3733 Implementing the BOOST (better outcomes for older people with spinal trouble) programme for older people with spinal stenosis
Williamson E., Srikesave C., Richmond H., Walker S., Henley W., Comer C., Rogers D., Dziedzic K., Lamb S.
Abstract Introduction Lumbar spinal stenosis is a disabling condition affecting older people and there is a need to provide effective rehabilitation. The BOOST programme is a group physical and psychological intervention for people with spinal stenosis that we evaluated in the BOOST randomised controlled trial (RCT). The BOOST programme significantly improved walking at 6 and 12 months, reduced falling risk and was cost-effective compared to best practice advice. Disability improved at 6 months. Method A two-stage implementation study. Stage 1: We worked with stakeholders to optimise the programme for implementation and evaluated delivery of the optimised programme at 4 sites. Participants completed the Oswestry Disability Index (ODI) and 6-minute walk test at baseline and 6 months. Stage 2: Integrating stage 1 feedback, we developed and evaluated a Massive Online Open Course (MOOC) to train physiotherapists. We evaluated outcomes when delivering the BOOST programme by a subset of MOOC learners at 9 sites. We used a synthetic control method to test the optimised programme and compare with the BOOST RCT. Results MOOC evaluation: 31 learners enrolled in the MOOC. 24/31 (77%) provided feedback and were satisfied with the training and confident to deliver the programme. 21/24 (87.5%) intended to implement it. At 6 months, 18/31 (58%) responded. 12/18 (66%) reported delivering the programme and 4/18 (22%) reported using programme elements. Clinical outcomes In total, 105 participants attended the optimised BOOST programme. 83 participants completed follow up (79%). Implementation study participants had larger reductions in ODI compared to the BOOST trial control arm [−4.65 points (95% CI -1.53, −7.78)] and walked further [64.85 m (95% CI 42.21, 87.49)]. Increases in walking were twice that seen in the RCT. Conclusions We demonstrated successful implementation of the BOOST programme using a MOOC to train physiotherapists. Improvements in outcomes suggest optimisation was worthwhile.