Simulation in physiotherapy students for clinical decisions during interaction with people with low back pain: randomised controlled trial

Carolina Sandoval-Cuellar, Margareth Lorena Alfonso-Mora, Adriana Lucia Castellanos-Garrido, Angélica Del Pilar Villarraga-Nieto, Ruth Liliana Goyeneche-Ortegón, Martha Lucia Acosta-Otalora, Rocío Del Pilar Castellanos-Vega, Elisa Andrea Cobo-Mejía, Carolina Sandoval-Cuellar, Margareth Lorena Alfonso-Mora, Adriana Lucia Castellanos-Garrido, Angélica Del Pilar Villarraga-Nieto, Ruth Liliana Goyeneche-Ortegón, Martha Lucia Acosta-Otalora, Rocío Del Pilar Castellanos-Vega, Elisa Andrea Cobo-Mejía

Abstract

Background: Low back pain (LBP) is a condition with a high global prevalence, which is getting health professionals' attention, including physiotherapists as they must have the skills to provide treatment that increases the patient's quality of life. Clinical simulations could be a pedagogic strategy that facilitates adequate training for students to acquire skills to improve their professional reasoning in this clinical situation.

Objective: This study sought to determine the effects of clinical simulations with simulated patients (SP) on the physiotherapy students' clinical decision-making within a role-playing (RP) scenario while caring of LBP patients.

Methods: This experimental study included 42 participants from two Colombian universities, randomized into two groups (SP, n = 21; RP, n = 21). The clinical skill of performing the Objective Structured Clinical Examination (OSCE-LBP) was evaluated while students cared for patients with LBP; after that, a pedagogical method was conducted that included clinical simulation and, finally, the OSCE-LBP was applied again to compare both groups.

Results: Changes occurred in the OSCE-LBP among both groups of students: the scores increased (0.66 and 0.59 in RP and SP, respectively), and neither of the two was superior (p value 0.01; 95%CI - 0.21 to 0.23).

Conclusion: Both types of simulation favor decision-making in professional reasoning in physiotherapy students during interactions with individuals with LBP. Trial registration https://ichgcp.net/clinical-trials-registry/NCT04428892 Identifying number: NCT04428892. It was retrospectively registered.

Keywords: Clinical skill; Physiotherapy; Simulated patient; Simulation.

Conflict of interest statement

The authors declare no conflict of interest regarding this manuscript.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow diagram of the study ‘Simulated practice in physiotherapy students from the University of Boyacá and University of La Sabana on decision-making in clinical skills while caring for a person with LBP’. Intervention group: simulated practice (SP); control group: ‘role-playing’ (RP)

