Lower Limb Amputee Rehabilitation Course - Evaluation Report

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Lower Limb Amputee Rehabilitation Final Report (June – August 2015)

Run in collaboration with and funded by the International Committee of the Red Cross

Course co-ordinators: Rachael Lowe(Physiopedia) and Barbara Rau (ICRC)

Course facilitators: Leslie Muller, Aicha Benyaich, Francois Friedel

Course sponsor: CR Equipements

Contents :

• Overview
• Cost to participants
• Characteristics of participants
• Aim of the course
• Platform
• Communication with participants
• Course textbooks
• Discussion forum
• Quizzes
• Final assignment
• Assessment
• Certificates
• Accreditation
• Course evaluation
• Impact of group work
• Impact on clinical practice
• Future
• Contact details
• Appendix 1 –Course participants: countries
• Appendix 2 – Course participants:profession
• Appendix 3 – Course participants: experience
• Appendix 4 – Case presentations provided for final assignment
• Appendix 5 – Course evaluation: specific responses
• Appendix 6 – Course evaluation: what worked well
• Appendix 7 – Course evaluation: what didn’t work well
• Appendix 8 - Course evaluation: examples of group work
• Appendix 9 – Course evaluation: selected testimonials
• Appendix 10 – Known examples of impact on clinical practice

Overview

Course Type - Open, Online

Course Co-ordinators - Barbara Rau, Rachael Lowe

Collaborating Partners - International Committee of the Red Cross (ICRC) and Physiopedia

About this course - This online course covers basic theoretical knowledge of lower limb amputee rehabilitation

Who was invited to take part - Physiotherapy and Physical Therapy clinicians, students and assistants; other interested professionals such as prosthetists/orthotists, occupational therapists, nurses or medical doctors interested in this subject are more than welcome to participate.

Date that it ran – 1 June to 26 July 2015

Time commitment - 24 hours over 8 weeks Requirements – Participants were required to complete online learning activities, engage with additional resources, take part in the conversation online and complete the course evaluation.

Assessment - There was a final quiz and participants were asked to write a case study on an individual with amputation.

Awards - Completion certificate plus 24 International Physical Therapy Continuing Education Units from the World Confederation of Physical Therapy (WCPT)

Cost to participants

The course was free to all participants

Characteristics of the participants

Ultimately, 7639 participants formally registered for the course. They were from 150 countries (see Appendix 1), were mainly working physiotherapists (see Appendix 2 and 3) and had a mix of experience (see Appendix 4). The most represented countries were:

United Kingdom USA	918 820
Canada	583
Australia India	537 441
Nigeria	252
Malaysia	235
South Africa	202
Philippines	185
Pakistan	166

Aim of the course

This course was aimed to provide workforce training for the International Committee of the Red Cross (ICRC).

The aims of this course were to:

1. provide participants with general knowledge about lower limb amputation,

2. present aspects of prosthetics and prosthetic fitting,

3. highlight the importance of a comprehensive approach of rehabilitation (from pre surgical activities to discharge and follow up),

4. present the overall rehabilitation process specificities, and

5. offer a worldwide discussion platform on lower limb amputee rehabilitation

Platform

The course was run through the Physiopedia website where all course pages were (and remain) openly available. These course pages were visited a total of 125,487 times through the duration of the course (I June – 26 July 2015). The breakdown is shown below:

Page in physiopedia	Link	Number of items visited
Week one	http://www.physio-pedia.com/PP06_-_Week_One	22,311
Week two	http://www.physio-pedia.com/PP06_-_Week_Two	16,603
Week three	http://www.physio-pedia.com/PP06_-_Week_Three	14,743
Course activities	http://www.physio-pedia.com/PP06_-_Course_Activities	14,383
Week six	http://www.physio-pedia.com/PP06_-_Week_Six	11,691
Week four	http://www.physio-pedia.com/PP06_-_Week_Four	11,098
Week five	http://www.physio-pedia.com/PP06_-_Week_Five	8,606
Main course page	http://www.physiopedia.com/Lower_Limb_Amputee_Rehabilitation_Course	7,979
Pre course activities	http://www.physio-pedia.com/PP06_-_PreCourse_Activities	7,326
FAQs	http://www.physio-pedia.com/PP06_-_FAQ%27s	275

Communication with participants

Participants were sent an email at the beginning of each week. This outlined what they were expected to do that week and directed them to an appropriate URL to find the details. It also provided an opportunity to communicate about any issues that had arisen in the previous week. The email was also posted online and linked to in the course pages and the discussion forum.

There were 6045 subscribers to the email list. Some of those who registered failed to provide a working email address so could not be added to list.

The course started with a 70% open rate and equivalent engagement of over 4000 people. By the end of the course engagement had dropped to around 40%, the equivalent engagement of around 2500 people. The drop is due to natural drop out rates and also due to the fact that people could also access the email online.

