Understanding Basic Rehabilitation Techniques - Evaluation Report

Acknowledgments

The Understanding Basic Rehabilitation Techniques MOOC was developed and delivered by ReLAB-HS and Physiopedia. The United States Agency for International Development (USAID) funded Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS) activity would like to thank the following people for their contributions to this work:

Course Coordinators: Rachael Lowe, Naomi O’Reilly

Content Contributors: Naomi O’Reilly, Vidya Acharya, Tarina van der Stockt, Wanda van Niekerk, Jess Bell, Matt Huey, Stacy Schiurring, Robin Tacchetti.

Webinar Content Experts: Stacy Schiurring, Matt Huey, Naomi O’Reilly

Course Facilitators: Naomi O’Reilly,  Jess Bell, Carin Hunter, Tarina van der Stockt, Lucy Aird.

Webinar Facilitators: Amanda Ager, Naomi O’Reilly, Lucy Aird.

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) through Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS). The contents are the sole responsibility of Physiopedia and ReLAB-HS and do not necessarily reflect the views of USAID or the United States Government.

For information regarding this report, please contact: Rachael Lowe ([email protected])

Summary

From September 4 to October 1st, 2023, Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS), led by Physiopedia, successfully delivered a Massive Open Online Course (MOOC) entitled “Understanding Basic Rehabilitation Techniques” via the Plus online learning platform. The program consisted of eight independent courses, which included:

1. Introduction to Rehabilitation Techniques and Intervention
2. Assessment Before Moving and Handling
3. Assessing Range of Motion
4. Assessing Muscle Strength
5. Assessing Muscle Length
6. Neurological Screen
7. Exploring Positioning
8. Exploring Transfers

In each course, the learner completed required learning activities and a final quiz that tested knowledge gained from the course. To complete the overall Understanding Rehabilitation as a Health Strategy program, the learner had the option to submit and pass a written assignment.

The program was also supported with two optional live webinars with physiotherapist, Stacy Schiurring and Matt Huey, to provide the opportunity for increased learner interaction and engagement with the content experts. The webinar recordings were also made available on the Plus platform for participants unable to access the webinars live.

1. Webinar 1: Clinical Case Studies of the Lower Limb
2. Webinar 2: Clinical Case Studies of the Upper Limb

Course Type: Free, Open, Online

Institution: ReLAB-HS via Physiopedia

About this Course: This MOOC aimed to equip health and social care professionals to develop knowledge of the fundamental rehabilitation techniques.

Target Audience: These courses were designed and written for health and social care professionals, clinicians, students, assistants, and other rehabilitation-related health systems stakeholders.

Time Commitment: 16 hours over four weeks (with an optional extra eight hours)

Date: September 4 to October 1, 2023, with live webinars on September 14 (Webinar 1: Clinical Case Studies of the Lower Limb)and on September 28 (Webinar 2: Clinical Case Studies of the Upper Limb ). These remain available on the Plus platform to members.

Requirements: Participants were required to complete online learning activities, engage with additional resources, and complete the course evaluations and quizzes.

Assessment: There was a quiz at the end of each course, and participants could complete an optional final written assignment to demonstrate knowledge gained from the programme of eight courses.

Awards: Eight course completion certificates awarding a total of 11.8 Plus (P+) points with an additional five Physioplus (P+) points available for the optional assignment to complete the programme.

Accreditation: Each individual course was accredited for continuing education and professional development (CE/CPD) in the USA, Australia and South African and is formally accepted without accreditation as a professional development activity by many other countries

Registrations MOOC: 11,331

Registrations Live Webinars: 533 Lower Limb Webinar and 526 Upper Limb Webinar

Countries Represented MOOC: 111

Countries Represented Live Webinars: 242 Lower Limb Webinar and 83 Upper Limb Webinar

Professions Represented MOOC: 32

Professions Represented Live Webinars: 20 Lower Limb Webinar and 8 Upper Limb Webinar

Introduction

The need for physical rehabilitation services is an urgent and growing global issue. According to a recent report, 2.41 billion individuals worldwide live with conditions that would benefit from rehabilitation services, with approximately 1 in 3 individuals requiring rehabilitation services throughout the course of their illness or injury. The proportion of the worldwide population over 60 will double in the next 30 years, the majority of whom will live with chronic diseases, particularly noncommunicable diseases. There are also approximately 150 million children and adolescents who experience disabilities, and injuries for people of all ages are becoming more frequent due to conflict, rapid urbanisation and motorisation. These changing health and demographic trends are contributing to rapid global increases in the numbers of people experiencing decline in functioning, resulting in enormous unmet rehabilitation needs. Much of these unmet needs are concentrated amongst the poorest and most vulnerable populations in low- and middle-income countries and conflict-affected settings, which are often ill equipped to cope with these increasing needs for rehabilitation services.

