Read the Annotation for Specific Review Standard 1.4 in the Qm Rubric

• Loading metrics

Open Admission

Peer-reviewed

Enquiry Commodity

Development of a Hybrid Grade on Wheelchair Service Provision for clinicians in international contexts

• Yohali Burrola-Mendez,
• Mary Goldberg,
• Rachel Gartz,
• Jon Pearlman

10

• Published: June 15, 2018
• https://doi.org/x.1371/periodical.pone.0199251

Figures

Abstract

Introduction

Wheelchair users worldwide are at loftier take chances of developing secondary wellness conditions and premature death due to inappropriate wheelchair provision by untrained providers. The International Social club of Wheelchair Professionals (ISWP) has developed a Hybrid Form based on the Earth Health Arrangement's Wheelchair Service Training Package—Basic Level. The Hybrid Course leverages online modules designed for low-bandwidth internet admission that reduces the in-person grooming exposure from five to three and a one-half days, making information technology less expensive and more convenient for both trainees and trainers.

Methods

The Hybrid Course was designed using a systematic approach guided by an international group of stakeholders. The development followed the Quality Matters College Educational Rubric, spider web design guidelines for low bandwidth, experts' opinions, and the best practices for blended class blueprint. A quasi-experimental approach was used to evaluate the effectiveness of the Hybrid Course taken past half-dozen graduate students in Rehabilitation Sciences at the Academy of Pittsburgh by measuring pre- and postal service knowledge using the validated ISWP Wheelchair Service Provision—Basic Test. The upshot measure was assessed using a paired sample t-test between pretest and posttest scores. The quality of the Hybrid Course was evaluated by three external reviewers using the Quality Matters Higher Educational Rubric who were blind to each others' evaluation and the results of the grooming intervention.

Results

Hybrid Course participants reported significant increases in scores on the ISWP Wheelchair Service Provision—Basic Exam later on participating in the training, with an average increment of 10.84±5.42, p = 0.004, Cohen's d = one.99. In addition, the Hybrid Course met the Quality Matters Standards in two out of iii evaluations and reported a percentage of agreement between evaluators of 84%.

Conclusions

The Hybrid Course met quality standards and proved to be effective in increasing basic level wheelchair knowledge in a group of Rehabilitation Scientific discipline graduate students.

Citation: Burrola-Mendez Y, Goldberg M, Gartz R, Pearlman J (2018) Evolution of a Hybrid Course on Wheelchair Service Provision for clinicians in international contexts. PLoS Ane thirteen(6): e0199251. https://doi.org/x.1371/journal.pone.0199251

Editor: Stefano Federici, Universita degli Studi di Perugia, Italy

Received: January 8, 2018; Accustomed: June 4, 2018; Published: June 15, 2018

Copyright: © 2018 Burrola-Mendez et al. This is an open access article distributed under the terms of the Artistic Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are inside the paper and its Supporting Data files.

Funding: This study was produced by ISWP in collaboration with the University of Pittsburgh, subaward number APC-GM-0068, through Advancing Partners & Communities (APC), a cooperative agreement funded by the U.S. Agency for International Evolution nether Agreement No. AID-OAA-A-12-00047, beginning October 1, 2012. This study is based upon work supported by Consejo Nacional de Ciencia y Tecnología México (CONACYT) Graduate Pupil Fellowship to YB. The contents of this publication do not necessarily reverberate the view of CONACYT. The funders had no role in report pattern, data collection and assay, decision to publish, or preparation of the manuscript.

Competing interests: The authors have alleged that no competing interests exist.

Introduction

The World Health Arrangement (WHO) estimates that x% of people with disabilities, approximately 112 million people, need a wheelchair for mobility and role. Even so, only 5%–15% of them take access to a properly fitted wheelchair, indicating that approximately 96 1000000 people practise not have a wheelchair or take one that does non see their needs [one–3]. Wheelchair users who do not have admission to appropriate wheelchair provision by trained providers are at a high take chances of developing secondary health conditions and premature death [1, four]. The lack of grooming of personnel delivering wheelchair services may consequence in poorly fitted wheelchairs that are difficult to propel, fail prematurely and crusade injuries to the user [1, 4, 5]. The health complications of inappropriate wheelchair provision include pressure injuries, falls, overuse or repetitive strain injuries, postural deformities, restricted breathing, and a limited range of motion [1, vi]. This state of affairs suggests that countries where inappropriate wheelchair service delivery is occurring are non fulfilling the promise of the United nations Convention on the Rights of People with Disabilities (UNCRPD), which entitles all people to the right of personal mobility [7].

In 2008 the WHO, the United States Agency for International Development (USAID), the International Society for Prosthetics and Orthotics, and Disabled Peoples' International launched the Guidelines for the Provision of Manual Wheelchairs in Less-Resourced Settings as an international effort to promote preparation and to assistance nations in fulfilling the United Nations Convention on the Rights of People with Disabilities (UNCRPD) [1]. The WHO Guidelines outline eight service steps and the minimum standards that form the basis of a comprehensive wheelchair service based on international evidence-based do and research [1, 6, 8, 9]. Following the release of the WHO Guidelines, the WHO and USAID, published a series of Wheelchair Service Training Packages (WHO WSTPs) to back up clinicians' grooming and to increase wheelchair access worldwide. To appointment, there are five WHO WSTPs: Basic, intermediate, managers', and stakeholders', and trainers' packages [10–xiv]. All of the WHO WSTPs follow a learning methodology of in-person training held over consecutive days. This preparation format may make it difficult for decorated providers to attend and to calibration across multiple settings, including university training programs. As a result, at that place even so is a widespread delivery of inappropriate wheelchairs worldwide, indicating that the grooming uptake has been dull, and capacity is bereft.

Blended learning, or hybrid learning, is a mix of dissimilar learning environments and approaches that include online and in-person methods [15]. This type of learning is a toll-effective [16] and student-accepted [17–19] method of knowledge broadcasting and could viable for global health education [20–22]. Literature has demonstrated that composite learning is as effective as in-person learning in medical and non-medical instruction [15, 17, 23–25] and tin exist a feasible solution to overcome cognition dissemination barriers in less-resourced areas [20].

