Measuring clinical competencies in facilitating group-based rehabilitation interventions: development of a new competency checklist

Abstract

Objective: Group-based intervention formats are common in rehabilitation, but no tool for objectively measuring clinical competencies in group facilitation currently exists. We aimed to develop a psychometrically sound group facilitation competency checklist for use in clinical, training, and research settings. Method: The Delphi method of expert consensus was used to establish checklist items that clearly describe competencies considered important for effective group facilitation. Inter-rater reliability was determined with two experienced psychologists who used the checklist to rate the competencies of psychology trainees facilitating a memory skills group. Results: After two Delphi rounds, consensus was reached on 17 items, defined as at least 80% agreement among the panel of 15 experts. The four checklist item categories were (a) Facilitating focused group discussion, (b) Communication skills, (c) Interpersonal style, and (d) Session structure. One item was removed after piloting. Inter-rater reliability was excellent (88% agreement) using a simple coding method (competent/incompetent). When using a detailed coding method that discriminated between ‘done adequately’ and ‘done well’, inter-rater reliability was weaker (κ = 0.481, 55% agreement); however, it improved to almost perfect after the raters calibrated their standards. Conclusion: The new group facilitation competency checklist is fit for purpose for measuring clinical competencies in delivering group-based rehabilitation interventions and can be used in the training of effective group facilitators.

Practice Considerations for Adapting In-Person Groups to Telerehabilitation

“…Further study is warranted to understand the effects of group telerehabilitation on patient-level outcomes (e.g., quality of life, physical function) in different patient populations. Current literature for group telerehabilitation is limited to small feasibility studies and populations with stable conditions (Cox et al, 2018;Hwang et al, 2017;Jennings et al, 2020;Kyrdalen et al, 2014;Lin et al, 2014;Pitt et al, 2019;VanRavenstein & Davis, 2018;Wong et al, 2019). For example, Hwang et al (2017) demonstrated that a home-based telerehabilitation program for persons with chronic obstructive pulmonary disease (COPD) was not inferior to a center-based, in-person program for functional outcomes (six-minute walk test) and had significantly higher attendance.…”

“…As a result, many providers, clinics, and healthcare systems are rapidly readjusting and providing new modes of care delivery with little evidence on what types of care delivery are effective and how to deliver this care (i.e., practice considerations). A small but growing body of literature suggests group telerehabilitation has promising outcomes across rehabilitation professions including within physical therapy and speech therapy ( Cox et al, 2018 ; Hwang et al, 2017 ; Jennings et al, 2020 ; Kyrdalen et al, 2014 ; Lin et al, 2014 ; Pitt et al, 2019 ; VanRavenstein & Davis, 2018 ; Wong et al, 2019 ). Yet uncertainty exists in how telerehabilitation groups differ from in-person groups, including how to adapt them to ensure efficient delivery and quality care.…”

Therapist competence and clinical outcome in the rehabilitation of memory following traumatic brain injury trial

“…Alternatively, the scoring method used may not have been adequate to detect sufficient variation in therapist competence, which may be why no relationship was found between competence and outcome. However, more fine-grained scoring methods for measures of therapist competence often result in poorer inter-rater reliability (25).…”

“…Videos were coded using the eNACT Group Facilitation Competency Checklist (25), contained in Supplementary Material. This checklist was designed to appraise the therapeutic skills demonstrated by facilitators of group-based interventions, and was developed in the context of a memory rehabilitation group for individuals with acquired brain injury.…”

“…Requisite skills are grouped into four categories: Facilitating group discussion, Communication skills, Interpersonal style, and Session structure. The detailed scoring method was used, as described by Wong and colleagues (25). For each item, skills are scored 0 (not observed despite opportunity to use skill), 1 (observed, not done well), 2 (observed, done adequately) and 3 (observed, done well).…”