Assessing the Need For and Effectiveness of a Presentation on Pediatric Equipment in Doctor of Physical Therapy Students

Assessing the Need For and Effectiveness of a Presentation on Pediatric Equipment in Doctor of Physical Therapy Students

By: Brennan Ehlinger Visser, SPT

Background:

Surprisingly, there is a wide variety of experience and knowledge among pediatric physical therapists when it comes to equipment. Some clinicians consider this practice area as a huge component of what they do, while others decide to abstain from participating in the equipment decision-making process, leaving the entire process up to the equipment vendor. In order to obtain and maintain extensive equipment knowledge, physical therapists must be dedicated to researching and staying up to date with available products, discussing cases with other clinicians, and building their skills over time. Pediatric physical therapists report receiving very little instruction on pediatric-specific equipment while in physical therapy school, but instead have to rely on “on the job” learning and mentoring from more experienced therapists. The lack of curriculum content covering pediatric equipment may be due to lack of time, ever-changing durable medical equipment technology, and small focus on the PT licensure exam. My capstone aims to foster critical thinking skills and provide basic foundational knowledge to allow DPT students to participate in the adaptive equipment process while on their clinical rotations and be more prepared in the future as pediatric therapists.

Project Overview:

My interest in pediatric equipment began during my clinical rotation in school-based physical therapy, where I worked with students with various diagnoses and multiple equipment needs. This interest led me to complete my Critically Appraised Topic (CAT) on the available evidence regarding a very commonly used piece of pediatric equipment. My CAT, which can be accessed here, set out to answer the following clinical question: In a child with cerebral palsy, is an anterior walker more effective than a posterior walker in improving upright posture (measured by decreased hip and trunk flexion), gait parameters (such as cadence, walking velocity, stride and step length, single and double support/stance time) and energy efficiency (measured by oxygen consumption)? This search for evidence helped begin to lay the foundation for my capstone presentation.

To address the need I saw for additional educational content regarding pediatric adaptive equipment, for the first part of my capstone I created a Voicethread presentation. It was used as a supplemental resource in the PHYT701 Motor Development course taken by first year DPT students, as well as an optional resource for second and third year students in the program interested in pursuing pediatrics. The goal of the presentation is not to provide students with a long list of specific equipment currently available, as new equipment comes out on the market constantly, leading to accumulation of outdated information over time. The learning objectives for the presentation include introducing DPT students to the different categories of pediatric adaptive equipment and their indications for use, and how to choose certain aspects of equipment based upon patient presentation. The categories of pediatric equipment included in the presentation are standers (dynamic, prone, supine, sit-to-stand), walkers, pacers/gait trainers, adaptive seating (strollers, school chairs, floor sitters), and ADL-related equipment.

Before listening to the Voicethread, all participating students filled out a Pre-Test Assessment & Survey I. The Pre-Test Assessment included one case-based question requiring knowledge on the following: 1) existing pediatric equipment, 2) ability to determine which piece of equipment is appropriate, and 3) determine suitable features and accessories based on patient presentation. The aim of Survey I was to assess general comfort level and familiarity with pediatric equipment, as well as the students’ views on a physical therapist’s role in the equipment decision-making process. After listening to the Voicethread, all participating students filled out a Post-Test Assessment & Survey II. The Post-Test Assessment utilized the same format as the Pre-Test Assessment, but with a different case scenario, in order to show whether or not the information on the Voicethread was helpful for clinical decision-making on a patient case. The questions on Survey II aimed to evaluate if the student felt the presentation had any impact on their comfort level with equipment, as well as the overall effectiveness and usefulness of the presentation.