As composite instruction proliferates, so do efforts to evaluate its effectiveness by research and cess groups worldwide such every bit the International Association for K-12 Online Learning (iNACOL) [26], Educational activity Elements [27], the University of Central Florida—Composite Learning Toolkit [28], Quality Matters [29], and Educause [thirty], among others. One such system, Quality Matters (QM), is an international leader in rubric development and quality assurance for online education. QM has developed rubrics intended to guide the development, evaluation, and comeback of online and blended courses, such as the QM Higher Education Rubric [29, 31]. This rubric includes 8 General Standards and 43 Specific Review Standards used to evaluate the pattern of online and blended courses [29, 31, 32]. To certify the quality of a class, QM requires at least 85% of the content to encounter the quality expectations of the rubrics. Multiple studies have used the QM Rubrics successfully to guide the development and to assess the quality of online and composite courses [33–37].

Motivated by the successful learning outcomes using blended courses every bit described in the literature and with the aim of offer alternative learning methodologies that increase the spread of wheelchair service delivery training, our goal was to develop and evaluate a blended learning arroyo for the WHO WSTP-Bones level (WHO WSTP-B).

The specific aims of this action research study were to:

1. Determine the online design criteria and content resource allotment and develop online modules in English.
2. Do a pilot test of the Hybrid Class to evaluate the learning effect.
3. Evaluate the quality of the Hybrid Course using the Quality Matters College Education Rubric.

We hypothesized that trainees of the Hybrid Grade would take significantly higher scores on the ISWP Wheelchair Service Provision–Basic Test later on receiving training and that the Hybrid Course would receive an acceptable rubric score (85%) to run into the quality standards for blended courses.

Materials and methods

Each specific aim was completed in sequence; the methods are described below.

Specific aim ane: Decide the online design criteria, the allocation of online content, and develop online modules in English language

Identify the online design criteria.

To address specific aim ane the International Society of Wheelchair Professionals (ISWP, a analogous body for the wheelchair sector) [38] formed the Hybrid Subcommittee (HSC), a multidisciplinary and international stakeholders grouping that guided the development of the Hybrid Form. The HSC was represented by eight members from high-, middle- and low-income countries (Brazil, Canada, Colombia, India, Mexico, Philippines, the United Kingdom, and the Us) with experience in delivering wheelchair training and developing educational programs for high- and depression-resources settings. Over the course of 12 months (May 2015 to Apr 2016), the HSC held synchronous monthly online meetings to discuss and advise upon the development of the Hybrid Class (Fig 1). ISWP staff attended the meetings to help coordinate the sessions and distribute the calendar and the minutes. All meetings were recorded and made available to HSC members [39]. An ISWP cadre team member and HSC member (YBM) with both curriculum and course development and clinical wheelchair feel was the primary developer of the Hybrid Course with advice from the co-authors of this study and the HSC.

Place design criteria.

The HSC considered the QM Higher Instruction Rubric [32] to be a useful framework to guide the development of the Hybrid Course. Still, the HSC identified that the Rubric lacks strategies to implement courses in international contexts where connectivity and low net speeds may exist challenging. The HSC reviewed the best practices on composite course design [40] and considered its members' experience developing educational programs and delivering training in international settings to offer suggestions that strengthened the QM Higher Educational activity Rubric and guided the development of online modules.

Make up one's mind the advisable allocation of online content.

The aim of the Hybrid Course is to offer an culling learning methodology for the WHO WSTP-B. The purpose of the WHO WSTP-B is to develop the skills and knowledge of personnel who are required to deliver basic level wheelchair services to people with mobility impairments who can sit upright without additional postural support [10]. No clinical background is required to access the training, which makes information technology feasible to replicate in places where at that place are few or no professionals in the field of seating and mobility [x]. Table 1 presents the content and fourth dimension allotment of the WHO WSTP-B in its original learning methodology of in-person training.

The HSC and the primary developer of the Hybrid Course analyzed the theoretical and applied components of the WHO WSTP-B to select the most appropriate content to host online.

Online module development.

The primary developer of the Hybrid Course (YBM) utilized the QM Higher Education Rubric [32], HSC recommendations, web pattern guidelines for low bandwidth [41] and best practices for blended course design [40] to develop a fix of specific review standards that guided the development of the Hybrid Form. The evolution of the online modules included 2 rounds of internal (co-authors) and external (HSC) revisions (Fig 1). In the first round, a module paradigm was developed and distributed to the HSC members to collect feedback about the visual design of the class, the modules' sections and the layouts. In the second round of revision, all modules and their respective content were created and distributed via the online platform. For this circular, feedback was solicited on curriculum and platform access. In terms of curriculum, reviewers were asked to verify that the content (learning objective, topics, quizzes, and activities) strictly followed the WHO WSTP course. To evaluate the platform access, HSC members were asked to test the modules in unlike settings with high and low internet connection speeds and using different technology devices such as smartphones, tablets, laptops, and desktop computers.

Specific aim ii: Do a pilot test of the Hybrid Form

To accost specific aim 2, a quasi-experimental trial utilized a pretest-posttest design to evaluate changes in basic level wheelchair noesis using the validated ISWP Wheelchair Service Provision–Basic Test [42]. The study was approved by the Academy of Pittsburgh Institutional Review Board.

Report sample.

The sample was selected using a convenience sampling method guided by the co-authors and the HSC. The inquiry team met with the bookish directors of the Physical Therapy (PT), Occupational Therapy (OT), Prosthetics and Orthotics (P&O), and Rehabilitation Science and Engineering science (RST) programs from the University of Pittsburgh to inform and share the scope of the projection. The bookish directors distributed the Hybrid Course flyer to their students inviting them to register for the Hybrid Form. The flyer included the clarification of the course, inclusion criteria, location, online and in-person time commitments, schedule, registration process and contact information (Fig 2).

The study'south inclusion criteria included: 1) students, staff, or professors from the PT, OT, P&O, and RST programs from the University of Pittsburgh; two) who have not taken the ISWP Wheelchair Service Provision–Bones Examination. We excluded participants who were simultaneously working on other wheelchair-related study or training.

Consequence measure out: Wheelchair Service Provision knowledge.