References

    1. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;6736(18):1–12.
    1. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736–747. doi: 10.1016/S0140-6736(16)30970-9.
    1. Delgado JÁG, Lara GV, del Torres JCM, Morales IP. Epidemiología del dolor de espalda bajo. Investig Medicoquirúrgicas. 2014;6(1):112–125.
    1. Palomino Aguado B, Jiménez Cosmes L, Ferrero MA. El dolor lumbar en el año 2009. Rehabilitacion. 2010;44:69–81. doi: 10.1016/j.rh.2009.09.009.
    1. American Physical Therapy Association. Guide to physical therapist practice; 2016. 10.2522/ptguide3.0_978-1-931369-85-5.
    1. ASCOFI, ASCOFAFI, ASCOFI COLFI, and COLFI A. ASCOFAFI. Perfil profesional y competencias del fisioterapeuta en Colombia. Bogotá: 2015.
    1. Atkinson HL, Nixon-Cave K. A tool for clinical reasoning and reflection using the international classification of functioning, disability and health (ICF) framework and patient management model. Phys Ther. 2011;91(3):416–430. doi: 10.2522/ptj.20090226.
    1. Otálora MLA, et al. Simulación clínica: una experiencia en fisioterapia. Universidad de La Sabana; 2020;144. 10.5294/978-958-12-0563-9.
    1. Phillips AC, Mackintosh SF, Bell A, Johnston KN. Developing physiotherapy student safety skills in readiness for clinical placement using standardised patients compared with peer-role play: a pilot non-randomised controlled trial. BMC Med Educ. 2017;17:1. doi: 10.1186/s12909-016-0842-7.
    1. Ruiz-Moral R, Caballero-Martínez F. Programa para seleccionar y entrenar pacientes estandarizados en el contexto de un currículo universitario de simulación clínica. FEM Rev la Fund Educ Médica. 2015;17:199–204.
    1. Ariza MR. El Aprendizaje Experiencial Y Las Nuevas Demandas Formativas. Rev Antropol Exp. 2010;8:89–102.
    1. World Confederation for Physical Therapy . Policy statement: education WCPT. London: World Confederation for Physical Therapy; 2017.
    1. Van Wyk R, Labuschagne MJ, Joubert G. Simulation as an educational strategy to deliver interprofessional education. Afr J Heal Prof Educ. 2020;12(2):74–80.
    1. Brack P, Shields N. Short duration clinically-based interprofessional shadowing and patient review activities may have a role in preparing health professional students to practice collaboratively: a systematic literature review. J Interprof Care. 2019;33(5):446–455. doi: 10.1080/13561820.2018.1543256.
    1. Seefeldt TM, Mort JR, Brockevelt B, Giger J, Jordre B, Lawler M, et al. A pilot study of interprofessional case discussions for health professions students using the virtual world Second Life. Curr Pharm Teach Learn. 2012;4(4):224–231. doi: 10.1016/j.cptl.2012.05.007.
    1. Sabus C, Sabata D, Antonacci D. Use of a virtual environment to facilitate instruction of an interprofessional home assessment. Allied Heal. 2011;40(4):199–205.
    1. Hayward LM, Blackmer B, Markowsky A. Standardized patients and communities of practice: a realistic strategy for integrating the core values in a physical therapist education program. J Phys Ther Educ. 2006;20(2):29–37. doi: 10.1097/00001416-200607000-00005.
    1. Hayward LM, Blackmer B, Hayward L. A model for teaching and assessing core values development in doctor of physical therapy students. Jopte. 2010;24(3):16–26. doi: 10.1097/00001416-201007000-00003.
    1. Marchal L, Barthod C, Goujon L, Büssing T. Design and development of a mechatronic infant torso simulator for respiratory physiotherapy learning. Mechatronics. 2011;22(1):55–64. doi: 10.1016/j.mechatronics.2011.11.008.
    1. Blackstock FC, Watson KM, Morris NR, Jones A, Wright A, McMeeken JM, et al. Simulation can contribute a part of cardiorespiratory physiotherapy clinical education: two randomized trials. Simul Healthc. 2013;8:32–42. doi: 10.1097/SIH.0b013e318273101a.
    1. Ohtake PJ, Lazarus M, Schillo R, Rosen M, Bourdin G, Barbier J, et al. Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment. Phys Ther. 2013;93(2):216–228. doi: 10.2522/ptj.20110463.
    1. Silberman NJ, Panzarella KJ, Melzer BA. Using human simulation to prepare physical therapy students for acute care clinical practice. J Allied Health. 2013;42(1):25–32.
    1. Shoemaker MJ, Riemersma L, Perkins R. Use of high fidelity human simulation to teach physical therapist decision-making skills for the intensive care setting. Cardiopulm Phys Ther J. 2009;20:13. doi: 10.1097/01823246-200920010-00003.
    1. Gough S, Yohannes A, Roberts P, Murrray J, Sixsmith J. Facilitating error recognition and patient safety awareness in pre-registration physiotherapy students using video reflexive ethnography and simulation-based education. Physiotherapy (United Kingdom) 2015;101:eS473.
    1. Smith N, Prybylo S, Conner-Kerr T. Using simulation and patient role play to teach electrocardiographic rhythms to physical therapy students. Cardiopulm Phys Ther J. 2012;23(1):36–42. doi: 10.1097/01823246-201223010-00007.
    1. Hough J, Levan D, Steele M, Kelly K, Dalton M. Simulation-based education improves student self-efficacy in physiotherapy assessment and management of paediatric patients. BMC Med Educ. 2019;19(1):1–11. doi: 10.1186/s12909-019-1894-2.
