The 2019 Pat Cosh Trust Grants have been awarded to David Snowdon, Sze-Ee Soh and Jenna Lang. They discuss their research projects.

IMPROVING CLINICAL SUPERVISION

Dr David Snowdon has been awarded $13,600 to develop, implement and assess the effectiveness of a clinical supervision training program for physiotherapists.

Overview

Qualified physiotherapists working in the Australian public health system are required to receive clinical supervision to ensure skill development and maintain a high quality of patient care. However, currently the practice of clinical supervision is ineffective for the majority of physiotherapists.

This training program aims to improve the effectiveness of clinical supervision of physiotherapists by improving their skills in receiving and delivering clinical supervision.

Current clinical supervision practice is predominantly reflective, where the physiotherapist meets with their supervisor and reflects on their treatment of patients over the past week, fortnight or month. Recent research suggests that physiotherapists prefer a more direct model of clinical supervision where their supervisor directly observes and guides their clinical practice. The training program will focus on this direct model and facilitating a constructive supervisory relationship.

A before and after trial will be conducted to assess the impact of the training program on the effectiveness of clinical supervision. The training program will involve interactive workshops, each covering an essential topic relating to clinical supervision of physiotherapists. The effectiveness of clinical supervision will be measured using a validated scale. Training will be provided to physiotherapists working for Peninsula Health, Victoria.

Importance of the funds

The grant will be used to develop workshop content and materials, purchase the licence to the clinical supervision scale and hire personnel to assist with conducting the project.

Pat Cosh Grant funding is essential to the project, as it will provide the necessary resources to develop and run the workshops. In particular, the personnel required to develop and implement the training program. Without this funding the project would not be possible.

Challenges

The greatest challenge for this project is developing workshops that facilitate a change in clinical supervision practice. Workshops will be highly interactive to ensure engagement of physiotherapists and facilitate changes in their behaviour. Further to this, these interactive components will align with active learning and social learning theory. Developing workshops that are consistent with learning theories will hopefully improve the ability of the workshops to facilitate a change in clinical supervision practice.

The future

The training program this project develops will aim to improve physiotherapists’ knowledge and skills in the practice of clinical supervision. Enhanced clinical supervision skills should lead to higher quality professional development and improved clinical skills of physiotherapists. This should also lead to improved patient care. Additionally, we aim to further develop this clinical supervision program for a wider audience of physiotherapists.

Dr David Snowdon, APAM, is the grade 4 research translation lead at Peninsula Health with an adjunct appointment at Monash University. His research focuses on clinical supervision of allied health professionals and the effect of clinical supervision on patient care.

PREVENTING FALLS

Dr Sze-Ee Soh has been awarded $14,600 to focus on embedding falls prevention activities into routine clinical care for older people with osteoarthritis.

Overview

This project builds on our 2018 research program, which was funded by Arthritis Australia, to understand the burden of falls among people with osteoarthritis and current clinical practice in this area. There is a perception that falls prevention is not relevant to this patient group, despite growing evidence that people with osteoarthritis are at a higher risk of falls and fall-related injuries. The healthcare costs associated with the predicted growth in osteoarthritis among older age groups is currently predicted to exceed $2.9 billion annually by 2030. Adding falls into this equation substantially increases the social and economic burden for the person, their families and society.

We know how to prevent falls in older people, but it appears that this knowledge is not being applied when caring for people with osteoarthritis. In our recent survey of 370 practising Australian physiotherapists who care for people with hip and knee osteoarthritis, only a third reported using a falls risk screening tool in their clinical assessment. A perceived lack of training, knowledge or skills was identified as a barrier. There is a clear need to develop resources for clinicians so that they are able to assess and manage falls among older people with osteoarthritis.

Importance of the funds

Funding from this grant will be used to develop an e-learning program on falls prevention assessment and management specific to people with osteoarthritis. The program will consist of three modules focusing on balance impairment and one module addressing exercise adherence.

Alongside the delivery of the program, I will also conduct a mixed-methods program evaluation to determine the reach, acceptability and impact of these resources on clinician knowledge and practice.