The ISWP Wheelchair Service Provision–Basic Test is a valid method for measuring the basic competency of wheelchair professionals independent of geographic location[42]. The test consists of 19 sociodemographic questions and 75 multiple-choice questions that evaluate bones wheelchair service delivery. The multiple-choice questions evaluate seven domains of wheelchair service commitment: 1) assessment, ii) prescription, 3) plumbing equipment, 4) production, v) user grooming, 6) process, and seven) follow-upwardly and maintenance every bit covered in the WHO WSTP-B. The domains take unlike weights based on the pre-set number of questions that each domain was allocated. Each domain has a pool of questions created to reduce the likelihood of receiving the same question when taking the test multiple times. Test scores greater than or equal to 53 points (lxx% of the full points) are considered passing scores. The examination was hosted and distributed online through the testing platform, Exam.com^®.

Intervention.

Fig iii presents the study's overview and timeline. The training was purposefully implemented interprofessionally. Two trainers were concrete therapists and one was an occupational therapist. The trainers had been trained in the WHO WSTP-B and have participated in the WHO Wheelchair Service Grooming of Trainers Parcel–Basic level [14]. In addition, all the trainers have facilitated the WHO WSTP-B and have provided basic level wheelchair services in both high- and less-resource settings.

Assessments were collected 1-week earlier and after the training intervention. The participants received an email with the instructions on how to log into the testing platform, Test.com^®, and the contact information of ISWP staff in example of technical problems or questions. Participants were instructed to consummate the exam without accessing course materials. The settings of ISWP Wheelchair Service Provision–Basic Test included: 1) a random distribution of questions and answers from the domains' pool of questions; 2) forced completion that required the participants to complete the test in a former entry; and 3) feedback and scores where the test provided the immediate test scores and the pick to review correct and incorrect answers.

Online preparation: Every bit indicated in Fig 3, the online learning was divided into three sequential phases. At each phase, the participants reviewed the content and completed the required activities asynchronously. Later on the completion of each stage, an online session (recitation) occurred synchronously between the participants and the trainers. During the recitations, trainers reinforced the key points of the modules, answered questions, discussed topics and promoted interactions between the participants. The recitations were recorded and made available to the participants and trainers. ISWP staff helped to coordinate the recitations and provide support if needed. Tabular array 2 presents the training agenda of the online and in-person sessions.

In-person training: After the completion of the online modules, the participants attended three days of in-person training led by the iii trainers at the Academy of Pittsburgh, USA (Table two). Iii experienced wheelchair users were also invited to participate as volunteers in the in-person sessions, and the trainees had the opportunity to work directly with them throughout the in-person sessions.

Data management and analysis.

All data was nerveless in a Test.com^® database, exported into a CSV file then into SPSS^® Version 24.0. Descriptive statistics were calculated. For the outcome measure, knowledge change, a paired sample t-test was calculated to compare the levels of knowledge between the baseline and post-training full scores. In improver, paired sample t-tests were calculated for each test domain to explore specific noesis changes. The issue size was calculated using Cohen'south d [43]. All analyses were carried out using an exploratory alpha level of 0.05.

Specific aim three: Evaluate the quality of the Hybrid Course using the Quality Matters Higher Education Rubric

To address specific aim 3, ISWP recruited 3 evaluators from 2 eye-income countries, fluent in English, with experience implementing educational health programs in loftier- and less-resourced settings using in-person and blended learning methodologies. This quality evaluation was conducted subsequently the implementation of the Hybrid Course.

The QM Higher Education Rubric was used to evaluate the quality of the Hybrid Form. This tool includes viii General Standards: 1) Course Overview and Introduction; 2) Learning Objectives (Competencies); three) Assessment and Measurement; 4) Instructional Materials; 5) Course Activities and Learner Interaction; 6) Course Applied science; 7) Learner Support; and 8) Accessibility and Usability; and 43 Specific Standards that are dichotomously rated as either "met" or "not met" [31, 32]. When a Specific Standard is met, it receives a pre-assigned value of 1, 2, or 3 points; those with point values of iii are considered "essential standards" and must exist met for a course to "run into standards" [32, 44]. The maximum score of the Rubric is 99 points. A score of 85 points out of 99, or 85%, besides every bit meeting all three-betoken essential standards, is required for a course to see the QM Standards.

The evaluators received an private invitation via electronic mail from the chief developer of the Hybrid Course to voluntarily review and evaluate the course using the QM College Pedagogy Rubric. Upon agreeing to participate, a 2d email was sent with the link and instructions to access and review the Hybrid Course and the QM Higher Teaching Rubric attached. Reviewers had six weeks to evaluate the Hybrid Grade and return the rated QM Rubric via e-mail. In add-on, they were encouraged to submit suggestions and comments to help to better the course and to contact the writer with any inquiries. Reviewers were blinded to both each other'southward evaluations and the airplane pilot results from the Hybrid Course.

The rated rubrics were transcribed to a Microsoft Excel spreadsheet database. A total score was obtained per reviewer past adding all the pre-assigned value (i, 2, or iii points) of the Specific Standards that were met. In addition, the percentage of agreement was computed by calculating the number of times raters agreed on a rating and then divided by the total number of ratings [45, 46]. This technique allows exploration of understanding of multiple evaluators and the opportunity to identify items that may exist problematic [46]. An odd number of reviewers was set to identify probably problematic items. The HSC and the co-authors of the study determined that if an item was rated as "not met" by two or more reviewers, it would be considered equally problematic. Addressing problematic items will be role of future studies. The additional recommendations offered by the HSC were included in the rubric. Reviewers were asked to evaluate if the items suggested by the HSC were "met" or "non met"; however, these items did not receive whatever points to not interfere with the QM's review process.

Results

Specific aim 1: Decide the online design criteria, the allocation of online content, and develop online modules in English

Place the online design criteria.

The HSC offered 8 suggestions to strengthen the QM Higher Education Rubric and to guide the development of the online modules. The suggestions were added to the original QM Rubric and are presented in Table 3. The items 1.x, 1.11, three.6, 3.7, 5.5, eight.6, viii.7, and 8.8 represent HSC'due south suggestions. The category Accessibility and Usability received the most suggestions (8.six, eight.vii, viii.8), reflecting HSC'south emphasis on developing a grade that could exist shared and scaled in the future. To meet the accessibility and usability requirements, the authors selected Adobe Captivate 9^® and CourseSites by Blackboard^® as the authoring tool and the learning management system, respectively, to develop and host the online modules of the Hybrid Course. The option was fabricated based on the availability of the Adobe Captivate 9^® program and the free hosting and publishing online courses that CourSesites^® offers [47].

