Occupational Medicine 2013;63:579–582 Advance Access publication 7 November 2013 doi:10.1093/occmed/kqt122

Short report

Evaluation of a musculoskeletal training package for occupational health practitioners I. Madan1 and K. Walker-Bone2 Department of Occupational Health, Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK, Occupational Rheumatology, MRC Lifecourse Epidemiology Unit, Southampton, UK.

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Correspondence to: I. Madan, Department of Occupational Health, Guy’s and St Thomas’ National Health Service Foundation Trust, Education Centre, York Road, London SE1 7EH, UK. Tel: +44 (0)77 9159 9272; e-mail: [email protected]

Aims

To assess the impact of the training package on the knowledge, confidence and reported behaviour of attendees.

Methods

Workshops were held in two regional centres in England. Delegates completed a questionnaire on arrival to establish their baseline knowledge and confidence and again at the end of the training. A  third questionnaire, with one reminder, was e-mailed to delegates 4  months following the workshops.

Results

Ninety-two OH professionals (77 nurses, 10 doctors and 5 ‘others’) attended and more than 80% reported that they had no previous training in examining the upper or lower limb or in distinguishing specific from non-specific MSDs. Confidence among delegates in examination, diagnosis and management of MSDs improved after the workshop and these changes were sustained and remained statistically significant from baseline 4 months afterwards. Following the training, 79% (50) of delegates reported that they had shared the knowledge and skills acquired with their colleagues and 71% reported that they had used the examination techniques in their day-to-day practice.

Conclusions We have developed a training package which resulted in improved knowledge among attendees and gave them confidence to use their skills in practice. Key words

Education; musculoskeletal disorders; occupational health; training.

Introduction Musculoskeletal disorders (MSDs) contribute import­ antly to disability among working-aged adults. Black called for increased development of professional occupational health (OH) expertise ‘based upon a sound academic base’ to lead forward programmes to minimize the impact of MSDs on society [1]. However, there is evidence that even where research exists and guidance has been published [2], for example, low back pain [3], there is still wide variation in practice in the management of affected workers [4]. Moreover, for other types of MSDs, for example, upper limb disorders, while there have been research developments [5,6], there is little evidence of translation of this into practical care of workers. Recognizing the gap between clinical

practice and research findings, a multidisciplinary audit implementation meeting convened by the Occupational Health Clinical Effectiveness Unit in 2009 concluded that the development of an educational package instructing in the diagnosis and management of MSDs with specific emphasis on examination skills was a high priority. Therefore, we developed and delivered such a package including workshops, teaching materials and a video. Here, we present the analysis of feedback from OH practitioners enrolled on the training.

Methods The training package was developed by consultants in occupational medicine (I.M.) and rheumatology

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Background Musculoskeletal disorders (MSDs) are a common cause of disability in the workplace. Despite this, there is known to be a wide variation in the assessment of MSDs by UK occupational health (OH) professionals. Therefore we developed a workshop, supported by a bespoke, on-line video, focussing on the assessment and management of MSDs.

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Results Two workshops were held, in London and Leeds, July– September 2011. Originally, maximum attendance numbers of 40 per workshop were specified but due to demand, additional capacity was created. In total, 92 OH professionals (86 women and 6 men) attended a workshop including 77 nurses, 10 doctors and 5  ‘others’ (mostly physiotherapists). Eighty per cent of delegates had more than 5 years OH experience.

Table 1.  Training among OH Professionals upon arrival at the MSDs workshop (T1) Training

Distinguishing specific and non-specific MSDs Risk factors for non-specific MSDs Examining the upper limb Examining the lower limb

Yes n (%)

No or do not know n (%)

8 (9)

84 (91)

20 (22)

72 (78)

18 (20) 17 (19)

74 (80) 75 (82)