Open rates and number of people that opened each email throughout the course are shown below:

	Open rate	Opened by
Joining  instructions	70.7%	4274
Week One	71.0%	4292
Week Two	53.8%	3252
Week Three	45.1%	2726
Week Four	43.5%	2630
Week five	39.6%	2394
Week six	41.1%	2484
Week Seven	37.8%	2285
Final Email	43.6%	2636

Course textbooks

There were three course textbooks:

1. Engstrom, B., and Van de Ven, C. Therapy for Amputees. Edinburgh: Churchill Livingstone, 1999.

2. Morvan, C., Packirisamy, V., Rechsteiner, M., and Friedel, F. Prosthetic Gait Analysis for Physiotherapists. ICRC. 2014.

3. Gailey, R., and Gailey, A. The Rehabilitation Series for Lower Extremity Amputees. Advanced Rehabilitation Therapy Incorporated (ARTI). 1994.

The copyright owner made online access to these books free for the duration of the course. In addition to this ICRC permitted a free PDF download of their book and Elsevier and ARTI made the exclusive offer to participants to purchase a PDF download of their books at a significantly discounted price. All proceeds from book sales were given to the copyright owner.

Participants were particularly grateful for this aspect of the course. It is evident that making books available online in this way during an online course has a significant impact on sales of the hard copy of the book.

Discussion Forum

Participants were required to participate in the discussion forum on a weekly basis. This was made a requirement as it provided a rich learning experience through self-reflection on learning and exposure to global discussions about amputee rehabilitation. This was the task that participants found most difficult to complete.

The discussion forum was hosted on Facebook as a private group where the weekly discussions were guided by 3 questions that participants were asked to comment on. Only course participants were invited to join and post comments in the group. It was clear that not all people engaging with the course joined the group and participated in the discussions.

Number of people who joined the Facebook group ........................................... 3,525

Number of people that contributed on a weekly basis …................. 969 (approx.)

Number of posts (estimation only) ........................................................ around 18,000

Quizzes

Each week participants were given the opportunity to assess their knowledge and understanding of the topic through multiple-choice quizzes. Participants received immediate feedback on right and wrong responses making this a rich learning experience.

In the final week participants were invited to attempt the final multiple-choice quiz. This quiz was designed to assess knowledge and no feedback was given. The pass mark was 80% and they could attempt the quiz as many times as they liked.

Number of individuals that attempted the quiz ……………………………..... 1,431

Number of quiz attempts ……………………………………………………………….. 3,491

Number of individual passes ………………………………………………………….. 1,303

Final Assignment

Reflecting on their learning and using the knowledge gained throughout the course participants were asked to prepare a simple case presentation of one of their own amputee patients OR if they weren’t currently working with amputee patients they were to complete a case assignment based on one of the cases provided (see Appendix 4).

Completed case assignment with own patient …………………………………… 524

Completed case presentation with case study provided ……………………... 615

Total final assignments submitted …………………………………………………….. 1,139

Assessment

In week 6 participants were directed to complete 2 final tasks that were assessed:

	Completed	Passed
Final quiz	1431	1303
Case study assignment	1139	1133

Certificates

Participants were provided with a certificate of completion provided they had completed the 5 required tasks that were clearly outlined from the outset of the course:

1. Passed the final quiz at 80% ……………………………………………….… 1303

2. Passed the final assignment ………………………………………………….. 1133

3. Completed the post course competency tool ………………………….. 1229

4. Completed the evaluation form ……………………………………………... 1196

5. Contributed to the discussion forum each week ………………………969 (approx.)

Participants were invited to apply for their certificate of completion after the final deadline for completion of all required tasks. Some people failed to contribute adequately to the discussion forum; these participants were issued with an alternative certificate.

• Full certificates – 799

• Alternative certificates – 274

• Total certificates issued – 1073

Course Accreditation

The course was accredited by WCPT for 24 International Physical Therapy Continuing Education Units (IPT-CEUs). These credits were given to the participants that received full certificates.

The South African Physiotherapy Society (SASP) who awarded CEU points for the course to South African residents also accredited the course.

Course Evaluation

Participants were asked to complete an online course evaluation at the end of the course (see specific responses in Appendix 5).

The number of participants who completed the evaluation ................... 1,196

Participants were overwhelmingly positive about the course (see Appendix 6 and 9) for details). They particularly liked:

• That it was free

• The opportunity for global conversation

• Quizzes to test knowledge and learning

• Videos: case studies and interviews with experts

• Course specific readings on Physiopedia

• Access to text books

• Variety of resources and learning methods

Aspects that some participants did not enjoy included (see Appendix 7):

• That Facebook was used for the discussion forum

• The requirement to post to the discussion forums

• The discussion posts were repetitive and not meaningful

• Discussions were hard to negotiate due to the number of course participants

• Slow internet limiting access to course materials

• The way the books were presented made them hard to navigate

• Took longer than stated time each week

Impact of group work

We asked people to let us know of any group work that took place in parallel to the course. We were pleased to see several dedicated groups that used group work for peer support and practical skills (see Appendix 8).

