论应用方面产生了显著影响。但这并没有反映在临床医生对 RTSS 语言的采用率上，也没有反映在他们病例记录中出现的临床推理质量上。定性分析表明，尽管临床医生对使用 RTSS 的概念理解和相对优势是普遍的，但他们认为将其感知的学术倾向转化为临床实践是一个挑战。
尽管 RTSS 的临床应用率仍然较低，但 RTSS 教学计划在提高自我报告的临床推理测量方面被证明是有效的。未来的迭代应该在物理治疗的各个专业领域进行，并在更大的样本中进行测试，同时考虑教学和文化措施，以支持 RTSS 的临床推广。
