E-learning program ("PEAK") for physiotherapists to manage knee osteoarthritis via telehealth during the COVID-19 pandemic: a 'real-world' evaluation using registration and survey data.

Jorge, Ana Elisa Serafim; Bennell, Kim Louise; Kimp, Alexander J; Campbell, Penny Kate; Hinman, Rana Shane

BACKGROUND The COVID-19 pandemic necessitated healthcare professionals to transition to telehealth, often with little preparation or training. E-learning is an accessible and scalable method of delivering health professional education. The PEAK (Physiotherapy Exercise and physical Activity for Knee osteoarthritis) e-learning modules were developed to upskill physiotherapists in evidence-based management of knee osteoarthritis (OA) via telehealth and in-person. In the research setting, the PEAK e-learning modules are perceived by physiotherapists as effective when part of a comprehensive training program for a clinical trial. However, effectiveness of the PEAK modules on their own, in a 'real-world' setting, is unknown. OBJECTIVE Evaluate reach, effectiveness, adoption and implementation of the PEAK e-learning modules. METHODS This is a longitudinal study informed by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Participants were clinicians, researchers, educators and healthcare students who registered for access to the modules between April 1st and November 30th 2020. Reach was evaluated by outcomes (countries; referral sources; attrition) extracted from registration data and embedded within pre-course surveys in the Learning Management System (LMS). Effectiveness was evaluated by outcomes (confidence with video-conferencing; likelihood to use education, strengthening exercise and physical activity in a treatment plan for knee OA; usefulness of modules) measured via 10-point numeric rating scales (NRS; score range from 1=not confident/likely/useful at all to 10=extremely confident/likely/useful) in pre- and post-course (upon completion) surveys in the LMS. Adoption and implementation were evaluated by demographic and professional characteristics and outcomes related to use of learnings and usefulness of program elements (measured via 4-point Likert scales (response options from not at all useful to extremely useful)) in a survey administered four months after module completion. RESULTS Broad reach occurred, with 6720 people from 97 countries registering for access. Amongst registrants, there were high levels of attrition, with 2463 (37%) commencing the program and pre-course survey and 1318 (20%) completing all modules and post-course survey. The program was effective. Learners who completed the modules demonstrated increased confidence with video-conferencing (mean change (95% CI) 3.1 (3.0, 3.3) NRS units), and increased likelihood to use education, strengthening and physical activity in a knee OA treatment plan, compared to pre-course. Adoption and implementation of learnings (n= 149 respondents) occurred at 4 months. More than half of respondents used their learnings to structure in-person consultations with patients (56%) and the patient information booklets in their clinical practice (53%). CONCLUSIONS This study provides evidence of reach and effectiveness of an asynchronous self-directed e-learning program in a real-world setting amongst physiotherapists. The PEAK e-learning modules offer clinicians an accessible educational course to learn about best-practice knee OA management, including telehealth delivery via video-conferencing. Attrition across the e-learning program highlight the challenges of keeping learners engaged with self-directed online learning. CLINICALTRIAL