“The ABCs of AD”: A prospective evaluation of the efficacy of an educational intervention to increase knowledge of autonomic dysreflexia management among emergency health care professionals

Abstract

Context/Objective: Despite the availability of consensus-based resources, first responders and emergency room (ER) health care professionals (HCPs) have limited knowledge regarding autonomic dysreflexia (AD) recognition and treatment. The purpose of this study was to assess the efficacy of "The ABCs of AD" educational seminar for improving HCPs' short-and long-term knowledge of AD recognition, diagnosis, and management. Design: Multi-center prospective pre, post, and follow-up questionnaire study. Setting: Level I trauma centers with emergency departments in British Columbia, Manitoba, and Ontario. Methods: ER professionals completed measures immediately before and after (n = 108), as well as 3-months following (n = 23), attendance at "The ABCs of AD" seminar. Outcome Measures: AD knowledge test; seminar feedback. Results: Following the seminar, participants had higher ratings of their AD knowledge and had significantly higher AD knowledge test scores (M ± SD pre = 11.85 ± 3.88, M ± SD post = 18.95 ± 2.39, out of 22; P < 0.001, d = 2.21). Most participants believed the seminar changed their AD knowledge, and rated the seminar information as having the potential to influence and change their practice. AD knowledge test scores significantly decreased between post-seminar and 3-month follow-up (M ± SD 3mo = 17.04 ± 3.28; P = 0.004, d = -0.70); however, 3-month scores remained significantly higher than baseline. Conclusion: "The ABCs of AD" seminar improves HCPs' perceived and actual AD knowledge in the short-term. To enhance knowledge retention in both the short-and long-term, the inclusion of additional active learning strategies and follow-up activities are recommended. The seminar is being translated into an online training module to enhance the dissemination of the AD clinical practice guidelines among first responders, ER staff, and SCI practitioners.

Online training improves paramedics’ knowledge of autonomic dysreflexia management guidelines

“…First, consistent with findings observed in paramedic trainees 16 and emergency health-care professionals, 11 the module proved effective for increasing professional paramedics' knowledge of how to recognise and manage AD, as reflected in significant improvements in AD test scores at all time points relative to baseline. It is encouraging to see that the effects were maintained at 6 months.…”

“…The original AD knowledge test was written by a group of physiatrists and other health-care professionals who had expertise in SCI and/or AD. 11 For the purpose of this study, items not relevant to paramedics were removed (e.g., questions regarding the administration of medication or protocols once the patient is admitted to hospital), leaving seven questions in different formats (e.g., multiple choice, case studies, matching; see Supplementary Material 1 for AD knowledge test) that assessed participants' current knowledge about recognising and managing a patient with AD. Responses were scored with a possible maximum score of 16.…”

“…To date, members of our research team have made progress addressing the above barriers to knowledge translation by conducting research in the area of AD and providing a strong evidence base regarding the importance of AD clinical management, [4][5][6]9 as well as creating and evaluating the 'ABCs of AD' educational module. 11,16 The senior author has also led the development of the 'International Standards to document remaining Autonomic Function after Spinal Cord Injury' (ISAFSCI) 41 ), of which AD is a component. Since their release in 2012, the ISAFSCI have been translated into multiple languages and implemented into medical practice around the world, including hospital accreditation requirements in Canada.…”

“…8,9 However, early recognition and prompt management of this life-threatening, but easily treatable condition, can mitigate the occurrence of negative outcomes. 4,8 Studies of AD knowledge among emergency room nurses and physicians in Australia 10 and Canada 11 have revealed limited knowledge of AD, which would impede the ability to initiate treatment according to the AD Clinical Practice Guidelines (AD-CPGs). 12 Given that paramedics are often the first medical professionals to respond to a person experiencing AD, paramedics have a vital role to play in ensuring that AD is properly identified and appropriate treatment is initiated promptly.…”

“…The 'ABCs of AD' is an educational module that was developed to educate emergency health-care professionals about the diagnosis and management of AD (as per the AD-CPGs 12 ) and has been shown to influence changes in health-care professionals' perceived and actual AD knowledge. 11 Yet, although improving paramedics' knowledge of the AD-CPGs is an important first step in improving AD management, strategies may also be needed to alter paramedics' beliefs about, and intentions to use, the AD-CPGs. Social cognitive beliefs such as one's attitude toward using a CPG, perceived social pressure and perceived control to use a CPG may have a stronger influence on health-care professionals' intentions to use a CPG than simply their knowledge of it.…”