- Email: [email protected]
The user-led development of web-based physio for people with spinal cord injury
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Methods: This is a quasi-experimental, two group pretest, post-test design in which the experimental group participated in a series of 4 CAL modules during their second year of study, prior to their first full-time clinical internship, while the control group did not. Outcome measures included a student self-efficacy survey addressing preparedness to practice in the hospital setting as well as a survey of clinical instructors regarding student preparedness. Additionally, results on a culminating clinical reasoning case were compared, as well as selected clinical performance data gathered from the Clinical Performance Instrument. Results: Four CAL modules and one culminating clinical reasoning case were developed and administered to two cohorts (n = 35, n = 33) of second year physical therapist students. Qualitative student feedback revealed that the CAL modules were perceived as a worth-while learning experiences that incorporated multiple aspects of patient care including recognition of precautions, contraindications, safety, clinical decision making and coordination of services. The students who engaged in the modules demonstrated a significant difference in self-efficacy regarding preparation to practice in the hospital based setting as compared to students who did not (p < .0001). Additionally students in the experimental group demonstrated improved outcome performance on the culminating clinical reasoning case. Clinical instructor feedback is currently being collected as the second cohort completes their final clinical experience. Conclusion(s): Preliminary results reveal that the addition of CAL modules into an existing curriculum provide student physical therapists additional opportunities to immerse themselves in the complex world of acute care prior to actual internship. Perceived self-efficacy to function in the acute care setting was higher in the cohort who participated in the CAL module as was their clinical decision making skills. Implications: Additional exposure to this practice setting using CAL modules may be an effective teaching and learning experience to help assist students meet the current demands in this complex practice setting. Keywords: Computer assisted learning; Clinical decision making; Acute care Funding acknowledgements: George Washington University Emerging Scholars Program. Ethics approval: George Washington University. http://dx.doi.org/10.1016/j.physio.2015.03.462
Special Interest Report Poster Presentation Number: SI-PO-21-08-Mon Monday 4 May 2015 13:00 Exhibit halls 401–403 THE USER-LED DEVELOPMENT OF WEB-BASED PHYSIO FOR PEOPLE WITH SPINAL CORD INJURY E. Coulter 1 , J. Hasler 2 , A. McLean 2 , D. Allan 2 , L. Paul 1 1 University
of Glasgow, School of Medicine, Glasgow, United Kingdom; 2 NHS Greater Glasgow & Clyde, Queen Elizabeth National Spinal Injuries Unit, Glasgow, United Kingdom Background: People with Spinal Cord Injury (SCI) are at a higher risk of Cardiovascular Disease and Diabetes and have a higher rate of mortality than their able bodied counterparts. Physical Activity (PA) and exercise are especially important for people with SCI and can increase the amount of lean muscle; result in better weight management and reduce disease risk. Adherence to PA and exercise is generally low. Patients describe experiencing difficulties in accessing services and encounter obstacles/barriers to participation. Telerehabilitation may provide a feasible option and may be useful for people who are unable to access ‘conventional’ rehabilitation or gyms such as those who live in rural locations, are housebound, have childcare commitments or transport problems. Our group developed web-based physio, www.webbasedphysio.com, which consists of, exercise pages (aerobic, strengthening, stretching and balance), exercise diary and an advice section. Each exercise page contains a video, text and an audio description of the exercise. Exercises are recorded at different levels of difficulty to be suitable for various levels of ability. Programmes and individual exercises can be progressed remotely. The website has been used with other patients with long-term conditions to good effect. Purpose: The purpose of this project was to develop and co-produce web-based physio for people with SCI and to explore the user perspective. Methods: A group of specialists (physiotherapists and consultants) and people with SCI were shown the current website and ideas and adaptations in order to customise the website were discussed. In light of their comments new exercises were filmed and uploaded to the website while some exercises already on the website library were already suitable for some injury levels. Advice pages were written in collaboration with specialists on the benefits of PA and exercise, autonomic dysreflexia and skin care. Views and feedback on the website were obtained again with specialists and four people with SCI (3 male; 2 paraplegia; >2 year since SCI). Results: People with SCI were positive about web-based physio, indicative quotes:
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
