Digital confidence, experience and motivation in physiotherapists: A UK-wide survey

Article accepted

This article has been accepted for publication. Peer reviews and author responses are available at the end of the article.

Abstract

Background: Healthcare digital transformation should focus on the use of innovative technologies to enhance quality, safety, efficiency of care services, and patient experience. Subsequently, the roles and skills of healthcare staff will change, requiring evaluation and elevation of digital literacy across the physiotherapy profession. Aim: To evaluate the confidence, motivation and competence of digital technologies in a cohort of UK physiotherapists (juxtaposed with a wider group of allied health professionals). Methods: A quantitative, cross-sectional online questionnaire of physiotherapists and other allied health professionals (AHPs) in the UK. Results: 282 responses from AHPs were received with 279 complete responses for further analysis (including 126 physiotherapists). Physiotherapists report moderate-high levels of confidence in the use of digital devices (7.6 ±1.77), and high levels of motivation in learning about digital technology (8.7 ±1.6). Physiotherapists self-rate their knowledge regarding the benefits of digital transformation as high (72%). Physiotherapists show a strong preference for daily communication via telephone (82%) and email (97%). Conclusion: Physiotherapists demonstrate moderate-high levels of confidence and motivation to use digital technologies (in line with those seen in other AHPs). Higher degrees of competence are reported regarding understanding the benefits of digital technology, and lower competence is reported regarding topic areas such as artificial intelligence and data analytics.

Reviews

Author: Simone Titus
Review date: 6th October 2020
DOI: 10.14426/opj/20201006
Permalink: Review - Digital confidence, experience and motivation in physiotherapists: A UK-wide survey

Dear Editor,

Thank you for the opportunity to review this paper entitled: ‘Digital Confidence, experience and motivation in physiotherapist: A UK-wide survey’

This paper offers valuable insights into the digital literacies, confidence and experiences of physiotherapists and other allied health professionals (AHP’s).

Abstract

Aim– I am not sure whether the information in brackets is needed as this does not appear to be a comparative study, as the paper is more descriptive in nature (besides the t-test).

Methods: Please expand the methods to state that it is a quantitative study. Was this a cross-sectional design?

The conclusion in the abstract does not fully align with the results showed in both the abstract and in the body of the paper. Just a short succinct conclusion as it (explicitly)relates to digital confidence, experience and motivation of physiotherapists would be sufficient.

The practical implications should include some of the core constructs of the paper (I.e confidence, motivation, digital confidence). It is unclear how learning is linked. If it is about health data analytics, then perhaps this should be made more overt.

Introduction

Good introduction which demonstrates the niche area and the gap in our understanding and the rationale for this paper. Improving digital skills may facilitate and boost staff competence and focus.

the title of the tool review closed caption “” and a comma

Methodology– there is some information missing in terms of design. Be specific about it being quantitative and also cross-sectional (if that is what you have used). The methods also indicate that a t-test was conducted, you do not discuss this t-test results.

I am not sure whether I have missed something-  Under the procedure, it states that survey responses were 143, yet the results response rate indicates 282 responses with 279 complete responses.

Results

The computed scores in Table 1 requires some context as it relates to the instrument. Whilst this is a 5-point Likert Scale, it would be useful to add an Annexure for the instrument used so that one can make some inferences about the items in each of the scales. Reporting of the mean and SD should be written in a more conventional manner.

The link between this study and TOPOL review is insightful in terms f the results and findings, given that this speaks to the clinical skills required in the digital age as it relates to digital literacy, transformation. It is unclear from the explanation of whether these figures are raw scores. Would be useful to indicate this in the table as an (n) as a  very minor addition.

The headings of the figures could be changed. Avoid using the direct questions as headings or words such as frequency as these are statistical terms for analysis. Figures 3 (a, b, c and d) follows one another without explanations in between to orientate the reader. Whilst having about 2 tables of the same (eg 3a and 3b) following one another with a summarised explanation as it offers an explanation and comparison of Physiotherapists and other AHP’s for the same scale. The same for Fig’s 4- It is a string of figures and as a reviewer, I kept having to scroll up for the explanation (which may require some more detailed explanation).

Kolachalama and Garg (2018) suggest that concerning AI/ML, curricula should aim for literacy, rather than proficiency; focusing on developing conceptual knowledge to assist clinical practice. Physiotherapy education could follow, by embedding technological knowledge relevant to patient care into workforce development strategies.’- I found that this is useful for practical implications as it demonstrates some of the conceptual and requisite knowledge which clinicians may require and therefore would need to be included in a curriculum.

