Stage One

Considering the BeST intervention in its entirety and the learning outcomes from the original face-to-face training, a set of learning aims for i-BeST were compiled as follows:

 To have an understanding of the cognitive behavioural (CB) model.  To have the skills to deliver a CB group intervention.

 To understand the aims and content of the BeST assessment and group sessions. For each aim, a set of learning objectives were devised, illustrated in Table 11.

Table 11. i-BeST course aims and learning objectives

Aim Learning Objectives

To have a basic understanding of the cognitive behavioural (CB) model.

 To have a basic understanding of the development of cognitive-behavioural therapy.

 To distinguish between a CB approach and CBT.

 To have a good understanding of the CB model, including its assumptions, theory, levels of cognition and use of problem specific formulations.

 To understand the implications of the CB model on thoughts, feeling and behaviours.

 To understand the CB model of LBP and how it forms the basis of the BeST intervention.

 To understand the ‘try it and see’ philosophy of the BeST intervention.

 To understand their scope of practice and their professional boundary.

To have the basic skills to deliver a CB group intervention.

 To be proficient in using an exploratory style of questioning when delivering the BeST intervention.  To be able to elicit and use feedback and summaries.  To understand the concept of guided discovery.

 To facilitate a group managing difficult group members, using active listening and maintaining a discursive style.  Express empathy including dealing with distress.  Effectively teach patients all the self-management skills

detailed in the group sessions 1-6. To understand and

effectively perform the BeST assessment.

 To be able to collaboratively set realistic goals and baselines with patients.

 To understand the steps involved in the patient assessment and how they differ from traditional physiotherapy assessments.

 To be able to perform a patient assessment using the assessment guidelines and form.

To effectively deliver session 1 to patients covering: understanding pain, the complexities of chronic pain, and the effects of inactivity.

 To understand the content of session one including: o Knowledge of the body’s neurophysiology. o Knowledge and implications of chronic pain and

the physiological and psychological factors thought to influence it.

o Knowledge and implications of inactivity.

 To be able to deliver session one to a group of patients following the session narrative and using the crib sheet if needed.

To effectively deliver session 2 to patients covering: the impact of activity levels on pain; the skills of pacing, goal and baseline setting.

 To understand the content of session two including: o The concept of negative activity cycling.

o To be able to explain negative activity cycling to patients.

o To understand and teach the concept of pacing and graded activity.

 To be able to deliver session two to a group of patients following the session narrative and using the crib sheet if needed.

To effectively deliver session 3 to patients covering: the identification of thoughts and their distinction from feelings, and the provision of skills to challenge thoughts.

 To understand the content of session three including: o How our thoughts affect our feelings which affect

our behaviours.

o Negative automatic thoughts (NATS). o Learning how to identify NATS. o Thought challenging techniques.

 To be able to deliver session three to a group of patients following the session narrative and using the crib sheet if needed.

To effectively deliver session 4 to patients covering: education on fear of movement and its associated vicious cycle,

 To understand the content of session four including: o Fear avoidance.

o The vicious cycle associated with fear avoidance. o Relaxation techniques.

and the teaching of relaxation skills.

 To be able to deliver session four to a group of patients following the session narrative and using the crib sheet if needed.

To effectively deliver session 5 to patients covering: education on the effects of worrying about pain, and further relaxation techniques.

 To understand the content of session five including: o Hypervigilance.

o The vicious cycle of behaviour associated with hypervigilance.

o Further relaxation techniques.

 To be able to deliver session five to a group of patients following the session narrative and using crib sheet if needed.

To effectively deliver session 6 to patients covering: planning how to cope during a pain flare up, and revisiting any areas selected by patient/s.

 To understand the content of session six including: o Flare ups and coping strategies for managing

them.

The learning objectives were compared to the assumptions and associated pedagogies of the three main approaches detailed above. A number of these objectives, namely those concerning the learning of factual material, followed that of an associative approach. The remaining outcomes fell under the constructivist perspective, requiring learners to actively integrate new concepts and skills (through practice) into their existing conceptual

knowledge. None of the learning outcomes were found to fit with the situative approach. Based on this assessment of the learning objectives, the online training course included the following learning strategies to ensure the activities matched the relevant theoretical perspectives:

 The content was organised and grouped into small modules.  These modules progressed with increasing difficulty.

 Complex skills, for example, the delivery (content and structure) of a group session, were not presented until the underlying smaller parts had been taught.

 Where applicable:

o Content encouraged experimentation and discovery of principles.

o Learners were presented with opportunities to take ownership of learning tasks.

o Guided discovery was used.

Having identified the perspectives applicable to the i-BeST course and selected relevant learning strategies, the second stage of course development commenced.