Make up one's mind the advisable allocation of online content.

The HSC reached a consensus and selected the Introduction and Cadre Knowledge to be the online components of the Hybrid Course due to their theoretical components and the few practical activities that they included (Table 4). The Wheelchair Service Basic Steps section was selected to be the in-person component of the Hybrid Course following the methodology proposed by the WHO WSTP-B. Table 5 presents the Hybrid Form content distribution.

Develop the online modules.

The specific actions implemented by the primary writer to fulfill the QM Rubric and the additional HSC suggestions are grouped based on the QM's Standards and described below.

1. Class Overview and Introduction: An Introductory module was adult that included: 1) an overview of the Hybrid Course that covered construction of the course, the purpose of the grade, target audience, prerequisites, instructional materials, technology requirements, instructional videos explaining how to admission CourseSites^® and how to navigate through the Adobe Captivate^® modules; and 2) tips on how to succeed in online learning. This module was hosted at ISWP's website and distributed via an external link to the participants prior to the commencement of the grade.
2. Learning Objectives: Each online module of the Core Knowledge included learning objectives co-ordinate to the WHO WSTP-B.
3. Assessment and Measurements: Short quizzes (3 to 5 questions) were adult to monitor the participants' comprehension of the material. They were developed by the primary author and reviewed by the co-authors and the HSC. The quizzes included different types of questions such equally multiple choice, multiple answers, matching columns, case studies, and true or false (Fig 4). The quizzes were automatically evaluated; this allowed the participants to receive feedback and to review the quiz immediately after its completion. Passing scores were non required to keep with the in-person training; nevertheless, all modules with their respective quiz needed to exist completed. Individual scores were automatically reflected in the grading eye allowing the participants and trainers to track the learning progress (Fig five).
4. Instructional Materials: An electronic version of the ii required materials, the WHO Reference Transmission for Participants and the Participant's Workbook, were available for participants to download from CourseSites^® prior to the training. Moreover, if the participants preferred to read the materials online, each module included the reading or activity that needed to be reviewed. This feature centralized resources and improved navigation throughout the course. Some modules included a folder with optional reading materials.
5. Course Activities and Learner Interaction: Class Activities: The online modules followed all the activities suggested by the WHO Trainer'south Manual–Basic Level; nevertheless, 25.eight% of the allocated time to Cadre Knowledge is used to practice skills (Table 3). In order to comply with the WHO WSTP-B content structure, the applied activities were allocated to the commencement 24-hour interval of the in-person portion. The online modules introduced the activity with a video; afterward watching it, the participants were informed that they will practice those skills during the in-person portion of the training.
   Learner Interaction: With the aim of supporting active learning and promoting participants' and trainers' interaction, two activities were developed: i) Give-and-take Forums, in which the participants were asked to post questions for each module and encouraged to respond to each others' inquiries. Trainers monitored the give-and-take forums and added necessary information. This feature promoted human being interaction consisting of ii-way communication betwixt one student to some other student and between students and trainers; and 2) Recitations, 3 synchronous recitations were conducted to monitor the online section; the first, subsequently the completion of the first iii modules; the 2d, after the completion of the next three modules; and the 3rd, after completing the concluding two modules (Fig 3). During the recitations, facilitators reinforced the key elements of each module and responded to participants' questions that were not addressed past their peers.
6. Grade Technology: The Introductory module included a section almost engineering requirements needed to admission CourseSites^®, where the online modules are hosted. This department has a link to a browser checker that verifies whether CourseSites^® supports a learner's browser and operating system [48] and provided feedback on what steps to follow to exist able to view content within CourseSites^®.
7. Learner Back up: The Introductory module included a section on how to succeed in online learning, that described effective communication skills and how to get technical support during the online components of the training. The participants could send emails to the trainers and master developer of the modules through CourseSites^®. In improver, the platform includes a help heart with information about mutual issues and student FAQs [49].
8. Accessibility and Usability: Adobe Captivate nine^® and CourseSites by Blackboard^® were selected as the authoring tool and the learning management system to develop and host the online modules. The tools are compatible with Sharable Content Object Reference Model (SCORM) and Learning Management System (LMS) criteria suggested by the HSC to share and scale the training program [50, 51]. Besides, Adobe Captivate^® and CourseSites^® met the low bandwidth requirements and mobile content accessibility needed to implement training programs in settings with irksome internet connection speeds [47, 52].

Specific aim two: Practice a pilot test of the Hybrid Course

A total of six participants were recruited; all of them completed the pre-and mail service-assessments, and therefore there were no dropouts. The average historic period was 26±iii years. The participants' characteristics are described in Table half-dozen. The demographic questions that referred to the work setting, historic period group served, and motivation to take the preparation allowed multiple answers, and the participants were asked to select all applicable options. Information was tested for normality and homogeneity of variance; the supposition of normal distribution between pre-and post-scores was met (Shapiro-Wilk test p>0.05). A paired-samples t-test indicated that mail-assessments scores were significantly college (M = 64.17, SD = 5.41) than pre-assessments scores (M = 53.33, SD = i.66), t(5) = 4.897, p = 0.004; Cohen'due south d = 1.99. Cognition changes per the test domains were analyzed; all domains except for "Follow upwardly and maintenance" saw an increase in mean scores between pretest and posttest (Table 7). There was a significant increase in scores in the domains of "Prescription", "User Training" and "Process" (Table 7).

Specific aim 3: Evaluate the quality of the Hybrid Class using the Quality Matters Higher Educational activity Rubric

The evaluators' reviews are included in Tabular array 2. The rated rubrics from evaluators one and 3 met the QM standards by (1) reporting a mean total score above the 85%; and (two) scoring as "met" all essential standards. Notwithstanding, results from evaluator 2 indicated that the total score did not fulfill the 85% threshold nor were essential standards were met; in particular, the essential standards not met were 2.4, three.3 and vi.2. The percentage of agreement between evaluators in the QM rubric was 84% (Table 8).

The items considered problematic, those rated as "not met" past two or more reviewers were: 7.4 Class instructions articulate or link to an explanation of how the establishment's educatee services and resources can assistance learners succeed and how learners can obtain them; and 8.vi The form was developed considering depression bandwidth requirements.