At baseline, more than 80% of delegates reported that they had received no training in examination of the upper or lower limb or distinguishing specific from nonspecific upper limb disorders or risk factors for MSDs (Table  1). The majority expressed low levels of confidence in examining, diagnosing and managing specific and non-specific MSDs (Table 2). Immediately after the workshop (T2), delegates scored their satisfaction with each session of the workshop. On a Likert scale ranked 1–7, where 1 was ‘strongly disagree’ and 7 was ‘strongly agree’, delegates were asked about content, what they liked and disliked and how they would improve the course. Overall, the training was well evaluated. The median score for satisfaction was 6 (interquartile range; IQR 6–7) for 4 out of the 6 aspects and 5 (IQR 4–6) in the remaining two aspects. Delegates were particularly positive about the practical nature of the workshops and examination training. However, a consistent comment was that there was a great deal of knowledge and skill to assimilate in 1 day. Table 2 summarizes the changes in knowledge, beliefs and confidence before and immediately after the workshop. Confidence among delegates in examination, diagnosis and management of MSDs was considerably improved at T2 and these changes were sustained and remained statistically significant from baseline 4 months later (T3) (Table 2). Also at T3, 79% (50/63) reported sharing the knowledge and skills acquired at the workshop with their colleagues and 71% reported that they had practised the examination techniques.

Discussion We designed a practical, interactive and evidence-based workshop which was popular and highly rated by OH professionals. After attending, delegates’ knowledge about MSDs improved, as did their self-rated confidence and skills with benefits sustained 4 months later. Moreover, attendees indicated that they had shared the knowledge gained with colleagues and were practising examinations themselves.

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(K.W.B.). Based upon research [7] and experience [8], interactive, problem-based workshops on the upper limb, lower limb and spine were designed, incorporating didactic teaching and practical examination skills. A bespoke video of simplified examination techniques was created to support the workshops and for attendees to access subsequently. The workshop was reinforced by a comprehensive participant workbook. An emphasis was made on the evidence-based assessment of the musculoskeletal system in order to differentiate specific conditions from non-specific pain [5]. All materials were piloted among a sample of OH practitioners. Two workshops were widely advertised. On arrival (T1), everyone completed a baseline questionnaire enquiring about knowledge of and confidence in assessment of MSDs among workers. Subsequently, we evaluated the training at the first three levels of educational evaluation according to the Kirkpatrick model [9]. All participants completed a second knowledge and confidence questionnaire at the end of the workshop (T2). Four months later, they were e-mailed a third questionnaire (T3), which included questions on confidence and implementation of new skills. One reminder was sent at 2 weeks. Questionnaire responses were anonymous to the researchers, but were linked by an alphanumeric code. Linkage of the questionnaire to the participant’s contact details was only available to the course a­dministrator, for the purpose of e-mailing the T3 questionnaire. Participation in the study was voluntary and workshop participants were informed of the evaluation prior to registration. Advice from the Guy’s and St Thomas’ National Health Service (NHS) Trust research ethics service was that ethical approval was not required. Data were analysed using SPSS version 20.0. Scores about knowledge, beliefs and confidence were ­summarized using descriptive statistics. Change in knowledge was compared using pairwise chi-­ square testing. For beliefs and confidence, median scores were calculated at baseline, T2 and T3 and compared using Wilcoxon’s signed rank test for comparison of ranks.

I. MADAN AND K. WALKER-BONE: EVALUATION OF A MUSCULOSKELETAL TRAINING PACKAGE  581

Table 2.  Comparison of knowledge, beliefs and confidence among OH Professionals before and after attendance at the MSDs workshop Answer correct at baseline (T1) n (%)

Answer correct at T2 n (%)

P-value (comparison between results at baseline and at T2)

Inflammation of the biceps tendon is rarely an isolated finding Lateral epicondylitis is associated with manual work Raynaud’s phenomenon rarely starts before the age of 30 Dupuytren’s contracture may be a sign of heavy alcohol intake Carpal tunnel usually has an occupational cause Non-specific forearm pain is more common in men than women Heberden’s nodes are a feature of osteoarthritis A history of morning stiffness is helpful in distinguishing articular and non-articular pain Working in awkward posture may be the cause of shoulder pain Illness is defined is an absence of wellbeing perceived by oneself or others Osteoarthritis of the hip is a prescribed industrial disease in certain occupational groups

60 (69) 60 (69) 64 (74) 22 (25) 44 (52) 70 (81)

70 (81) 73 (96) 69 (79) 74 (85) 49 (57) 61 (61)

NS

Evaluation of a musculoskeletal training package for occupational health practitioners.

Musculoskeletal disorders (MSDs) are a common cause of disability in the workplace. Despite this, there is known to be a wide variation in the assessm...
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