“When you are discharged home you feel very alone, isolated, and it’s hard. If I had this it would have been good, there would be continuity in your care when you go home” RB “This looks great, I would use it” JP “I don’t like watching the person on the video do stuff that I can’t do so it’s important for the exercises to be tailored for me” JM “It wouldn’t be for me as I play [wheelchair] basketball, but it would be good for people who can’t get out or can’t go to the gym” CM “It’s simple, easy to follow, you don’t need to be a computer or gadget wizz to use it” JM. Conclusion(s): Web-based physio consists of advice and exercises that are suitable for para and tetraplegics. Webbased physio may be acceptable and suitable for people with SCI whose adherence to PA and exercise is low. Implications: Web-based physio may be used in practice to deliver individualised interventions in the community. This would allow people with SCI to complete regular exercise after discharge from specialist units. Keywords: Spinal cord injury; Exercise; Telerehabilitation Funding acknowledgements: This project was funded by the Queen Elizabeth National Spinal Injury Unit, Glasgow. Ethics approval: Ethical approval was not required. http://dx.doi.org/10.1016/j.physio.2015.03.463 Research Report Poster Presentation Number: RR-PO-21-07-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 AN EVALUATION OF WEB-BASED PHYSIO FOR PEOPLE WITH SPINAL CORD INJURY E. Coulter 1 , J. Hasler 2 , A. McLean 2 , D. Allan 2 , L. Paul 1 1 University
of Glasgow, School of Medicine, Glasgow, United Kingdom; 2 NHS Greater Glasgow & Clyde, Queen Elizabeth National Spinal Injuries Unit, Glasgow, United Kingdom Background: People with Spinal Cord Injury (SCI) are at a higher risk of Cardiovascular Disease (CVD), stroke, Diabetes and have a higher rate of mortality than their able bodied counterparts. Adherence to PA and exercise is generally low. Patients describe experiencing difficulties in accessing services and encounter obstacles and barriers to participation and depending on their level of injury, some people with SCI find participating in exercise increasingly challenging. However, the importance of participating in regular PA and exercise has been highlighted with the recently developed PA guidelines specifically for people with SCI.
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Telerehabilitation may provide a feasible option for people with a SCI after discharge to exercise at home. Telerehabilitation has many advantages over exercise leaflets and may be useful for people who are unable to access ‘conventional’ rehabilitation or gyms such as those who live in rural locations, are housebound, have childcare commitments or have transport problems. Web-based physio, www.webbasedphysio.com, was recently developed and coproduced by our group with specialists and people with SCI. The website consists of a home page, exercise pages (aerobic, strengthening, stretching and balance), exercise diary and advice pages. Each exercise page contains a video, text and an audio description of the exercise. The website has a library of exercises at different levels of difficulty suitable for para and tetraplegics. Programmes and individual exercises can be progressed remotely. Purpose: The purpose of this study was to evaluate the compliance with a web-based physio exercise intervention; estimate the sample size required and inform the recruitment strategy for a fully powered randomised controlled trial; and to evaluate the participant experience of a web-based physio intervention in 24 people with a SCI. Methods: Participants with SCI who mobilised using a manual wheelchair and/or walked with aids were recruited. Participants were randomised on a 2:1 ratio into web-based physio (n = 16) or control/ usual care (n = 8). Each participant logged on to the website to access their individually tailored exercise programme; consisting of 20 minutes of aerobic and strengthening exercises, and a warm up/cool down and stretches. Participants were instructed to complete the web-based physio programme twice per week over 8 weeks. Participant online exercise diaries were monitored and exercises progressed remotely. Assessments were conducted at baseline and post intervention. Outcome measures included the 6 Minute Wheelchair/Walk Test, Muscle Strength, Heart Rate, Borg Scale of Perceived Exertion, Spinal Cord Independence Measure, Hospital Anxiety and Depression Scale and WHO Quality of Life-Bref Scale. A website evaluation questionnaire and telephone interviews were completed post intervention. Results: Data collection is due to be completed in December 2014. Results will be presented. Conclusion(s): Depending on the results of the study, on demand web-based physio may be a feasible option for delivering physiotherapy to people with SCI in the community, allowing patients to chose the time of their ‘therapy’ to suit their own personal circumstances. Implications: This project will inform a larger fully powered randomised trial to investigate the effectiveness of web-based physio for people with SCI. Web-based rehabilitation allows access to therapy regardless of the day, time and geographical location. Keywords: Spinal cord injury; Exercise; Telerehabilitation