Discussion

We developed a Hybrid Course based on the WHO WSTP-B using a systematic arroyo guided past an international committee of experts, the HSC, with experience delivering wheelchair training and developing educational programs for international contexts. The HSC was composed of members from low to high-income countries with experience developing and facilitating wheelchair service grooming in different settings. Studies have argued that stakeholder date is a key mechanism for increasing the relevance of research, promoting knowledge translation, and enhancing positive effects in a customs [53–55]. Collaborating with stakeholders results in more usable, relevant and transferable knowledge that could aid solve global health bug[54–56]. In particular, the rehabilitation field calls for a greater involvement and collaboration of stakeholders in all phases of the inquiry process[54, 57–59] and we followed this guidance and ensured that the HSC was involved in all phases of the development and implementation processes.

In addition to our primary evaluation mechanism (international stakeholder feedback), we used the Quality Matters Standards to identify areas of opportunity for future evolution and provide insight into any areas that may be problematic for the initial implementation of the form. The Hybrid Course met the Quality Matters Standards in well-nigh of its reviews [29, 44] and reported a percentage of understanding betwixt evaluators at an acceptable value of 84% (>80%) [46]. The two items considered problematic were 7.four Course instructions clear or link to an explanation of how the institution'south student services and resource tin aid learners succeed and how learners can obtain them; and 8.half-dozen The course was developed considering low bandwidth requirements. A commencement approach to address these items could exist (vii.4) to clearly enlist the resources and support that the participants could access throughout the course; and (viii.6) to state that the course was developed considering depression bandwidth requirements. Given the fact that the Hybrid Course was adult considering spider web design guidelines for low bandwidth [41] and using an authoring tool and a learning direction organization that met low bandwidth requirements [fifty, 51] as described in the Methods and Results section, nosotros believe that this item was marked equally "not met" due to the lack of a clear argument of this feature and/or the inability of the reviewers to test this feature. The objective of this first quality review was to collect preliminary results that could help identify areas of opportunity. As the Hybrid Form is implemented in other settings, hereafter studies could go on exploring the quality of the course and include additional sources of feedback such every bit the participants' levels of satisfaction afterwards the training intervention.

It is worth noting that multiple studies have used the QM Rubrics to guide the development of online and blended courses; however, the courses represented in those studies were developed for learners from the United States and other high-income countries [33–37]. In contrast, the Hybrid Class is intended for international contexts including low to high resources settings. Therefore, the HSC slightly adapted the QM Higher Education Rubric to include items that make it more contextually advisable for less-resourced settings (e.k. 8.vi The course was developed considering depression bandwidth requirements, and viii.8 The course is hosted in a platform that allows mobile content access). Future studies could continue working on this rubric and include validity evidence that back up its use.

Additionally, there were significant increases in both the total ISWP Wheelchair Service Provision–Basic Test score and several domain scores, further demonstrating the training's potential value and the feasibility of improving the participants' basic wheelchair cognition. Prior to the course, the participants' mean pre-test score was slightly above the passing cutoff of the exam (53 points), which indicates that our sample had some basic level wheelchair knowledge; despite that, the Hybrid Grade still positively impacted the participants' noesis, reporting a significant increment in the hateful mail-test scores (p = 0.004) with an effect size (d = 1.99) that exceeded Cohen's convention for large outcome size (d = 0.80)[43]. This may suggest that the Hybrid has potential to increase knowledge for participants who take a range of baseline cognition, including those who may be more than advanced.

Moreover, paired t-tests were calculated per domain to explore specific knowledge modify. Participants' scores significantly increased after the training in some domains, just not all. There is some show to suggest that may exist due to the emphasis placed on domain content through applied sessions in the in-person preparation and the participation of wheelchair users. For example, the "Prescription", "User Grooming" and "Process" domains all resulted in significantly higher scores, and the participants were able to fully experience those aspects of the provisioning procedure with wheelchair users in the practical sessions of the training. It is worth noting these domains likewise are highly represented in the test, suggesting that a meaning increase would be more likely. However, this finding was not universal as the "Cess" and "Fitting" domains, which are also highly represented in the test and include in-person applied sessions, did not demonstrate a significant increase on the post-test. This could exist considering the "Assessment" domain baseline knowledge was already high before the test (pre-score of 80.vii%) and resulted in a final increase to xc.iv%. It is of import to annotation that the alpha level for multiple testing was not adjusted because this is an exploratory written report with a minor sample size and we were concerned nigh the potential of making a Type II error [60–62]. Furthermore, nosotros were interested in exploring the magnitude of the result rather than statistical significance. A larger sample size would assistance to determine the Hybrid Grade's specific bear on on each domain and to explore which learning modalities are likely to take the biggest impact on the participants' knowledge.

The Hybrid Course, due to its proposed scalability, flexibility, and effectiveness in improving participant knowledge, may have the potential to build local and global capacity by increasing the number of people trained in bones level wheelchair delivery. Increasing the number of trained personnel delivering wheelchair services may reduce secondary complications due to inappropriate wheelchair provision such as pressure injuries, postural deformities, and restricted animate that may pb to better health outcomes among wheelchair users. The unique characteristics of the Hybrid Class design, such every bit its depression bandwidth design [41], its mobile accessibility [47, 63], and its compatibility with SCORM and LMS [50, 51] let the course to be adjusted to different contexts and to exist scaled to dissimilar levels [64, 65]. At the local level, governments could utilise the Hybrid Grade to spread trainings across regions and to fulfill the promise of the United Nations Convention on the Rights of People with Disabilities. At the international level, the Hybrid Course could be an available tool for nations aligned with the WHO Global Cooperation on Assistive Engineering science (GATE) goals of promoting access to high-quality, affordable assistive products to lead a healthy, productive and dignified life [66]. Moreover, ISWP'due south range of partners that including NGO's, universities, and inability organizations [67] could use the Hybrid Course to implement trainings more efficiently. The reduced number of the in-person sessions and their associated costs, without compromising the effectiveness of the training, may allow organizations to allocate resource to more underserved regions.

