Educating caregivers of persons with cerebral palsy in night-time postural care: A randomized trial comparing two online training programs

Abstract

Objective: Compare effectiveness of two differently formatted training programs in educating night-time postural care implementers. Design: Mixed-methods parallel-group double-blind design with random assignment. Setting: United States academic institution. Participants: Thirty-eight adult caregivers/providers of children with cerebral palsy. Interventions: Both 2-hour online programs included content on night-time postural care evidence, risk-factor monitoring, sleep-system types, positioning methods, and assessments. Group A used interactive videos, Group B summary information with web-links. Main Measures: We measured self-perceived competence via questionnaires (baseline, post-training, post-simulation) containing 4-point rating-scales of knowledge, ability, and confidence and measured positioning ability via a simulation observation instrument comprising 16 positioning-task ratings with space for describing performance. We recorded participant actions/statements using fieldnotes. Results: Thirty-eight completed training (19 per group). Group A (vs B) showed significantly greater self-perceived competence changes post-training (0.46 points (SE 0.17), P = 0.008). Thirty-seven positioned a standardized “client,” with groups not differing significantly on total tasks completed correctly ( F(1, 92.32) = 1.91, P = 0.17) averaging 11.85 (SE 0.83) and 12.60 (SE 0.84) of 16 tasks correct. Group A’s post-positioning/simulation self-ratings were significantly associated with actual ability ( r = 0.53, P = 0.019). In both groups ⩾47% of caregivers incorrectly completed the tasks of placing head and neck in neutral and snugging up all [positioning] parts. Conclusion: The sleep care positioning training program (interactive video-based format) is effective in building caregivers’ self-perceived competence for night-time postural care. While the lesson was well-received by caregivers and considered a “match [to their] learning style,” the lesson did not lead to greater improvement in actual ability to position the “client” compared to control training.

Educating rehabilitation professionals on clinical skills for postural care services: A scoping review

“…17–25 Two articles examine the current postural care training needs for clinical practice. 9,11 Two articles describe the development or effectiveness of a postural care training program for parents, school staff, and nurses. 26–27 Two examine and evaluate specific postural care training programs intended for both parents and rehabilitation professionals.…”

“…9–11,27,28 Two of these studies were descriptive/exploratory in which both caregivers and multidisciplinary team members reported dissatisfaction and a lack of overall knowledge due to the amount of postural care training they received. 9,11 Another study identified knowledge differences that occur across disciplines such that nurses and occupational therapists reported having more knowledge than speech therapists and psychologists. 9 One single-subject design and one experimental study showed that that postural care training programs for parents and teachers have a positive impact, but parents and teachers may need additional training compared to professionals.…”

“…Many studies were descriptive, used non-probability sampling, and either did not report cultural demographics or lacked diversity, limiting generalizability. 9–11,17,18,23,25,27 In addition, self-created and self-report outcome measures were common, and researchers often failed to report replicable methodology for the procedure, data collection, and data analysis. 10,11,17,18,20,21,23 These investigators have laid the groundwork for knowledge on the topic of educational methods for rehabilitation professionals, and future investigators can learn from them as they advance the quality of research moving forward.…”

“…Eleven studies specified the types of interactive and active learning approaches that can be used to increase factors such as clinical reasoning, confidence, and skill transfer among healthcare professionals. 10,[17][18][19][20][21][22][24][25][26][27] Examples of these approaches include practice (i.e., simulations, case studies, practice coaching, kinesthetic activities, and demonstrations), collaboration (i.e., mentorship, group discussion, problem-based learning, think-pair-share, and peer-teaching), and/or feedback (i.e., reflection, debrief, digital-recording review, written/ verbal feedback from instructors/peers, learning checkpoint quizzes, intermittent click-drag exercises, and final exam assessment). 10,[17][18][19][20][21][22][24][25][26][27] Out of the 11 articles, two were systematic reviews and two were theoretical/conceptual papers that described how collaboration and feedback benefitted learners by supporting and validating their knowledge.…”

“…11 In addition, differently formatted training programs have been shown to result in differences in both self-perceived competence and potential for selfassessing actual positioning ability post-training. 10 In order for health professionals to gain the necessary skills for implementing NTPC and have an effect on the health of those served, we need to understand which educational practices are most effective.…”