    1. Zhong B. How to calculate sample size in randomized controlled trial? J Thorac Dis. 2009;1(1):51–54.
    1. Carvajal A, Centeno C, Watson R, Martínez M, Sanz RA. How is an instrument for measuring health to be validated? An Sist Sanit Navar. 2011;34:63–72. doi: 10.4321/S1137-66272011000100007.
    1. Campo-Arias A, Herazo E. Concordancia intra- e interevaluadores. Rev Colomb Psiquiat. 2010;39(2):424–432. doi: 10.1016/S0034-7450(14)60261-4.
    1. Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low back pain: an updated systematic review within the framework of the cochrane back review group. Spine (Phila Pa 1976) 2009;34:1669–1684. doi: 10.1097/BRS.0b013e3181ad7bd6.
    1. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2011 doi: 10.1002/14651858.CD008112.pub.
    1. Parreira P, Heymans MW, van Tulder MW, Esmail R, Koes BW, Poquet N, et al. Back Schools for chronic non-specific low back pain. Cochrane Database Syst Rev. 2017;8:CD011674.
    1. Engers AJ, Jellema P, Wensing M, van der Windt DA, Grol R, van Tulder MW. Individual patient education for low back pain. Cochrane Database Syst Rev. 2008 doi: 10.1002/14651858.CD004057.pub.
    1. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database Syst Rev. 2006 doi: 10.1002/14651858.CD004750.pub2.
    1. Whitehead A, Gould Fogerite S. Yoga treatment for chronic non-specific low back pain. Explor J Sci Heal. 2017 doi: 10.1002/14651858.CD010671.pub2.
    1. Hayden JA, Van Tulder MW, Malmivaara AV, Koes BW. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med. 2005;142:765–775. doi: 10.7326/0003-4819-142-9-200505030-00013.
    1. Hargreaves S. the Relevance of non-verbal skills in physiotherapy. Aust J Physiother. 1982;28(4):19–22. doi: 10.1016/S0004-9514(14)60774-1.
    1. Blackstock FC, Watson KM, Morris NR, Jones A, Wright A, McMeeken JM, et al. Simulation can contribute a part of cardiorespiratory physiotherapy clinical education. Simul Healthc J Soc Simul Healthc. 2013;8(1):32–42. doi: 10.1097/SIH.0b013e318273101a.
    1. Pilat A. Terapias miofasciales: induccion miofascial. Mcgraw-Hill Interamericana De España SL, editor; 2003.
    1. Wang XQ, Zheng JJ, Yu ZW, Bi X, Lou SJ, Liu J, et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS ONE. 2012;7:e52082. doi: 10.1371/journal.pone.0052082.
    1. Paolucci T, Attanasi C, Cecchini W, Marazzi A, Capobianco SV, Santilli V. Chronic low back pain and postural rehabilitation exercise: a literature review. J Pain Res. 2019;12:95–107. doi: 10.2147/JPR.S171729.
    1. Egbewale BE, Lewis M, Sim J. Bias, precision and statistical power of analysis of covariance in the analysis of randomized trials with baseline imbalance: a simulation study. BMC Med Res Methodol. 2014;14:49. doi: 10.1186/1471-2288-14-49.
    1. Huang J, Tang Y, Tang J, Shi J, Wang H, Xiong T, et al. Educational efficacy of high-fidelity simulation in neonatal resuscitation training: a systematic review and meta-analysis. BMC Med Educ. 2019;19(1):323. doi: 10.1186/s12909-019-1763-z.
    1. Dennis D, Furness A, Duggan R, Critchett S. An interprofessional simulation-based learning activity for nursing and physiotherapy students. Clin Simul Nurs. 2017;13:501–510. doi: 10.1016/j.ecns.2017.06.002.
    1. Wright A, Moss P, Dennis DM, Harrold M, Levy S, Furness AL, et al. The influence of a full-time, immersive simulation-based clinical placement on physiotherapy student confidence during the transition to clinical practice. Adv Simul. 2018;3:3. doi: 10.1186/s41077-018-0062-9.
    1. Labrague LJ, McEnroe-Petitte DM, Bowling AM, Nwafor CE, Tsaras K. High-fidelity simulation and nursing students’ anxiety and self-confidence: a systematic review. Nurs Forum. 2019;54(3):358–368. doi: 10.1111/nuf.12337.
    1. Pritchard SA, Blackstock FC, Nestel D, Keating JL. Simulated patients in physical therapy education: systematic review and meta-analysis. (research report) Phys Ther. 2016;96(9):1342. doi: 10.2522/ptj.20150500.
    1. Roberts F, Cooper K. Effectiveness of high fidelity simulation versus low fidelity simulation on practical/clinical skill development in pre-registration physiotherapy students: a systematic review, vol. 17, JBI database of systematic reviews and implementation reports. Lippincott Williams and Wilkins; 2019. p. 1229–55.
    1. Brauer S et al. Proceedings of the Australian and New Zealand Association for Health Professional Educators. In: improving clinical preparation, communication, confideence and satisfaction in physiotherapy students through role-playing. Launceston; 2009. p. 84.
    1. Judd BK, Scanlan JN, Alison JA, Waters D, Gordon CJ. The validity of a professional competence tool for physiotherapy students in simulation-based clinical education: a Rasch analysis. BMC Med Educ. 2016;16:196. doi: 10.1186/s12909-016-0718-x.
    1. Lee JH, Lee H, Kim S, Choi M, Ko IS, Bae JY, et al. Debriefing methods and learning outcomes in simulation nursing education: a systematic review and meta-analysis. Nurse Educ Today. 2020;87:104345. doi: 10.1016/j.nedt.2020.104345.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera