Airway clearance techniques: an e-learning method to enhance acquisition of evidence-based knowledge and skills for physiotherapists and patient user groups

Supervisors: Dr Eleanor Main, Dr Harriet Shannon and Professor Chris O'Callaghan

Airway clearance techniques (ACTs) are used by physiotherapists and patients to treat many respiratory conditions. However, there are national and international variations in the knowledge and skills of people administering and using such treatments, and access to high quality, evidence-based training is limited. It is essential that on-going, cost-effective training is provided for patients and physiotherapists to ensure consistently excellent patient care and that ACT skills meet best practice standards.

Multi-media ACT e-learning is a novel, potentially efficacious and cost-effective way to educate under- and post-graduate physiotherapists and patients who are required to use ACTs in the short and long term. It is a clinically relevant, powerful method of producing consistently high standard teaching which can be responsive and updated when new evidence becomes available. It offers an opportunity to deliver widely accessible training through video and complex, standardised interactive simulated environments.

Feedback from students attending the UCL Physiotherapy MSc programmes has suggested that multi-media training may provide an effective, alternative method of teaching/learning which can be done independently and may be effective in ensuring a spiral curriculum physiotherapy course design (Biggs and Tang, 2010). Recent reports have shown that physiotherapy education can be powerfully supported using multi-media training (Peacock and Hooper, 2007).

Patients and families have also reported that if a multi-media tool was available as a reference for airway clearance techniques, they would avail of it to ensure best practice when treatments are being carried out independently at home. However, there are few such resources currently available to cardio-respiratory physiotherapists or users and little is known about the enhancement of physiotherapy learning in this way.

The proposed research will involve designing and developing two airway clearance technique (ACT) e-learning multi-media learning packages: content appropriate for a) physiotherapists and b) patients using ACTs. The research will then objectively evaluate the efficacy of using these multi-media packages for teaching and learning ACT skills.

The two multi-media e-learning packages will consist of the basic and physiological principles of ACTs demonstrated in a pragmatic and easily accessible way, using videos and animations. ACTs will be explained and demonstrated in appropriate audio-visual formats and the evidence for each technique will be described and explained using animations and graphics.

The teaching packages will then be evaluated in terms of the efficacy of using these ACT multi-media packages as an alternative method of teaching and learning ACT skills for under- and post-graduate physiotherapists, and patients and their families, in contrast to more traditional didactic/practical methods.

The study will involve recruiting 3 groups of participants, with 36 in each group (108 total). Half of the participants in each group will be randomised to the control and half will be randomised to the intervention groups respectively. The control groups will receive ‘standard’ ACT literature and instructions. The intervention groups will receive the multi-media e-learning package.

The 3 groups will include

1) 36 final year undergraduate physiotherapists
2) 36 post-graduate non-respiratory specialist physiotherapists (with at least 2 years’ experience)
3) 36 paediatric respiratory patients (6-16 years old, eg those with cystic fibrosis, who are required to self-administer regular (ie daily) airway clearance techniques).

Assessment of the knowledge and skills acquisition and retention for each participant will take place on two occasions at different intervals from delivery of the learning package (on the same day and one month later) to evaluate both the quality of acquisition (in terms of practical skills learned and ability to articulate these) and the retention of the knowledge and skills delivered in different ways.

For the physiotherapy participants, assessments will be done by means of specifically designed questionnaires and standard objective structured clinical examinations (OSCEs), during which physiotherapists will be video recorded while teaching and performing ACT’s on volunteers. The recordings will be independently assessed by specialist ACT therapists who are unaware of group allocation.

Patients will be assessed by means of specifically designed questionnaires and video recorded observations of self-administered treatments, which will be independently assessed by specialist ACT therapists who are unaware of group allocation. These standardised approaches will allow statistical evaluation to be performed and will allow the effectiveness of the educational intervention to be determined in terms of the quality of acquisition and retention of ACT knowledge and skills.

If successful, E-learning may be a potentially cost effective training package for physiotherapists and patients using airway clearance techniques as part of a physiotherapy treatment programme. It has the potential to improve child healthcare nationally and internationally by providing an on-going method of consolidating and refreshing knowledge and has the potential to be widely accessible using professional platforms such as the iCSP (interactive Chartered Society of Physiotherapy webpage).

1) Peacock, S. and Hooper, J. (2007) E-learning in physiotherapy education, Physiotherapy, 93, 218-228.
2) Preston et al. (2012) The Physiotherapy eSkills Training Online resource improves performance of practical skills: a controlled trial. BMC Medical Education, 12, 119.
3) Biggs, J. and Tang, C. (2010) Teaching for Quality Learning at University, 4th ed, McGraw Hill International.
4) Ruiz, J.G. et al (2006). The impact of E-learning in medical education. Academic Medicine, 81, 3, 207-212.