Several limitations of this report are of import to annotation in planning for future research and interpreting the current results. Although nosotros have previously discussed the benefits of stakeholders' date throughout all phases of the research process, the Hybrid Course may still confront operational challenges that were non identified by our stakeholders' group or were unsuccessfully addressed in the online evolution. These challenges would exist realized more than clearly through the implementation of the Hybrid Course in different contexts; this is part of our ongoing work. In this study, we had a pocket-size and highly educated sample size that may not reflect the population nosotros intend to target and brand our findings not generalizable to wheelchair providers from different settings.

We used the QM Higher Education Rubric to evaluate the quality of the Hybrid Course. This rubric uses a unidimensional approach with a dichotomous rating that asked reviewers to select if each of the Specific Standards had been "met" or "non met". This approach may be too constricting and limit the analysis. A different scale format, like a v-bespeak Likert type-scale, could help quantify evaluators' opinions and perceptions and provide detailed feedback on how to address the grade'south limitations. Moreover, we merely recruited three external reviewers that were not certified every bit Quality Matters' Master Reviewers. Their responses were analyzed using a percentage of agreement that does not business relationship for the bear on of take chances agreement and may overestimate or underestimate the agreement between evaluators [45, 46]. Conducting an official Quality Matters review or having more than reviewers from different geographic locations may have uncovered greater disagreement between the evaluators or operational challenges in accessing the online modules. The implementation of the Hybrid Course in low-, medium- and high-income countries is a topic of ongoing work and will help us to address the limitations of this report and measure out the bear upon of the training in other contexts.

Ongoing & future work

Ongoing and future piece of work will exist focused on implementing the Hybrid Course in different contexts to evaluate the feasibility of the training program to be used for global capacity edifice. Implementation of the Hybrid Course was recently completed in Bharat and Mexico (after translation into Castilian), and results are being compared to the traditional 5-24-hour interval in-person training. The results of these comparisons will exist the topic of futurity research publications. Additional future work includes translating the Hybrid Course into different languages, disseminating the preparation material through global partners, and expanding the Hybrid Course training program by moving more content into online training modules, including content from other WHO WSTP programs (e.grand., the intermediate, managers', stakeholders', and trainers' packages).

Conclusions

A Hybrid Course on Wheelchair Service Provision for wheelchair providers in international contexts was developed using a systematic approach guided past an international grouping of stakeholders. The Hybrid Course met quality standards in two out of 3 evaluations and proved to exist effective in increasing basic level wheelchair knowledge in a pilot study held at the University of Pittsburgh. Comparisons between the Hybrid and traditional in-person preparation are currently beingness performed equally office of a feasibility study in international contexts.

Supporting information

Acknowledgments

Authors would like to acknowledge Lee Kirby, chair of the Hybrid Subcommittee, for his support and guidelines throughout the development of the Hybrid Course, Nancy Augustine for her critical revision of the manuscript, and to our external evaluators Norma Jimenez García, Eduardo Jacome Sampieri, and Francisco J. Bonilla-Escobar.

