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Howe, Louise (2024) A realist evaluation of a training programme to enable experienced therapists to implement a complex rehabilitation intervention in a research setting. PhD thesis, University of Nottingham.

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Abstract

Background

Our ageing population is living longer; many people live with comorbid conditions that affect their function, health, and quality of life. This population requires complex rehabilitation interventions, and large-scale randomised controlled trials (RCTs) are the preferred method of evaluating their effectiveness. The therapists delivering these interventions need training and support to ensure they provide a high-quality intervention with fidelity to the manual. Little has been reported in trial papers around training, which varies in terms of the type of training and the detail of documentation. There have been a number of multi-site RCTs of complex rehabilitation interventions that did not demonstrate positive results. It has been suggested that inconsistent intervention delivery or a lack of training may have contributed to the results. This PhD evaluates the training programme designed to support therapists in delivering a rehabilitation intervention for the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) RCT.

Methodology

Realist evaluation was chosen to identify how the training programme works in a research setting, to what extent, and why. Programme theories to explain the causal mechanisms at play within the training programme were identified, refined, and consolidated through three stages. Stage one was a scoping review of learning theories for training experienced therapists. Stage two was a mixed methods exploratory study utilising semi-structured interviews and observations of intervention sessions via video recordings. This stage aimed to understand the therapists’ experiences and ascertain whether they delivered the intervention with fidelity. The final stage consisted of realist interviews with therapists to test and consolidate the programme theories generated in the first two stages. Stakeholders were consulted throughout the process to improve rigour and provide a broader perspective.

Findings

Overall, the PhD resulted in seven consolidated programme theories. These theories included three directly related to the nature of the training. The use of a multi-component training programme and flexible, consistent mentoring led to therapists developing a deeper knowledge of the intervention and expertise in delivering it to more complex cases. The use of case studies was considered effective in consolidating knowledge and applying theory to practice. Programme theories were also identified within the training programme’s broader context pertinent to successful engagement with the training programme. A team culture with leadership, organisation structures and supportive peers facilitated opportunities to engage with the training programme. Training alongside other team members leads to effective team building. Finally, developing relationships across the multiple sites enabled effective knowledge sharing, problem-solving and reassurance.

Conclusion

The realist evaluation enabled the training programme to be explored and understood in depth. It has contributed to the field an understanding of what training programmes should look like, how site teams can be organised to maximise intervention delivery with fidelity and how sites can work together to share and learn from each other. A list of recommendations for constructing training programmes for research settings has been developed for future complex intervention RCTs.

Item Type:	Thesis (University of Nottingham only) (PhD)
Supervisors:	Harwood, Rowan Logan, Pip Booth, Vicky
Keywords:	Rehabilitation interventions; Training of therapists; Programme theories; Realist evaluation
Subjects:	W Medicine and related subjects (NLM Classification) > WB Practice of medicine
Faculties/Schools:	UK Campuses > Faculty of Medicine and Health Sciences > School of Health Sciences
Item ID:	78043
Depositing User:	Howe, Louise
Date Deposited:	02 Aug 2024 12:30
Last Modified:	02 Aug 2024 12:30
URI:	https://eprints.nottingham.ac.uk/id/eprint/78043

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