This funding will allow me to develop innovative falls prevention resources specific to people with osteoarthritis, meeting the clinician information gaps we have identified. Changing the attitudes of clinicians and improving their knowledge will allow them to support people with osteoarthritis to better understand their falls risk. We hope this will lead to a reduced incidence of falls and fall-related injuries, which could have positive impacts on health outcomes.

Challenges

One of the challenges is to develop resources for clinicians that are flexible and accessible. We know that clinicians are time poor and have multiple competing priorities. Therefore, any modules we develop must incorporate evidence-based information but without being time-intensive. Diverse learning approaches will be applied to allow key information to be integrated into practice, and we will also build an online forum to allow participants to share their experiences.

The future

A 2018 editorial published in Journal of Physiotherapy by our team highlighted the current ‘siloed’ approach towards patient care, with falls prevention and osteoarthritis care being delivered separately by different clinical teams. An outcome I hope to achieve is to raise awareness of falls among clinicians who work with people with osteoarthritis. I also hope to integrate falls prevention into routine management for people with osteoarthritis so that we deliver care that is more holistic, efficient and sustainable.

Dr Sze-Ee, APAM, is a lecturer and research fellow at Monash University. She is a physiotherapist with extensive experience working with older adults. She has a keen interest in biostatistics and her main areas of research include falls, Parkinson’s disease, quality of life and validating outcome measures.

INTERVENTIONS IN CRITICAL CARE

Jenna Lang has been awarded $15,000 to develop a competency assessment tool for physiotherapists delivering exercise and rehabilitation interventions to intensive care patients.

Overview

Australia is emerging as a world leader in the investigation of early mobilisation for critically unwell patients. There are many studies supporting the potential benefits of early mobilisation in the intensive care unit (ICU) and a current ongoing international phase three randomised controlled trial lead by Australian researchers from the Australian and New Zealand Intensive Care Research Centre. In this context, high volumes of research investigating the barriers and facilitators to implementation of this intervention have emerged. Staff expertise has been identified as a key barrier, with staff training and education recommended as important methods to facilitate delivery of this intervention. While medical and nursing staff receive formal postgraduate training regarding the management of intensive care patients, physiotherapy education in this area remains highly variable with no formal process of credentialing and skills recognition. My current research focuses on identifying the quality of clinical practice guidelines for early functional rehabilitation in the ICU, and the development of competency assessment tools and training for physiotherapists delivering exercise and rehabilitation interventions to critically ill patients.

Importance of the funds

The Pat Cosh Trust Grant will be used to fund a modified Delphi expert consensus: the ‘Mobility expertise in intensive care competency’, or MOvE-ICU study, of clinicians, educators and researchers from physiotherapy, medical and nursing fields. The study aims to develop a competency assessment tool for physiotherapists that identifies and assesses the key elements and performance criteria, which are required for safe and effective delivery of early functional rehabilitation in the ICU. Focus groups with consumers, including ICU survivors and their caregivers, will be undertaken to inform the panel regarding items and skills that are important to our ICU patients and families.

This funding provides the opportunity to expand the scope of this project to ensure all key stakeholders from consumer to end-user can be included in a rigorous consensus process. Funding will facilitate the use of multiple project phases to ensure all components of the assessment tool are addressed by the expert panel.

Challenges

The major challenge of this project is anticipated to be in achieving a consensus document which meets the needs of various intensive care units of differing acuities, patient mixes, staff expertise and locations. This will be addressed through the use of the modified Delphi methodology, which supports heterogeneous panels to achieve consensus through a process of feedback and repeated rating of items. Additionally, the option to include items as either mandatory or supplementary on the final assessment tool will improve flexibility and ease of implementation of the final product.

The future

It is anticipated that this project will demonstrate the feasibility of developing mutually recognised competency assessments for physiotherapists working in intensive care. In the long-term this will begin the process of developing consistent postgraduate training and credentialing of physiotherapists working in intensive care to facilitate skills recognition. The continued development of a skilled workforce in this complex work area will enable equality of evidence-based patient care between diverse practice environments.

Jenna Lang is a Master of Philosophy student at Monash University and a senior clinician cardiorespiratory physiotherapist   at Western Health. Jenna’s research focuses on the quality of existing guidelines and training for clinicians providing rehabilitation interventions in the ICU.