Impact on clinical practice

We have heard of several particular instances where clinical practice has been directly impacted by the course. These instances relate to re-evaluation of service delivery in clinical departments and/or individuals who have been motivated to try to makes changes in their departmental service delivery (see Appendix 10 for details).

Future

The plan is for this course to be run on a biannual basis as part of the Global Health Certification that Physiopedia is developing. We are currently seeking funding to support this plan.

Appendix 1 – Course participants: countries

United Kingdom	918		Thailand	21		Cayman Isalnd	4
USA  21	820		United Arab Emirates	21		Bahrain	4
Canada	583		Dominican Republic	20		Mali	4
Australia	537		Hungary	20		Senegal	4
India	443		Uganda	19		Venezuela	4
Nigeria	252		Nepal	19		Togo	4
Malaysia	235		Norway	19		Botswana	4
South Africa	202		Zimbabwe	17		Syria	4
Philippines	185		Lebanon	16		Morocco	4
Pakistan	166		Germany	15		Niger	3
Jamaica	161		Japan	15		Algeria	3
Sudan	132		Democratic Republic of Congo	15		Grenada	3
Singapore	132		Croatia	14		Fiji	3
Jordan	121		Switzerland	14		Seychelles	3
Saudi Arabia	120		Estonia	13		Brunei	3
Mexico	111		Chile	13		Iran	3
Egypt	109		Romania	13		Swaziland	3
Israel	104		Haiti	12		Benin	3
Afghanistan	102		Guyana	12		Antigua	3
Palestine	99		Sweden	11		New Caledonia	2
Ethiopia	94		Oman	11		Bosnia and Herzegovina	2
Greece	86		Lithuania	11		Iceland	2
Malta	85		Mauritius	10		Libya	2
Iraq	78		Bulgaria	10		South Sudan	2
New Zealand	76		Cambodia	10		Uruguay	2
Colombia	67		Peru	10		Cyprus	2
Italy	65		Barbados	9		Kosovo	2
Costa Rica	63		Kuwait	9		Papua New Guinea	2
France	54		Iraq	9		North Korea	2
Bangladesh	53		Denmark	9		Ivory Coast	2
Ghana	52		Madagascar	9		Burkina Faso	2
Spain	51		Slovakia	8		Bermuda	2
Ireland	50		Somalia	8		Tajistan	2
Netherlands	50		Reunion	8		Guatemala	1
Sri Lanka	47		Qatar	7		Laos	1
Portugal	44		Belgium	7		Cayman Islands	1
Kenya	38		Bhutan	7		Macedonia	1
Rwanda	37		Bahamas	7		Martinique	1
Poland	35		Albania	7		Luxembourg	1
Vietnam	35		Bolivia	7		Slovenia	1
Puerto Rico	31		Zambia	7		Aruba	1
Turkey	31		Malawi	7		Gabon	1
Hong Kong	29		Czech Republic	6		St. Lucia	1
Brazil	26		Cameroon	6		Chad	1
Indonesia	25		Mongolia	5		Curacao	1
Finland	25		Tunisia	5		Paraguay	1
Yemen	25		Serbia	5		Taiwan	1
Trinidad and Tobago	24		Panama	5		Central African Republic	1
Myanmar	23		China	5
Tanzania	23		Burundi	5
Namibia	22		Argentina	4

Appendix 2 – Course participants: profession

Physiotherapist	6506 85.17%
Prosthetist/Orthotist	382 5.00%
Occupational Therapist	281 3.68%
Therapy Assistant	127 1.66%
Doctor	103 1.35%
Other	74 0.97%
Sports Therapist	52 0.68%
Student	47 0.62%
Nurse	18 0.24%
Orthopaedic Technologist	15 0.20%
Osteopath	8 0.10%
Athletic Trainer	7 0.09%
Kinesiologist	6 0.08%
Physiotherapy Educator	5 0.07%
Podiatrist	5 0.07%
Technical Instructor	2 0.03%

Appendix 3 – Course participants: experience

< 1 year	3012	39.43%
No experience	1553	20.33%
> 5 years	1067	13.97%
1 to 5 years	2010	26.31%

Appendix 3 – Course participants: professional role

Clinician	5154	67.47%
Student	1976	25.87%
Educator	410	5.37%
Other	76	0.99%
Manager	18	0.24%

Appendix 4 – Case presentations provided for final assignment

	Link	Number of times accessed
Diabetic	http://www.physio-pedia.com/PP06-Diabetic_Case_Presentation	1,602
Older Person	http://www.physio-pedia.com/PP06-Older_Person_Case_Presentation	902
High Level Rehabilitation	http://www.physio-pedia.com/PP06-High_Level_Case_Presentation	586
Low Resourced Setting	http://www.physio-pedia.com/PP06-Low_Resourced_Case_Presentation	463
Paediatric Case	http://www.physio-pedia.com/PP06-Paediatric_Case_Presentation	435
Upper Limb Considerations	http://www.physio-pedia.com/PP06-Upper_Limb_Case_Presentation	271

Appendix 5 – Course evaluation: specific responses