The World Health Organisation defines rehabilitation as "a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments”. Rehabilitation is in effect composed of multiple components or interventions to address issues related to all domains within the World Health Organisation's  International Classification of Functioning, Disability and Health (ICF). These rehabilitation techniques and interventions address impairments, activity limitations and participation restrictions, considering contextual factors both personal and environmental, including assistive technology, that impact functioning. When selecting a rehabilitation intervention, it is always important to remember that one cannot change what you cannot measure. Hence, accurate measuring and monitoring using basic rehabilitation techniques, is essential to select and provide appropriate rehabilitation intervention. A clinician's care plan is only as thorough as their assessment. Confidence in fundamental rehabilitation assessment techniques is essential for efficient care.

During September 2023, ReLAB-HS, led by Physiopedia, delivered the Massive Open Online Course (MOOC), “Understanding Basic Rehabilitation Techniques Programme”. The MOOC was delivered as eight individual courses with an optional written final assignment to complete the full program of courses. The aim of the MOOC was to equip rehabilitation professionals with a comprehensive knowledge of fundamental rehabilitation techniques and principles guiding selection of rehabilitation techniques so they can play an effective and proactive role in global and local efforts to increase access to high quality rehabilitation and improve health outcomes.

The four-week-long program presented different topics exploring fundamental rehabilitation techniques through a variety of learning activities to suit all learning styles. The required learning activities within each course were developed to take between one to two hours depending on the participant's learning style, with optional activities provided should the participant wish to take part in additional learning. A short orientation period before the course provided participants with an opportunity to become familiar with the delivery platform and the topics via the provided pre-course resources.

The course was delivered through the Plus eLearning platform, an innovative platform specifically developed to provide online education and support participants with a personalized learning dashboard. For each course, the related learning activities were outlined on a specific course page. Participants engaged with each course and the respective learning activities, and their activity was recorded and displayed in their personal learning dashboard.

A course was considered complete once the learner finished all required learning activities and successfully passed the final quiz that tested the knowledge gained within each individual course of the program. On completion of each course the participants had the option to download a completion certificate and export a record of their learning from their activity log. There was also an optional written assignment designed for participants to apply the knowledge gained from the overall program consisting of  seven courses.

This report evaluates the engagement and experiences of the participants on the MOOC, Understanding Basic Rehabilitation Techniques Programme.

1.0 About the Program of Courses

1.1 Aim

Through this MOOC, ReLAB-HS aimed to equip health and social care professionals with a comprehensive knowledge of fundamental rehabilitation techniques and principles guiding selection of rehabilitation techniques so they can play an effective and proactive role in global and local efforts to increase access to high quality rehabilitation and improve health outcomes.

The program included an introduction to rehabilitation techniques and interventions, assessment before moving and handling and assessment for range of motion, muscle strength, muscle length and neurological screening and explored positioning and transfers.

1.2 Learning Objectives

At the end of this program of courses, participants were able to:

1. discuss the term "rehabilitation", the World Health Organization's definition of rehabilitation and the global need for rehabilitation
2. discuss the key elements of the International Classification of Functioning, Disability and Health (ICF) model and its role in rehabilitation
3. identify at least four principles that guide the selection of rehabilitation techniques and interventions
4. identify at least three factors that may impact patient safety during moving and handling tasks
5. discuss the measuring procedures and abnormal rates for at least two basic vital signs
6. select an appropriate response from healthcare professionals during moving and handling tasks based on given case scenarios
7. describe the key features of active, active-assisted, and passive range of motion and end-feel
8. identify at least three factors that can impact range of motion
9. describe at least three principles that guide the assessment and measurement of range of motion
10. identify at least two types of muscle contraction and at least three factors that can affect muscle strength
11. list at least two contraindications to muscle strength testing
12. discuss at least two methods of muscle strength testing, the Medical Research Council Scale for grading manual muscle testing and optimal positions for muscle strength testing
13. discuss the basic characteristics of skeletal muscle
14. describe the two main testing methods to assess muscle length, three measurement tools, at least two factors that affect muscle length and key principles of the muscle length assessment
15. identify an appropriate test or testing position to assess muscle length for at least three muscles
16. identify the purpose of the neurological screen and at least three indications to conduct a neurological screen
17. discuss the three main components of the neurological screen and the key features of upper and lower motor neurone lesions
18. identify the potential location of a lesion based on information from a neurological screen in a given case scenario
19. identify at least three indications and contraindications for therapeutic positioning
20. explain at least four key principles of patient positioning
21. identify at least five common patient positions used in rehabilitation and when they should be used
22. identify the key benefits, risks, indications, precautions and levels of assistance for patient transfers
23. discuss at least three guiding principles to ensure safe, appropriate transfers in clinical practice and common patient transfer techniques
24. identify an appropriate transfer technique for a patient in a simple case scenario

1.3 Intended Audience

This course is suitable for all rehabilitation professionals, students, and assistants, including but not limited to: physiotherapists, occupational therapists, speech and language therapists, rehabilitation doctors, rehabilitation nurses, prosthetists, orthotists, psychologists, audiologists, dietetics, social workers, and community-based health workers. Other health, social, and rehabilitation professionals interested in this subject are also invited to participate.

