Alternative strategies to classroom based manual handling update training: achieving consensus using the Delphi Method

Purpose: This study aimed to explore potential alternatives to classroom based manual handling update training and determine if a consensus of opinion could be reached for the alternatives identified.
Relevance: Currently, within the United Kingdom, manual handling training is mandatory, often requiring physiotherapists to attend annual update training. However, classroom based manual handling training is costly and there is an substantial body of evidence suggesting that it is ineffective at reducing back pain or injuries as a standalone intervention. With an increasing pressure to employ evidence based practice, this study explored whether the current approach of classroom based update training, which frequently is delivered to and by physiotherapists, could be improved upon.
Participants: The Manual Handling Service Leads from all fifteen acute sector Health Boards within the National Health Services in Scotland were approached by the researchers and consented to participate as expert panellists.
Methods: A three round Delphi method was used to identify and seek consensus on alternative strategies to classroom based manual handling update training. The initial round, using open ended questions to gather potential alternatives to update training strategies, was followed by two rounds in which the expert panellists (Service Leads) were asked to rank and score the strategies. Each round was preceded by a pilot study of manual handling staff who were not included in the study.
Analysis: Qualitative data were analysed for themes, developed into statements for subsequent rounds and independently checked for accuracy and potential bias. Quantitative data, in the form of ordinal level ranks and scores attributed to the statements, enabled medians to be calculated. Consensus ‘in support’ of a statement was identified when the group median of ranks and scores was ≥51%, and ‘not in support’ was ≤50%. Spearman’s rank correlation (rs) was used to measure the stability of responses between the second and third Delphi rounds.
Results: The response rates for the three Delphi rounds were 100%, 79% and 86%, respectively. The results indicated that the manual handling Service Leads reached consensus in several areas; however, a fourth round may have increased the stability of responses as six of the fifteen rs values calculated did not reach statistical significance (p < 0.05). The alternative strategies that achieved support were the use of competency assessments and onsite coaching/training. Furthermore, the expert panellists agreed that trainees assessed as competent need not attend routine update training. Consensus also determined that poor manual handling practice and low competency scores should be triggers for trainees to attend classroom based update training; although, this contradicts the literature evidence that suggests that this type of training is ineffective at changing work practices.
Conclusions: Consideration should be given to utilising competency assessments as an alternative to classroom based manual handling update training; however, thought should be given as to how to address the learning needs of staff who fail these assessments.
Implications: The widespread policy of insisting on routine manual handling classroom based update training potentially should be altered to one of addressing professional practitioners’ specific learning needs through a process of ongoing competency assessments.