Determining a capability framework and training requirements to support provision of physiotherapy via telehealth in an Australian public tertiary health setting: a multi-methods study

Inadequate clinician training and support is a primary challenge to physiotherapists’ adopting telehealth. Training must be underpinned by relevant capability frameworks and co-developed to meet the needs and preferences of the existing physiotherapy workforce. Establish a capability framework for delivery of care via telehealth and understand training requirements to achieve competency specifically for the publicly funded physiotherapy workforce. Sequential multi-methods study design. Phase 1: Physiotherapists with telehealth experience participated in a 2-round e-Delphi process to establish consensus on core capability framework domains (Round 1, <i>n</i> = 29; Round 2, <i>n</i> = 26). Phase 2: Physiotherapists (<i>n</i> = 35) subsequently rated their current knowledge and confidence for each capability item. Phase 3: Participatory focus groups, involving physiotherapists (<i>n</i> = 37) from six facilities, identified theoretical and practical domains most relevant to local contexts via thematic analysis. Fifty-three capability items were produced across eight domains (Compliance, Patient privacy and confidentiality, Patient safety, Technology Skills, Telehealth Delivery, Assessment and Diagnosis, Care Planning and Management, Access and Equity). Knowledge and confidence were ranked lowest within the Technology Skills domain (% respondents reporting high levels of confidence = 28.6%–42.9%), and highest in Telehealth Delivery (% respondents reporting high levels of confidence = 54.2% −80%). Focus groups identified technology skills, risk management (patient safety) and superuser support as priority areas for training. Physiotherapists identified additional local training competencies to compliment the 53-item capability framework. Adopting a sequential multi-methods and participatory approach successfully produced a training package framework suitable for implementation in a public outpatient setting.

临床医生培训与支持不足是物理治疗师采用远程医疗（telehealth）的主要挑战。培训必须以相关能力框架（capability framework）为基础，并通过合作开发以满足现有物理治疗团队的需求与偏好。本研究旨在为远程医疗服务提供建立能力框架，并明确实现公立物理治疗团队专业能力所需的培训要求。

采用序贯多方法研究设计（sequential multi-methods study design）。第一阶段：具有远程医疗经验的物理治疗师参与了两轮电子德尔菲法（e-Delphi process），以就核心能力框架领域达成共识（第一轮n=29；第二轮n=26）。第二阶段：35名物理治疗师（n=35）随后对自身在各能力项上的现有知识与信心进行了评分。第三阶段：参与式焦点小组（participatory focus groups）纳入来自6个机构的37名物理治疗师（n=37），通过主题分析（thematic analysis）确定了与本地情境最相关的理论及实践领域。

研究最终形成了涵盖8个领域的53项能力条目，包括合规性（Compliance）、患者隐私与保密（Patient privacy and confidentiality）、患者安全（Patient safety）、技术技能（Technology Skills）、远程医疗服务交付（Telehealth Delivery）、评估与诊断（Assessment and Diagnosis）、护理计划与管理（Care Planning and Management）、可及性与公平性（Access and Equity）。物理治疗师在技术技能领域的知识与信心评分最低（报告高信心水平的受访者占比为28.6%–42.9%），而在远程医疗服务交付领域评分最高（报告高信心水平的受访者占比为54.2%–80%）。焦点小组确定技术技能、风险管理（患者安全）及超级用户支持为培训优先领域。物理治疗师还提出了补充53项能力框架的本地化培训能力要求。

采用序贯多方法与参与式方法成功构建了适用于公立门诊环境的培训包框架。