1.4 Cost to Participants

The course was free to all participants who completed the course within the 4-week timeframe and remains free to all Plus members and residents of low-income countries outside of this timeframe.

1.5 Course Availability

The program of eight courses were made available on September 4, 2023. Participants had until October 1, 2023 to complete the courses under their free access to Plus. The course remains available on the Plus platform to members; with membership free to individuals from low-income countries and available at a discounted rate to individuals in middle-income countries.

1.6 Courses, Course Awards, and Accreditation

Eight individual courses were created for the Understanding Basic Rehabilitation Techniques Program, which could each be completed individually or can be completed as a program of courses with an optional assignment. Plus provided individual course completion certificates to all participants that passed each individual course or attended the webinars. For each course completion participants were also awarded continuing professional development (CPD) points (equivalent to hours of learning). Individuals who completed all eight courses and completed the assignment were also provided with a program certificate in recognition of programme completion.

Course 1: Introduction to Rehabilitation Interventions (1.1 P+ Points)

Course 2: Assessment Before Moving and Handling (1.6 P+ Points)

Course 3: Assessing Range of Motion (1.7 P+ Points)

Course 4: Assessing Muscle Strength (1.8 P+ Points)

Course 5: Assessing Muscle Length (1.1 P+ Points)

Course 6: Neurological Screening (1.4 P+ Points)

Course 7: Exploring Positioning (1.8 P+ Points)

Course 8: Exploring Transfers (1.3 P+ Points)

Course Program: Understanding Basic Rehabilitation Techniques Programme P (5.0 P+ Points)

Webinar 1: Clinical Case Studies of the Lower Limb (1 P+ Points)

Webinar 2: Clinical Case Studies of the Upper Limb (1.2 P+ Points)

2.0 Demographics of the Participants

2.1 Country

Of the 11,331 individuals from 167 countries registered for the MOOC, 1388 individuals from 106 countries completed the Pre-Course Knowledge and Competency Self-Rating Tool. Course 1 (Introduction to Rehabilitation Interventions) was started by 1350 individuals from 103 countries, while 443 individuals from 67 countries started Course 8 (Exploring Transfers) before October 1, 2023. The Post-Course Knowledge and Competency Self-Rating Tool was completed by 102 individuals from 40 countries.

Figure 1 and Table 1 below show the numbers of participants and completion rates for the MOOC for the top 10 represented countries across all eight courses, with completion determined by completion of Course 8 of the MOOC. The highest level of participation for each of these countries occurred in Course 1 (Introduction to Rehabilitation Interventions) with 1350 total participation. Of the 10 most represented countries, South Africa had the highest completion rate overall at 44%, followed by Nigeria at 38%.

A full list of all countries with the number of participants from each country and completion rates for each course can be found in Appendix 1.  

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Table 2 - 4 below show a breakdown of participation data and completion rates based on country income classification. The highest number of participants for seven of the eight courses and the program were from low-middle-income countries. The highest participation numbers in an individual course was observed in Course 1 (Introduction to Rehabilitation Interventions) with 508 participants starting the course from low-middle income countries. This was closely followed by participants from high-income countries with 411 participants.

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Table 3 shows the percentage completion data by country income classification for each individual course. While the lowest number of participants were seen from low-income countries, the completion rate for these participants was the highest across all groups. The highest completion rates for the individual courses were predominantly seen among those from low- (79% - 100%) and  low- to middle-income countries (71% - 95%) with 100% completion rates observed for low-income countries for Course 3 - 8., outlined in red below.

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Table.4 shows that overall MOOC completion rates, based on the percentage of participants who completed course 8 of the MOOC, were similar across all income classifications ranging from 31% for high-income countries to 36% for upper-middle income countries.

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Finally, Table.5 highlights the participation and completion rates of participants from ReLAB-HS countries, with the highest number of participants for all eight courses and the program coming from Pakistan, with participation ranges for each individual course ranging from 62 - 100%, with 100% completion seen by participants in Uganda in Course 7 and 8, outlined in red  below.

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