References

1. 1. World Wellness Organization. Guidelines on the provision of manual wheelchairs in less resourced settings. Geneva: WHO; 2008.
2. two. World Health Organization. Earth Written report on Disability. Geneva: 2011.
3. 3. United Nations, Department of Economical and Social Affairs, Population Division. Earth Population Prospects: The 2017 Revision, custom information acquired via website. Geneva: United nations; 2017 [cited 2018 January iii]. https://esa.un.org/unpd/wpp/DataQuery/.
4. 4. Toro ML, Worobey L, Boninger ML, Cooper RA, Pearlman J. Type and Frequency of Reported Wheelchair Repairs and Related Adverse Consequences Among People With Spinal String Injury. Arch Phys Med Rehabil. 2016;97(10):1753–60. Epub 2016/05/08. pmid:27153763.
   • View Article
   • PubMed/NCBI
   • Google Scholar
5. v. Mhatre A, Martin D, McCambridge Chiliad, Reese N, Sullivan Chiliad, Schoendorfer D, et al. Developing product quality standards for wheelchairs used in less-resourced environments. Afr J Disabil. 2017;6:288. Epub 2017/09/25. pmid:28936410.
   • View Article
   • PubMed/NCBI
   • Google Scholar
6. 6. Greer Northward, Brasure M, Wilt TJ. Wheeled mobility (wheelchair) service delivery: scope of the show. Ann Intern Med. 2012;156(2):141–6. Epub 2012/01/18. pmid:22250145.
   • View Article
   • PubMed/NCBI
   • Google Scholar
7. seven. Un, Division for Social Policy and Evolution Disability. Convention on the Rights of Persons with Disabilities (CRPD) New York: United Nations; 2006 [cited 2018 Jan 3]. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html.
8. 8. Visagie S, Scheffler E, Schneider M. Policy implementation in wheelchair service delivery in a rural South African setting. Afr J Disabil. 2013;2(1):63. Epub 2013/09/09. pmid:28729993.
   • View Article
   • PubMed/NCBI
   • Google Scholar
9. nine. Toro ML, Eke C, Pearlman J. The touch of the Globe Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: a cohort study in Indonesia. BMC Health Serv Res. 2016;16:26. Epub 2016/01/24. pmid:26801984.
   • View Article
   • PubMed/NCBI
   • Google Scholar
10. 10. Earth Health Organization. Wheelchair Service Preparation Package: Basic Level. Geneva: WHO; 2012.
11. 11. World Health System. Wheelchair Service Grooming Package: Intermediate Level. Geneva: WHO; 2013.
12. 12. World Health Organization. Wheelchair Service Preparation Package: Managers. Geneva: WHO; 2015.
13. 13. World Health Organization. Wheelchair Service Training Package: Stakeholders Geneva: WHO; 2015.
14. 14. World Health Organization. Wheelchair Service Preparation of Trainers Package. Geneva: WHO; 2018.
15. 15. Frehywot S, Vovides Y, Talib Z, Mikhail N, Ross H, Wohltjen H, et al. Due east-learning in medical educational activity in resource constrained low- and heart-income countries. Hum Resour Health. 2013;11:4. Epub 2013/02/06. pmid:23379467.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
16. 16. Maloney S, Nicklen P, Rivers G, Foo J, Ooi YY, Reeves South, et al. A Cost-Effectiveness Analysis of Composite Versus Contiguous Delivery of Evidence-Based Medicine to Medical Students. J Med Internet Res. 2015;17(7):e182. Epub 2015/07/23. pmid:26197801.
    • View Article
    • PubMed/NCBI
    • Google Scholar
17. 17. Atkins S, Yan W, Meragia E, Mahomed H, Rosales-Klintz S, Skinner D, et al. Student experiences of participating in five collaborative blended learning courses in Africa and Asia: a survey. Glob Health Activity. 2016;nine:28145. Epub 2016/ten/12. pmid:27725077.
    • View Article
    • PubMed/NCBI
    • Google Scholar
18. 18. Motschnig-Pitrik R. Participatory Action Inquiry in a Blended Learning Course on Project Management Soft Skills. 36th ASEE/IEEE Frontiers in Education Briefing; San Diego, CA: IEEE; 2006.
19. 19. Lewis PA, Tutticci NF, Douglas C, Grayness Thou, Osborne Y, Evans K, et al. Flexible learning: Evaluation of an international distance education programme designed to build the learning and teaching chapters of nurse academics in a developing land. Nurse Educ Pract. 2016;21:59–65. Epub 2016/10/19. pmid:27756057.
    • View Article
    • PubMed/NCBI
    • Google Scholar
20. 20. Liyanagunawardena TR, Aboshady OA. Massive open online courses: a resource for wellness teaching in developing countries. Glob Wellness Promot. 2017:1757975916680970. Epub 2017/01/31. pmid:28134014.
    • View Article
    • PubMed/NCBI
    • Google Scholar
21. 21. Marrinan H, Firth South, Hipgrave D, Jimenez-Soto E. Permit's Accept it to the Clouds: The Potential of Educational Innovations, Including Blended Learning, for Capacity Building in Developing Countries. Int J Wellness Policy Manag. 2015;iv(9):571–3. Epub 2015/09/05. pmid:26340485.
    • View Article
    • PubMed/NCBI
    • Google Scholar
22. 22. Protsiv M, Atkins Due south, Arcade consortium. The experiences of lecturers in African, Asian and European universities in preparing and delivering blended health research methods courses: a qualitative report. Glob Wellness Action. 2016;9:28149. Epub 2016/10/12. pmid:27725078.
    • View Article
    • PubMed/NCBI
    • Google Scholar
23. 23. Ruiz JG, Mintzer MJ, Leipzig RM. The Touch on of E-Learning in Medical Instruction. Academic Medicine. 2006;81(3):207–2012. pmid:16501260
    • View Article
    • PubMed/NCBI
    • Google Scholar
24. 24. Dantas AM, Kemm RE. A blended arroyo to active learning in a physiology laboratory-based subject facilitated by an eastward-learning component. Adv Physiol Educ. 2008;32(1):65–75. Epub 2008/03/xiii. pmid:18334571.
    • View Article
    • PubMed/NCBI
    • Google Scholar
25. 25. Means B, Toyama Y, Murphy R, Bakia M, Jones Thousand, Center for Technology in Learning. Evaluation of evidence-based practices in online learning: A meta-analysis and review of online learning studies. Washington, D.C.: U.S. Section of Education, 2010.
26. 26. International Association for M-12 Online Learning. Well-nigh iNACOL. Vienna, VA: iNACOL; 2015 [cited 2018 Jan 3]. https://world wide web.inacol.org/virtually/.
27. 27. Educational activity Elements. Washington, DC: Didactics Elements; 2018 [cited 2018 April 3]. https://www.edelements.com/.
28. 28. University of Central Florida. Blended Learning Toolkit. Orlando, FL: University of Central Florida; [cited 2018 April 3]. https://blended.online.ucf.edu/.
29. 29. Quality Matters. Nigh Quality Matters. Annapolis, Doctor: Quality Matters; 2017 [cited 2018 April three]. https://www.qualitymatters.org/about.
30. 30. Educause. Educause Initiatives 2018 [cited 2018 Apr 03]. https://world wide web.educause.edu/.
31. 31. Quality Matters. College Education Course Design Rubric. Annapolis, Md: Quality Matters; 2014 [cited 2018 April 3]. https://world wide web.qualitymatters.org/qa-resource/rubric-standards/higher-ed-rubric.
32. 32. Quality Matters. Non-annotated Standards from the QM College Education Rubric. Annapolis, MD: Quality Matters; 2014 [updated 2017 Feb 22; cited 2018 April three]. Fifth Edition:[https://www.qualitymatters.org/sites/default/files/PDFs/StandardsfromtheQMHigherEducationRubric.pdf.
33. 33. Lowenthal P, Hodges C. In search of quality: Using Quality Matters to clarify the quality of massive, open up, online courses (MOOCs). Int Rev Res Open Dis. 2015;sixteen(5):83–101.
    • View Article
    • Google Scholar
