Rheumatoid arthritis (RA) is a chronic, progressive disease, and strong evidence supports physiotherapy care in the co-management of patients with RA. Despite evidence demonstrating the efficacy of physiotherapy services being delivered in primary care settings, access to services specifically for people with RA has historically been limited to tertiary hospital settings.
Physiotherapists must have the capacity to identify, manage and respond to variable disease states and related red flags in people with RA. However, recent data indicate low confidence and high professional development needs in this clinical physiotherapy area. Clinical education initiatives need to be readily accessible, using a flexible and engaging platform, regardless of geographic location. In a recent survey among practicing clinicians, 78% selected online delivery as one of their preferred delivery modes for professional development.
This single-blind, randomized controlled trial (RCT) over four weeks was performed to determine the effectiveness of the Rheumatoid Arthritis for Physiotherapists–eLearning (RAP-eL) tool in improving 159 Australian-registered physiotherapists’ self-reported confidence in knowledge and clinical skills in managing people with RA, satisfaction with their ability to manage people with RA, knowledge of red flags and critical clinical management issues, and practice behaviors assessed through clinical vignettes.
RAP-eL includes four learning modules and two clinical case studies. The modules are: 1) RA: the disease and recognition in practice; 2) RA: the early stage of the disease; 3) RA: the chronic stage of the disease; and 4) extra-articular features of RA and comorbid conditions. RAP-eL purposely links knowledge with clinical skills; however, this does not imply that the Web-based learning environment can replace clinical skills education that requires “doing” rather than just “thinking about doing.”
In the study, 80 physiotherapists were randomized into the intervention group and 79 into the control group. Fifty-six and 48, respectively, provided baseline data. Significant between-group differences were observed for change in confidence in knowledge (mean difference 8.51; 95% confidence interval [95% CI] 6.29, 10.73; effect size 1.62) and skills (mean difference 7.26; 95% CI 5.1, 9.4; effect size 1.54), with the intervention group performing better. Satisfaction in ability to manage RA, four of the six clinical statements and responses to vignettes demonstrated significant improvement in the intervention group.
Fary RE, Slater H, Chua J, et al. Policy-into-practice for rheumatoid arthritis: Randomized controlled trial and cohort study of E-learning targeting improved physiotherapy management. Arthritis Care Res (Hoboken). 2015 Jul;67(7):913–922.