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Educating caregivers of persons with cerebral palsy in night-time postural care: a randomized trial comparing two online training programs [with consumer summary]
Hutson JA, Hodges JS, Snow L
Clinical Rehabilitation 2021 Sep;35(9):1317-1328
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: Compare effectiveness of two differently formatted training programs in educating night-time postural care implementers. DESIGN: Mixed-methods parallel-group double-blind design with random assignment. SETTING: United States academic institution. PARTICIPANTS: Thirty-eight adult caregivers/providers of children with cerebral palsy. INTERVENTIONS: Both 2-hour online programs included content on night-time postural care evidence, risk-factor monitoring, sleep-system types, positioning methods, and assessments. Group A used interactive videos, group B summary information with web-links. MAIN MEASURES: We measured self-perceived competence via questionnaires (baseline, post-training, post-simulation) containing 4-point rating-scales of knowledge, ability, and confidence and measured positioning ability via a simulation observation instrument comprising 16 positioning-task ratings with space for describing performance. We recorded participant actions/statements using fieldnotes. RESULTS: Thirty-eight completed training (19 per group). Group A (versus B) showed significantly greater self-perceived competence changes post-training (0.46 points (SE 0.17), p = 0.008). Thirty-seven positioned a standardized "client", with groups not differing significantly on total tasks completed correctly (F[1,92.32] = 1.91, p = 0.17) averaging 11.85 (SE 0.83) and 12.60 (SE 0.84) of 16 tasks correct. Group A's post-positioning/simulation self-ratings were significantly associated with actual ability (r = 0.53, p = 0.019). In both groups 47% of caregivers incorrectly completed the tasks of placing head and neck in neutral and snugging up all (positioning) parts. CONCLUSION: The sleep care positioning training program (interactive video-based format) is effective in building caregivers' self-perceived competence for night-time postural care. While the lesson was well-received by caregivers and considered a "match (to their) learning style", the lesson did not lead to greater improvement in actual ability to position the "client" compared to control training.

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