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Methods: This is a quasi-experimental, two group pretest, post-test design in which the experimental group participated in a series of 4 CAL modules during their second year of study, prior to their first full-time clinical internship, while the control group did not. Outcome measures included a student self-efficacy survey addressing preparedness to practice in the hospital setting as well as a survey of clinical instructors regarding student preparedness. Additionally, results on a culminating clinical reasoning case were compared, as well as selected clinical performance data gathered from the Clinical Performance Instrument. Results: Four CAL modules and one culminating clinical reasoning case were developed and administered to two cohorts (n = 35, n = 33) of second year physical therapist students. Qualitative student feedback revealed that the CAL modules were perceived as a worth-while learning experiences that incorporated multiple aspects of patient care including recognition of precautions, contraindications, safety, clinical decision making and coordination of services. The students who engaged in the modules demonstrated a significant difference in self-efficacy regarding preparation to practice in the hospital based setting as compared to students who did not (p < .0001). Additionally students in the experimental group demonstrated improved outcome performance on the culminating clinical reasoning case. Clinical instructor feedback is currently being collected as the second cohort completes their final clinical experience. Conclusion(s): Preliminary results reveal that the addition of CAL modules into an existing curriculum provide student physical therapists additional opportunities to immerse themselves in the complex world of acute care prior to actual internship. Perceived self-efficacy to function in the acute care setting was higher in the cohort who participated in the CAL module as was their clinical decision making skills. Implications: Additional exposure to this practice setting using CAL modules may be an effective teaching and learning experience to help assist students meet the current demands in this complex practice setting. Keywords: Computer assisted learning; Clinical decision making; Acute care Funding acknowledgements: George Washington University Emerging Scholars Program. Ethics approval: George Washington University. http://dx.doi.org/10.1016/j.physio.2015.03.462
Special Interest Report Poster Presentation Number: SI-PO-21-08-Mon Monday 4 May 2015 13:00 Exhibit halls 401–403 THE USER-LED DEVELOPMENT OF WEB-BASED PHYSIO FOR PEOPLE WITH SPINAL CORD INJURY E. Coulter 1 , J. Hasler 2 , A. McLean 2 , D. Allan 2 , L. Paul 1 1 University
of Glasgow, School of Medicine, Glasgow, United Kingdom; 2 NHS Greater Glasgow & Clyde, Queen Elizabeth National Spinal Injuries Unit, Glasgow, United Kingdom Background: People with Spinal Cord Injury (SCI) are at a higher risk of Cardiovascular Disease and Diabetes and have a higher rate of mortality than their able bodied counterparts. Physical Activity (PA) and exercise are especially important for people with SCI and can increase the amount of lean muscle; result in better weight management and reduce disease risk. Adherence to PA and exercise is generally low. Patients describe experiencing difficulties in accessing services and encounter obstacles/barriers to participation. Telerehabilitation may provide a feasible option and may be useful for people who are unable to access ‘conventional’ rehabilitation or gyms such as those who live in rural locations, are housebound, have childcare commitments or transport problems. Our group developed web-based physio, www.webbasedphysio.com, which consists of, exercise pages (aerobic, strengthening, stretching and balance), exercise diary and an advice section. Each exercise page contains a video, text and an audio description of the exercise. Exercises are recorded at different levels of difficulty to be suitable for various levels of ability. Programmes and individual exercises can be progressed remotely. The website has been used with other patients with long-term conditions to good effect. Purpose: The purpose of this project was to develop and co-produce web-based physio for people with SCI and to explore the user perspective. Methods: A group of specialists (physiotherapists and consultants) and people with SCI were shown the current website and ideas and adaptations in order to customise the website were discussed. In light of their comments new exercises were filmed and uploaded to the website while some exercises already on the website library were already suitable for some injury levels. Advice pages were written in collaboration with specialists on the benefits of PA and exercise, autonomic dysreflexia and skin care. Views and feedback on the website were obtained again with specialists and four people with SCI (3 male; 2 paraplegia; >2 year since SCI). Results: People with SCI were positive about web-based physio, indicative quotes:
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
