Abstract

BackgroundDespite persistent calls to measure the effectiveness of educational interventions on patient outcomes, few studies have been conducted. Within musculoskeletal physiotherapy, the effects of postgraduate clinical mentoring on physiotherapist performance have been assessed, but the impact of this mentoring on patient outcomes remains unknown. The objective of this trial is to assess the effectiveness of a work-based mentoring programme to facilitate physiotherapist clinical reasoning on patient outcomes in musculoskeletal physiotherapy.Methods/DesignA stepped wedge cluster randomised controlled trial (CRCT) has been designed to recruit a minimum of 12 senior physiotherapists who work in musculoskeletal outpatient departments of a large National Health Service (NHS) organization. Participating physiotherapists will be randomised by cluster to receive the intervention at three time periods. Patients will be blinded to whether their physiotherapist has received the intervention. The primary outcome measure will be the Patient-Specific Functional Scale; secondary outcome measures will include the EQ-5D, patient activation, patient satisfaction and physiotherapist performance. Sample size considerations used published methods describing stepped wedge designs, conventional values of 0.80 for statistical power and 0.05 for statistical significance, and pragmatic groupings of 12 participating physiotherapists in three clusters. Based on an intergroup difference of 1.0 on the PSFS with a standard deviation of 2.0, 10 patients are required to complete outcome measures per physiotherapist, at time period 1 (prior to intervention roll-out) and at each of time periods 2, 3 and 4, giving a sample size of 480 patients. To account for the potential loss to follow-up of 33%, 720 sets of patient outcomes will be collected.All physiotherapist participants will receive 150 hours of mentored clinical practice as the intervention and usual in-service training as control. Consecutive, consenting patients attending treatment by the participating physiotherapists during data collection periods will complete outcome measures at baseline, discharge and 12 months post-baseline. The lead researcher will be blinded to the allocation of the physiotherapist when analyzing outcome data; statistical analysis will involve classical linear models incorporating both an intervention effect and a random intercept term to reflect systematic differences among clusters.Trial registrationAssigned 31 July 2012: ISRCTN79599220.Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-409) contains supplementary material, which is available to authorized users.

Highlights

  • Despite persistent calls to measure the effectiveness of educational interventions on patient outcomes, few studies have been conducted

  • There are, limitations to this design, which are strongly emphasised by one group of authors in making their case for the superiority of standard parallel cluster randomised controlled trial (CRCT) [141]

  • The limitations of the design are that the stepped-wedge design will take longer to conduct than a standard CRCT, the repeated measurements of the dependent variable increase the burden on participants and researchers, the potential risk of contamination or attrition in participants from a cluster due to receive the intervention at one of the later steps, and that an intervention is implemented in all clusters of the trial when it has not yet been proven to be effective

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Summary

Background

Outcomes research has been defined as the assessment of what does and does not work in the delivery of healthcare [1]. For a realistic sample of 12 participating physiotherapists, who will be organized into three clusters, and setting an intergroup difference of 1.0 on the PSFS with a standard deviation of 2.0 (based on previous patient data from the NHS organization and values of PSFS outcomes from published studies [87,102,134]), ten patients are required to complete the outcome measures per physiotherapist at each of the four time points. This will result in a total sample size of 480 sets of patient outcomes. Ethical approval Ethical approval for the study was sought and obtained from the South East Wales Research Ethics Committee C on 20/04/2012 (ref: 12/WA/0078)

Discussion
18. Alderson D
58. Schön D: The Reflective Practitioner
69. IFOMPT: Educational standards in orthopaedic manipulative physical therapy
78. Campbell MJ
80. Hughes JP
95. Jette AM
Findings
99. World Confederation of Physical Therapy
Full Text
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