A qualitative study of health professions curricula and management of lateral ankle ligament sprain demonstrates inconsistency

Toni Green,Kieran Fallon,Grant Willson

doi:10.1186/s12909-020-02013-8

Toni Green, Kieran Fallon + Show 1 more

Open Access

https://doi.org/10.1186/s12909-020-02013-8

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Abstract

BackgroundHealth educators aim to graduate students who are safe, effective and practice evidence-based medicine (EBM). Clinical Practice Guidelines (CPGs) are tools for translating evidence into clinical practice for health professionals and educators who lack time to appraise the evidence. There have been CPGs published for lateral ankle ligament sprains (LALS) for physiotherapists, nurses, and doctors. Clinical decision rules have also been developed for LALS to increase the safety of practice. The Ottawa Ankle Rules (OAR) were developed to screen for the need for an x-ray following an ankle or foot injury.MethodsEducators from the Australasian College of Sports and Exercise Physicians (ACSEP), St John Ambulance first aiders, pharmacy, nursing, and physiotherapy disciplines were participants in this study. Using purposeful sampling with semi-structured questions and a LALS case study, 19 Australian educators were interviewed. Curricula and textbooks were also collected and analysed. Two researchers independently analysed the data using a deductive method.ResultsAnalysis found that no educator used a CPG to inform their teaching. There was no common LALS curriculum for the five groups studied. There were two approaches: a triage curriculum (St John Ambulance, pharmacy, nursing) and a reflective curriculum (ASCEP and physiotherapy). Textbooks influenced curriculum for physiotherapy, pharmacy and first aid educators. The triage curricula recommend rest, ice, compression and elevation (RICE) alone, while the reflective curricula uses OAR, RICE, immobilisation if the LALS is severe, functional support (brace), exercises and manual therapy. In addition, ACSEP and physiotherapy do not recommend electrotherapy. All five groups were cautious about the use of non-steroidal anti-inflammatory drugs (NSAIDs).ConclusionsPhysiotherapy and ACSEP educators teach OAR. Despite not using the CPGs to inform curriculum, physiotherapy and ACSEP have unintentionally aligned their curriculum with current LALS CPG recommendations. However, nursing, pharmacy and first aid trainers are not teaching OAR or aligned with LALS CPGs. Educators in pharmacy, nursing and first aid should re-examine their curricula and consider possibly teaching OAR and using CPG. Clinical practice guideline developers should consider pharmacists and first aiders as users of their LALS CPGs.

Highlights

Health educators aim to graduate students who are safe, effective and practice evidence-based medicine (EBM)
Choosing content involves educators assessing the quality of resources such as randomised clinical trials, systematic reviews, textbooks, diagnostic studies, and clinical practice guidelines (CPGs), investigating current professional practice and utilising feedback from students, recent graduates and employers [5,6,7]
Acute lateral ankle ligament sprains (LALS) are a common injury [8, 9] resulting in a significant impact on health [10]

Summary

Introduction

Health educators aim to graduate students who are safe, effective and practice evidence-based medicine (EBM). There have been CPGs published for lateral ankle ligament sprains (LALS) for physiotherapists, nurses, and doctors. Choosing content involves educators assessing the quality of resources such as randomised clinical trials, systematic reviews, textbooks, diagnostic studies, and clinical practice guidelines (CPGs), investigating current professional practice and utilising feedback from students, recent graduates and employers [5,6,7]. LALS are managed by different disciplines including doctors, physiotherapists, pharmacists, nurses and first aid officers. A recent LALS CPG [27] published after the inclusion of studies in the systematic review, updates the 2012 Dutch guideline [28]. It is surprising that no published CPGs exist for community pharmacies (pharmacists, pharmacy assistants and shop assistants) or first aid officers It is common for acute LALS patients to seek advice at pharmacies. In a New Zealand study 96 % of pharmacists recommended RICE (rest, ice, compression, elevation) and saw a mean of nine acute LALS per month [29]

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