Discussion

Do not repeat the results in the discussion section- only discuss the findings. This being said, there are some very interesting findings in this study which could potentially have a good impact on the physiotherapy curriculum. It is somewhat clear from the discussion that much work is needed in areas where there is a lack of knowledge with regard to the use of more recent developments in the health sectors, such as machine learning/AI and informatics. Whilst the author offers recommendation in the discussion about these areas, it does require a discussion explicitly about these based on the findings of the study before a recommendation could be offered. the author does this, using the results. I recommend removing the results and having a discussion about it. Then, when one considers the ‘poor knowledge’ scores as it relates to ML and informatics, one would question how this impacts on digital confidence and motivation. Therefore, it may be useful to cross-reference some of your findings by way of your discussion.

Author: Jay Shaw
Review date: 11th September 2020
DOI: 10.14426/opj/20201011
Permalink: Review - Digital confidence, experience and motivation in physiotherapists: A UK-wide survey

Thank you for the opportunity to review this article reporting on the findings of a survey of digital confidence, experience and motivation among physiotherapists in the United Kingdom. The article is clearly written and succinct, and presents a useful contribution to understanding the readiness of the physiotherapy profession to incorporate digital technologies into physiotherapy practice in meaningful ways in one jurisdiction (UK).

There are a few grammatical issues to be addressed, but the article accomplishes its stated goals in its current form. One point I was left wondering about was the broader implications of the digital transformation of health care on a profession that so prominently incorporates touch. To what extent will the digital transformation affect physiotherapy practice? What would be a “good” amount of digital transformation in physiotherapy? How would that vary by practice setting? For example, it’s like that an inpatient rehabilitation physiotherapist would have less need for virtual visit technology than would an outpatient musculoskeletal physiotherapist. Addressing this point could strengthen the sophistication of the discussion section. I would suggest that the digital transformation will have a more substantial effect on certain practice settings, but that physiotherapists will need to enhance their digital literacy across care settings in order to remain attuned to an increasingly digitizing system.

Abstract

The abstract reports levels of confidence in using digital devices on a numeric scale, but does not present anchors to help the reader understand the results. For example, “moderate-high levels of confidence in the use of digital devices (7.6 ±1.77)”.

Introduction

Paragraph 1 uses semicolons in ways that are not grammatically correct. This occurs at locations throughout the manuscript. I would suggest reviewing the correct uses of semicolons and then doing a search and find within the document to correct their uses.

In paragraph 1 there are no end brackets on the title of Topol review.

Subjects

Could this section be referred to as “participants”? The term “subjects” comes across as outdated.

Which allied health professional designations were included in the sample? I see this information is provided in the results section, but this is also a methodological decision. Why were these designations included?

Respondent Profile

What is “professional banding” and “Agenda for Change Band”? As a reviewer not located in the United Kingdom, I’m not sure what these refer to.

Do the authors have a sense for why physiotherapists are so prominently represented in the final sample? Does that respondent profile match the distribution of these health human resources across the UK?

Table 2

Could table 2 please include percentages of respondents in each category? That would make it much easier to contextualize the number provided in each cell.

I also think it might be easier to interpret for the read if Table 1 was present with the first three columns of results being all those pertaining to physiotherapists, and the final three columns of results being all those pertaining to AHPs.

Regarding Figure 4c, communication via Whatsapp, was it clarified in the survey that this question refers to communication about work, as opposed to only while at work? Is communicating about patient care via Whatsapp compliant with relevant health information policy in the UK?

Discussion

The discussion section is built around “Two competency areas are deemed vital components of digital competency by the guiding literature both in UK and abroad”, identified in this case as machine learning/AI and health informatics. However, these do not strike me as a reviewer as the most fundamental elements of digital competency for clinical practice. Instead, a much more basic digital literacy seems to be the most fundamental competency to establish, enabling providers to acquire and learn to use digital applications across devices (laptops, phones, other digital interfaces). If the author would like to structure the discussion around ML/AI and health informatics, I think that is completely fine! I would just like to see further justification as to why that decision is made, as opposed to focusing on the more basic skills related to digital literacy.

The discussion section states: “The development of training standards in radiology for AI/ML is in the nascent stages. In both the USA and UK, standards require training radiologists to understand basics of imaging informatics (e.g. data privacy, post-processing imaging) (American Board of Radiology (2019). However, syllabi do not explicitly include AI/ML within the curriculum.”

However, it is very likely that syllabi are now including AI/ML across professional programs. As a reviewer I can say that this is certainly true in both faculties of public health and medicine at the University of Toronto. Please remove the final sentence in that paragraph regarding syllabi.

Please provide a sub-heading titled “Conclusion” prior to the final paragraph.

Conflict of interest statement

The authors report no conflict of interest.

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