34. 34. Parscal T, Riemer D. Assuring quality in big-scale online grade development. OJDLA. 2010;thirteen(ii).
    • View Article
    • Google Scholar
35. 35. Ralston-Berg P, Nath L, editors. What makes a quality online grade? The student perspective. Proceedings of the 24th Almanac Conference on Distance Teaching and Learning; 2008 Aug vii.
36. 36. Puzziferro M, Shelton K. A model for developing high-quality online courses: Integrating a systems approach with learning theory. Periodical of Asynchronous Learning Networks. 2008;12:119–36.
    • View Article
    • Google Scholar
37. 37. Legon R, Runyon J. Research on the impact of the quality matters course review process. 23rd Almanac Conference on Altitude Pedagogy & Learning; Aug 8–ten 2007; Madison: Library Hi Tech News; 2007.
38. 38. International Society of Wheelchair Professionals (ISWP). Near ISWP Pittsburgh, PA: ISWP; 2015 [cited 2018 April 3]. http://wheelchairnet.org/about-us.
39. 39. International Society of Wheelchair Professionals (ISWP). Training Working Groups 2018 [cited 2018 April 03]. http://www.wheelchairnet.org/training-working-groups.
40. 40. McGee P, Reis A. Composite course design: A synthesis of all-time practices. Periodical of Asynchronous Learning Networks. 2012;16(4):7–22.
    • View Article
    • Google Scholar
41. 41. Aptivate The Digital Bureau for International Development. Wed Blueprint Guidelines for Low Bandwidth [cited 2018 April 03]. http://www.aptivate.org/webguidelines/Multimedia.html.
42. 42. Gartz R, Goldberg G, Miles A, Cooper R, Pearlman J, Schmeler M, et al. Evolution of a contextually appropriate, reliable and valid basic Wheelchair Service Provision Test. Disabil Rehabil Assist Technol. 2016;12(4):333–40. Epub 2016/04/22. pmid:27100362.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
43. 43. Cohen J. Statistical power analysis for the behavioral sciences. Second Edition ed. Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers.; 1988.
44. 44. Zimmerman WA. Rater Agreement and the Measurement of Reliability in Evaluations of Online Class Blueprint Using the Quality Matters Rubric. State College, PA: Pennsylvania State University; 2011.
45. 45. Bajpai South, Chaturvedi H, Bajpai R. Evaluation of Inter-Rater Agreement and Inter-Rater Reliability for Observational Data: An Overview of Concepts and Methods. Journal of the Indian Academy of Applied Psychology. 2015;41(3):20–seven.
    • View Commodity
    • Google Scholar
46. 46. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276–82. Epub 2012/10/25. pmid:23092060.
    • View Article
    • PubMed/NCBI
    • Google Scholar
47. 47. Coursesites by Blackboard. Get the most powerful tools for your classroom [cited 2018 May 29]. https://www.coursesites.com/webapps/Bb-sites-course-creation-BBLEARN/pages/learn.html.
48. 48. Blackboard Cb. Browser Ckecker [cited 2018 May 29]. https://aid.blackboard.com/Acquire/Instructor/Getting_Started/Browser_Support/Browser_Checker.
49. 49. Coursesites past Blackboard^®. Oftentimes Asked Questions: Blackboard^®; [cited 2018 April 3]. https://world wide web.coursesites.com/webapps/Bb-sites-course-creation-BBLEARN/pages/faq.html.
50. 50. Adobe. Uploading an Adobe Captivate project to a Learning Management System 2017 [cited 2018 May 29]. https://helpx.adobe.com/in/obsess/using/learning-direction-system-lms.html.
51. 51. Blackboard. SCORM Parcel [cited 2018 May 29]. https://help.blackboard.com/Moodlerooms/Teacher/Activities_and_Resources/Assignments_and_Submissions/SCORM_Package.
52. 52. Adobe^®. How to improve the file size of Adobe Obsess output: Adobe^®; 2016 [updated 2016 Oct 17; cited 2018 Jan 3]. https://helpx.adobe.com/obsess/using/captivate-output.html.
53. 53. Tamburrini AL, Gilhuly K, B H-R. Enhancing benefits in health impact assessment through stakeholder consultation. Impact Assessment and Project Appraisal. 2011;29(3):195–204.
    • View Article
    • Google Scholar
54. 54. Camden C, Shikako-Thomas G, Nguyen T, Graham E, Thomas A, Sprung J, et al. Engaging stakeholders in rehabilitation research: a scoping review of strategies used in partnerships and evaluation of impacts. Disabil Rehabil. 2015;37(15):1390–400. Epub 2014/09/23. pmid:25243763.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
55. 55. Bowen SJ, Graham ID. From knowledge translation to engaged scholarship: promoting research relevance and utilization. Arch Phys Med Rehabil. 2013;94(1 Suppl):S3–viii. Epub 2012/eleven/13. pmid:23141502.
    • View Article
    • PubMed/NCBI
    • Google Scholar
56. 56. Hinchcliff R, Greenfield D, J B. Is it worth engaging in multi-stakeholder health services research collaborations? Reflections on cardinal benefits, challenges and enabling mechanisms. International journal for quality in health care 2014;26(two):124–8. pmid:24519121
    • View Article
    • PubMed/NCBI
    • Google Scholar
57. 57. Morris C, Shilling V, McHugh C, G. West. Why information technology is crucial to involve families in all stages of childhood inability enquiry. Developmental Medicine & Child Neurology. 2011;53(8):769–71.
    • View Commodity
    • Google Scholar
58. 58. Menon A, Korner-Bitensky N, Kastner K, McKibbon M, S S. Strategies for rehabilitation professionals to move evidence-based knowledge into practice: a systematic review. Journal of Rehabilitation Medicine. 2009;41(13):1024–32. pmid:19893996
    • View Article
    • PubMed/NCBI
    • Google Scholar
59. 59. Rosenbaum P. Family unit-centred enquiry: what does it hateful and can nosotros practice it?. Developmental Medicine & Child Neurology. 2011;53(2):99–100.
    • View Article
    • Google Scholar
60. sixty. Jaeger R, Halliday T. On confirmatory versus exploratory research. Herpetologica. 1998:S64–S6.
    • View Article
    • Google Scholar
61. 61. Moore C, Carter R, Nietert P, Stewart P. Recommendations for Planning Pilot Studies in Clinical and Translational Research. Clinical and translational scientific discipline. 2011;iv(five):332–seven. pmid:22029804
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
62. 62. Perneger Goggle box. What's wrong with Bonferroni adjustments. BMJ. 1998;316(7139):1236–eight. Epub 1998/05/16. pmid:9553006.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
63. 63. Pew Inquiry Eye. Communications Engineering in Emerging and Developing Nations Washington, DC: Pew Research Center,; 2015 [updated 2015 Mar 19; cited 2018 April iii]. http://www.pewglobal.org/2015/03/19/1-communications-technology-in-emerging-and-developing-nations/.
64. 64. Hensley G. Creating a hybrid higher course: Instructional design notes and recommendations for beginners. J Online Learn Teach. 2005;1(2):66–78.
    • View Article
    • Google Scholar
65. 65. Henrich A, Sieber S. Blended learning and pure e-learning concepts for information retrieval: experiences and futurity directions. Information Retrieval. 2009;12(ii):117–47.
    • View Article
    • Google Scholar
66. 66. Globe Health System. Global Cooperation on Assistive Applied science (GATE). Geneva: WHO; 2014 [cited 2018 April 3]. http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/.
67. 67. International Lodge of Wheelchair Professionals (ISWP). Collaborators 2018 [cited 2018 April 03]. http://world wide web.wheelchairnet.org/collaborators.

hamiltonhentwonce.blogspot.com

Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199251

Share this post