Project Products:

• The ~30 minute Voicethread on Pediatric Equipment can be accessed here, or if you prefer to download a PowerPoint version of the presentation to refer to later, you can do so here.
  • Full list of references from the Voicethread: Capstone Presentation References
• Pre-Test Assessment & Survey I to be completed before the Voicethread.
• Post-Test Assessment & Survey II to be completed after the Voicethread.
• Here is the Answer Key which states the correct answers for the Pre- and Post-Test Assessment case-based questions, as well as provides an explanation for scoring.
• I also wrote an extensive qualitative report, discussing the results of the assessments and surveys, and their implications for DPT education. This report can be accessed here: Summary of Results

Results: 

As for first year DPT students, even though 38% reported observation experience in various settings, only one DPT student out of thirty answered the pre-test question correctly. This shows that observation experience does not lead to an increase in actual pediatric equipment knowledge and decision-making ability. When describing rationale for equipment decisions, it was obvious that some of the first year students had good critical thinking skills, yet lacked the knowledge of pediatric equipment available or even just the appropriate terminology to use. Even further than knowing the available equipment to choose from, DPT1 students had very little knowledge regarding features and accessories. There was a dramatic improvement in the amount of DPT1 students that answered correctly on the Post-Test Assessment, with 73.3% giving an appropriate recommendation. A 70 percent increase in the amount of first year students answering correctly after listening to the Voicethread points to the effectiveness of this educational resource for those with very little, if any, clinical experience.

In contrast to the extremely low 3% of DPT1 students to correctly answer the pre-test question, 66.7% of DPT2 & DPT3 students correctly answered the pre-test question. Although DPT2 and DPT3 students did very well on the Pre-Test Assessment, there was still significant improvement after listening to the Voicethread, as 100% of these students answered the Post-Test Assessment correctly. This demonstrates the effectiveness of the Voicethread to not only teach foundational basic equipment knowledge to those with little clinical experience, it also shows its effectiveness in teaching information on areas that may have been missed on a pediatric clinical rotation.

Evaluation & Self-Assessment:

In addition to evaluating the effectiveness of the Voicethread by comparing results of the pre- and post-test assessments, a post-test survey was given to assess the participants’ perceptions of the presentation. The post-test survey asked if participants felt the presentation adequately addressed various considerations required to choose appropriate equipment for the pediatric population and if the information would be useful to reference later on, if they now have an understanding of what devices are available and for which type of patient they are appropriate, if they feel comfortable making decisions regarding a child’s adaptive equipment, and finally, if they felt it was an effective presentation. In addition, participants were given the opportunity to make comments or suggestions for improvement. All of this feedback can be found in my Summary of Results.

Throughout the process, I sought edits from my committee on all components of the capstone, asking for feedback on the PowerPoint presentation and Voicethread script, Pre- and Post-Test Assessments and Surveys, and the Answer Key early on, and more recently requested feedback on the qualitative report that summarized my findings. Because this presentation was designed for DPT students, instead of completing a health literacy assessment, I aimed to make changes to ensure it was more learner-friendly. To achieve this, I decreased the amount of text on each slide, allowing more room for images of equipment. I also made a PowerPoint version of the Voicethread available to students, to allow them to take notes during the presentation and keep for future reference. I was also able to incorporate a video of a child utilizing a piece of equipment. This patient video was particularly helpful because it corresponds to the case-based question in the Pre-Test Assessment, which allowed students to learn the correct answer and understand the critical thinking process behind that answer before having to complete another case-based question in the Post-Test Assessment.

Overall, I am extremely pleased with the final result, and proud of all the work I have done to get to this point. My initial goal was just to create a presentation on pediatric equipment for first year students in PHYT701, but I am glad that my committee members Dana McCarty and Laurie Ray pushed me to include a pre- and post-test assessment. I think adding this component, along with the surveys, shows the need for and effectiveness of my presentation and will allow my project to make an impact on future UNC DPT students interested in pursuing pediatrics.

Acknowledgements:

This project would not have come to fruition or been a success without the support and direction from several individuals. A huge thanks to my committee members Dana McCarty PT, DPT, PCS, C/NDT and Laurie Ray PT, MPT, PhD for pushing me outside of my comfort zone, for trusting me to provide supplemental educational content in the PHYT701 course, and for the endless knowledge and feedback they gave throughout the process that helped shape my project into what it is today. Thank you to Karen McCulloch, PT, PhD, NCS for your encouragement and feedback throughout the process. I also would like to thank my clinical instructors from my school-based clinical rotation, Janet Harbeck and Jen Wilkins, for fostering my interest in pediatrics and providing me with such strong foundational knowledge regarding pediatric equipment in the school setting. Finally, to my husband William, thank you for your unwavering support throughout this program; I would not have made it here without you!