PHYS THER
Vol. 86, No. 9, September 2006, p. 1252
DOI: 10.2522/ptj.20050382.bl
The Bottom Line
[Brennan GP, Fritz JM, Hunter SJ. Impact of continuing education interventions on clinical outcomes of patients with neck pain who received physical therapy. Phys Ther. 2006;86:1251–1262.]
The Bottom Line is a translation of study findings for application to clinical practice. It is not intended to substitute for a critical reading of the research article. Summaries are written by members of The Bottom Line Committee.
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What problems did the researchers set out to study, and why?
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Continuing education (CE) courses are very popular among many physical therapists, but it is unknown whether participation in CE leads to improved outcomes in patients who receive physical therapy from therapists who take CE courses. The authors examined the effects of 2 different CE delivery models on patient outcomes in clinical settings.
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What types of patients participated in the study?
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Thirty-four of 57 physical therapists employed in 13 clinics in Utah attended a 2-day CE course. Eleven of these 34 attendees further participated in an ongoing clinical improvement project for patients with neck pain. Outcome data were obtained for 1,365 patients; average age was 42 years, and more than two thirds of the patients were women. Chief complaint was neck pain.
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What new information does this study offer?
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To date, studies examining the impact of CE on patient care have focused primarily on physician practice. The studies evaluating the impact of traditional lecture presentations in physician professional practice do not indicate that didactic presentations improve clinical performance. In contrast, some researchers1 have shown that the use of small-group discussion and practice sessions to enhance clinical skills may be effective in improving physician practice. The current study adds to our knowledge of the impact that the mode of delivery of CE may have on the performance of physical therapists in the clinic.
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How did the researchers go about the study?
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Two experienced educators and physical therapist clinicians with fellowship status in the American Academy of Orthopedic Manual Therapy taught a 2-day course at the participating clinics, focusing on manual therapy of the spine and therapeutic exercise interventions for physical therapists. The course included lecture and interactive hands-on practice sessions. Course notes were provided to all participants. After completion of the course, a separate clinical improvement project was conducted in 4 of the participating 13 physical therapy clinics, which included monthly meetings to review the examination and manual therapy techniques taught in the course. The clinical improvement project utilized facilitators and an instructional CD-ROM as learning resources. An additional small-group follow-up, with a 4-hour period of hands-on instruction with one of the original course instructors, was attended by the physical therapists participating in the clinical improvement project.
Data on outcomes for eligible patients treated by the physical therapists who did or did not attend the CE course were collected before (pre-course) and after (post-course) the period when the CE course was offered. Neck Disability Index (NDI) scores from the initial and final therapy sessions, 0–10 numeric pain rating scales, utilization information, and physical therapy charges were tracked and recorded for each patient. The effectiveness of the 2-day CE course was examined by comparing the clinical outcomes of patients who were treated by attending or nonattending therapists during the year preceding the course with the outcomes in the year following the course. To examine the effectiveness of the additional clinical improvement project, researchers compared clinical outcomes during the pre- and post-course periods between patients who were treated by the course attendees who participated in the "extra" education project and patients treated by therapists who attended only the 2-day course. Differences in physical therapy visits and charges also were examined.
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How might the results of this study apply to patients who are treated by physical therapists from this point forward?
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No differences were found in clinical outcomes between attendees and nonattendees in either the pre- or post-course period for baseline pain or NDI scores, number of visits, length of stay, or physical therapy charges. Attendance at the CE course did not affect clinical treatment outcome in any of the ways that were examined by the investigators. However, comparing treatment outcomes between the therapists who attended only the CE course with those who both attended the course and participated in the clinical improvement project suggested that the "extra" project improved clinical outcomes from the pre- to post-course period, whereas therapists who attended the CE course and who did not participate in the clinical improvement project experienced a decrease in clinical outcomes over the same time period.
This study shows that the CE course did not result in improved clinical outcomes when comparing patient outcomes between therapists who did and did not attend a 2-day course. Closer examination of the outcomes for the clinicians who attended the course suggests that physical therapists should consider the manner in which CE is delivered prior to attending a course. The totality of evidence to date provides preliminary support for the notion that interactive workshops with practice sessions may be more effective in improving professional practice than CE courses delivered in a lecture format only. Furthermore, the results of this study indicate that follow-up sessions and practice aimed at facilitating the synthesis of course material into clinical practice may promote improved outcomes for the patients of some therapists.
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What are the limitations of the study, and what further research is needed?
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As the authors acknowledged, physical therapists who attended the CE course from participating clinics were self-selected to attend or not attend, and it is possible that skill levels in manual therapy or other uncontrolled factors may have had an impact on therapists' decision to attend the course. A selection bias also may have existed for the ongoing clinical improvement project, as researchers chose clinic participation based on volume of patients and geographic considerations. Future research—using prospective, randomized studies where possible—should focus on the effectiveness of practicing clinical skills and the use of follow-up sessions to promote improved clinical outcomes in physical therapy CE courses.
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References
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- Thomson O'Brien MA, Freemantle N, Oxman AD, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes.
Cochrane Database of Systematic Reviews. 2001: CD003030. Issue 1.
Related Article
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Impact of Continuing Education Interventions on Clinical Outcomes of Patients With Neck Pain Who Received Physical Therapy
- Gerard P Brennan, Julie M Fritz, and Stephen J Hunter
Physical Therapy 2006 86: 1251-1262.
[Abstract]
[Full Text]
[PDF]
Copyright © 2006 by the American Physical Therapy Association.
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