Impact of training on Malaysian respiratory physiotherapists' ability in detecting velcro crackles from pre-recorded lung sounds.

Abstract

Incidence of idiopathic pulmonary disease (IPF) is increasing worldwide and currently there is no curative therapy for IPF. Velcro crackles are associated with IPF and could be detected during auscultation. There is a need to train healthcare professionals to detect Velcro crackles during auscultation to help with earlier diagnosis of IPF in clinical settings. There is a paucity regarding the impact of training on healthcare professionals’ ability in detecting Velcro crackles from patients with IPF, particularly amongst Malaysian respiratory physiotherapists. The purpose of this research is to explore the impact of training on Malaysian respiratory physiotherapists in detecting Velcro crackles from pre-recorded lung sounds of patients with IPF. To this end, the research was conducted over two studies. The first study used a test-retest design to explore the impact of training on the intra and inter-observer reliability of respiratory physiotherapists ability to identify Velcro crackles from pre-recorded lung sounds. Twelve participants were randomly assigned into two groups and assessed on two separate occasions. The findings suggested that intra-observer reliability for the trained Group A indicated substantial to perfect agreement (k=0.67-1), in contrast fair to moderate agreement found for the untrained Group B (k=0.29-0.54) during Assessment 1. However, intra-observer reliability for Group B improved, from moderate to perfect agreement (k=0.50-0.90) after the training session during Assessment 2. Inter-observer reliability score for the trained Group A reflects moderate agreement (k=0.59), whereas the untrained Group B represents slight agreement (k=0.19) during Assessment 1. Nonetheless, inter-observer reliability for Group B improved to moderate agreement (k=0.59) at Assessment 2 after receiving the ii training session. However, this first study has several limitations. Therefore, the second study was conducted after further improvements and development on its design to counter those limitations. In the second study, a longitudinal mixed methods design was used to achieve the study aim, via the following objectives: 1) to evaluate the impact of training on reliability, accuracy, sensitivity and specificity of Malaysian respiratory physiotherapists in detecting Velcro crackles over time; 2) to explore participants’ experiences of Velcro crackles at the baseline and after the training session; 3) to explore participants’ perceptions of the training sessions; and 4) to explore participants’ experiences of skill retention and skill transfer in clinical practice. This study suggested that the training has significantly improved in inter-observer reliability, accuracy and sensitivity of participants in detecting Velcro crackles from the pre-training to the post-training assessments (k improved from 0.20 to 0.56 indicates poor to moderate agreement, p < 0.001; accuracy increased from 58% to 87%, p < 0.001; sensitivity increased from 43% to 85%, p < 0.001 respectively). However, the reliability, accuracy and sensitivity significantly declined from the post-training to the two-month follow-up assessments (k reduced to 0.50 indicates moderate agreement, p < 0.05; accuracy decreased to 83%, p < 0.05; sensitivity decreased to 80%, p < 0.05). There were significant negative correlations between days of leave with accuracy and sensitivity at twomonth follow-up assessment (rs = -0.85 & -0.84 respectively, p < 0.05). Specificity remained constant over time, p > 0.05. The qualitative findings corroborated with these findings suggest that there were: 1) perceived benefits of the training session; 2) comprehension towards the training; and 3) recognition of Velcro crackles immediately after the training. However, at the two-month follow-up interview session, qualitative findings suggest that there were: 1) decline in skill retention; 2) time constraint to practise the newly acquired skill in clinical practice; 3) skill transfer was achieved by some participants; and 4) acknowledgement of the importance of the skill in clinical practice. In addition, qualitative findings suggest that there should be a continuous learning programme through online and interactive training workshop, which should be delivered earlier to healthcare professionals and undergraduate students. Therefore, this thesis suggests the need for implementing the training of Velcro crackles detection in clinical practice to train health care professionals in iii detecting Velcro crackles, thus promoting earlier diagnosis of IPF in clinical settings.

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