“When you are discharged home you feel very alone, isolated, and it’s hard. If I had this it would have been good, there would be continuity in your care when you go home” RB “This looks great, I would use it” JP “I don’t like watching the person on the video do stuff that I can’t do so it’s important for the exercises to be tailored for me” JM “It wouldn’t be for me as I play [wheelchair] basketball, but it would be good for people who can’t get out or can’t go to the gym” CM “It’s simple, easy to follow, you don’t need to be a computer or gadget wizz to use it” JM. Conclusion(s): Web-based physio consists of advice and exercises that are suitable for para and tetraplegics. Webbased physio may be acceptable and suitable for people with SCI whose adherence to PA and exercise is low. Implications: Web-based physio may be used in practice to deliver individualised interventions in the community. This would allow people with SCI to complete regular exercise after discharge from specialist units. Keywords: Spinal cord injury; Exercise; Telerehabilitation Funding acknowledgements: This project was funded by the Queen Elizabeth National Spinal Injury Unit, Glasgow. Ethics approval: Ethical approval was not required. http://dx.doi.org/10.1016/j.physio.2015.03.463 Research Report Poster Presentation Number: RR-PO-21-07-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 AN EVALUATION OF WEB-BASED PHYSIO FOR PEOPLE WITH SPINAL CORD INJURY E. Coulter 1 , J. Hasler 2 , A. McLean 2 , D. Allan 2 , L. Paul 1 1 University
of Glasgow, School of Medicine, Glasgow, United Kingdom; 2 NHS Greater Glasgow & Clyde, Queen Elizabeth National Spinal Injuries Unit, Glasgow, United Kingdom Background: People with Spinal Cord Injury (SCI) are at a higher risk of Cardiovascular Disease (CVD), stroke, Diabetes and have a higher rate of mortality than their able bodied counterparts. Adherence to PA and exercise is generally low. Patients describe experiencing difficulties in accessing services and encounter obstacles and barriers to participation and depending on their level of injury, some people with SCI find participating in exercise increasingly challenging. However, the importance of participating in regular PA and exercise has been highlighted with the recently developed PA guidelines specifically for people with SCI.
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Telerehabilitation may provide a feasible option for people with a SCI after discharge to exercise at home. Telerehabilitation has many advantages over exercise leaflets and may be useful for people who are unable to access ‘conventional’ rehabilitation or gyms such as those who live in rural locations, are housebound, have childcare commitments or have transport problems. Web-based physio, www.webbasedphysio.com, was recently developed and coproduced by our group with specialists and people with SCI. The website consists of a home page, exercise pages (aerobic, strengthening, stretching and balance), exercise diary and advice pages. Each exercise page contains a video, text and an audio description of the exercise. The website has a library of exercises at different levels of difficulty suitable for para and tetraplegics. Programmes and individual exercises can be progressed remotely. Purpose: The purpose of this study was to evaluate the compliance with a web-based physio exercise intervention; estimate the sample size required and inform the recruitment strategy for a fully powered randomised controlled trial; and to evaluate the participant experience of a web-based physio intervention in 24 people with a SCI. Methods: Participants with SCI who mobilised using a manual wheelchair and/or walked with aids were recruited. Participants were randomised on a 2:1 ratio into web-based physio (n = 16) or control/ usual care (n = 8). Each participant logged on to the website to access their individually tailored exercise programme; consisting of 20 minutes of aerobic and strengthening exercises, and a warm up/cool down and stretches. Participants were instructed to complete the web-based physio programme twice per week over 8 weeks. Participant online exercise diaries were monitored and exercises progressed remotely. Assessments were conducted at baseline and post intervention. Outcome measures included the 6 Minute Wheelchair/Walk Test, Muscle Strength, Heart Rate, Borg Scale of Perceived Exertion, Spinal Cord Independence Measure, Hospital Anxiety and Depression Scale and WHO Quality of Life-Bref Scale. A website evaluation questionnaire and telephone interviews were completed post intervention. Results: Data collection is due to be completed in December 2014. Results will be presented. Conclusion(s): Depending on the results of the study, on demand web-based physio may be a feasible option for delivering physiotherapy to people with SCI in the community, allowing patients to chose the time of their ‘therapy’ to suit their own personal circumstances. Implications: This project will inform a larger fully powered randomised trial to investigate the effectiveness of web-based physio for people with SCI. Web-based rehabilitation allows access to therapy regardless of the day, time and geographical location. Keywords: Spinal cord injury; Exercise; Telerehabilitation