Effectiveness of active learning-based transfer movement training for caregivers working in a residential care home

Abstract

[Purpose] This study examined the effectiveness of active learning-based transfer movement training provided to caregivers by physical therapists. [Participants and Methods] This study enrolled 29 participants (age: 47.0 ± 10.1 years, 22 female participants) working at a residential care home. The participants were shown a video in which caregivers experienced difficulty in transferring a patient; this was followed by group discussions. To verify the effectiveness of this educational intervention, a questionnaire including six items related to reducing the burden on caregivers, daily living care, and rehabilitation was administered to the participants at three time points (before training, three days after training, and one month after training). Multiple comparisons were performed, and the effect size (r) was calculated. [Results] Significant differences were observed between the responses obtained before training and three days after training and between the responses obtained before training and one month after training for all six items. The effect sizes (r) after three days and one month of training were above 0.6 for all six items. [Conclusion] The training improved the assessment skills of caregivers, and its effects persisted after one month, suggesting the effectiveness of active learning-based transfer movement training.

INTRODUCTION

According to the 2024 Nursing Care Labor Survey, 41% of nursing care workers experience heavy physical burden¹⁾, with low back pain being a major health concern causing work disabilities worldwide²⁾. Consequently, reducing the physical burden on caregivers by improving their assessment skills to understand the activities of patients is crucial. Several practical case studies have reported the necessity of assessing patient care from the perspective of behavioral analysis³⁾. However, previous studies on the physical burden on caregivers have only reported teaching caregiving techniques⁴⁾ and the use of lifting devices⁵⁾.

Residential care home is a facility that houses older adults and provides either meals, nursing care, provision of household chores, or health care⁶⁾ and do not require physical therapist members as a part of their facility standards. Therefore, the transfer movement training in this study focused on active learning⁷⁾, a learning method that differs from conventional one-way lecture formats. Active learning involves activities such as writing, speaking, presenting, and externalizing cognitive processes, such as using knowledge to solve problems, speaking, writing, and presenting to others⁸⁾. Notably, nurturing human resources with continuous learning ability throughout their lives, along with independent thinking, is imperative.

Health education on low back pain prevention for caregivers working at university hospitals resulted in a significant decrease in Oswestry Low Back Pain Disability Questionnaire scores, with a large effect size of the intervention⁹⁾. Providing transfer movement training by physical therapists to caregivers working in residential care homes may improve their understanding of patients’ conditions through self-awareness, thereby preventing excessive or insufficient care and contributing to reducing the physical burden on caregivers, in addition to supporting the independence of patients. Notably, promoting self-awareness among caregivers and improving their assessment skills through case studies with other caregivers involving patients with whom they interact on a daily basis are necessary. To our knowledge no reports of educational interventions for caregivers using active learning, systematic reviews of lower back pain have often targeted hospital staff^10,11,12), and there have been insufficient surveys of caregivers working in residential care home.

This study aimed to examine the effectiveness of active-learning-type transfer movement training provided by a physical therapist to caregivers working at a residential care home for older adults using case studies.

PARTICIPANTS AND METHODS

This study was intervention study. The participants were caregivers working in residential care homes who participated in a training session held between November and December 2023. The inclusion criteria were caregivers who had completed an entry-level caregiver training course or had a caregiver certification. Care workers were defined as those who worked at designated long-term care insurance facilities other than home-visit care facilities and provided direct care¹³⁾. Nurses, clerks, kitchen staff, and those who submitted incomplete answers to the questionnaire were excluded. This study followed the principles of the Declaration of Helsinki and was approved by the Ethics Committee of the Ota College of Medical Technology (approval number: 231015). The purpose of the study was explained to the participants, and consent was obtained by writing their names on the questionnaire. The sample size (effect size=0.5, α=0.05, 1-β=0.8) of 27 was calculated using the power analysis application G*Power ver. 3.1.9.6 (Heinrich-Hein University, Düsseldorf, Germany) with reference to Cohen¹⁴⁾.

Information on the basic attributes, including certification, sex, age, and work history, of the participants were obtained through the questionnaire. The training was conducted jointly at three facilities by a certified physical therapist in orthopedic disorders as the facilitator. Although the facilities that participated in the training session had patients who used home rehabilitation services, there was no opportunity for physical therapists to provide commonly training to caregivers.

This is about the flow of active learning-based training. First, shown a video of a patient in which the caregivers experienced difficulty transferring patient, the participants were explained the patient’s physical condition and the body mechanics of assistance. Next, the participants were classified into eight groups, with four or five participants in each group. These groups then discussed patient where the caregivers experienced difficulty with transfers. Notably, the groups were mixed so that participants from different facilities could share their opinions. The physical therapists served as a facilitator during the discussion, focusing on the use of the body during transfers, selection of welfare equipment, and other issues. The specific learning process of active learning is based on the Japanese version of Engeström’s book^{15, 16)}, and involves moving from motivation (confronting a difficult case and being unable to deal with the problem with the knowledge and experience gained so far) to orientation (starting learning activities with the goal of solving the problem) to internalization (acquiring the knowledge necessary to solve the problem). The lecturers conveyed the process from motivation to internalization.

To evaluate the effectiveness of the training, a questionnaire survey was conducted at three time points—pre-training, 3 days after training, and 1 month after training—by one representative from each of the three facilities and a physical therapist who served as the facilitator. The questionnaire included six items related to reducing the burden on caregivers, daily living care, and rehabilitation. The items for reducing the burden on caregivers and daily living care were as follows: (Ⅰ) safe and comfortable positioning is considered and practiced, (Ⅱ) assist patients with minimal physical and mental burden, (III) select and use appropriate welfare equipment for patients. of the items for rehabilitation were as follows: (IV) use assistance methods that maximize patients residual functions, (V) conscious of talking to the patients to motivate them, (VI) encourage patient participation through motivational interactions. A 10-point scale ranging from 1 (not at all) to 10 (completely) was used to score each item. The questionnaire survey items at the three-time points were the same, and free-response columns were provided for the participants’ perceptions of daily transfers and their feedback on the training sessions.

Statistical analysis for each survey item in the questionnaire was performed using the Friedman test, followed by multiple comparisons adjusted using the Bonferroni method. IBM SPSS Statistics 29 for Mac (Armonk, NY, USA) was used for the statistical analysis, and the significance level was set at 0.05. The effect size (r) was calculated when a significant difference was observed. As a rule of thumb, an effect size (r) >0.5 was considered a large effect size¹⁴⁾.

RESULTS

Of the 37 participants who attended the training and provided their consent, 29 caregivers were included in the analysis after excluding 8 participants based on the exclusion criteria (Fig. 1). The basic attributes of the participants are presented in Table 1. In total, 29 caregivers working in residential care homes participated in the training, of which 21 (72%) were care workers. The mean (standard deviation) age of the participants was 47.0 ± 10.1 years, and the number of years of experience as a care worker was 15.8 ± 8.8 years. Notably, all participants were full-time employees.

Fig. 1.

Flowchart of study participants.

Table 1. Basic attributes of the participants.

	n=29
Age: years (mean ± SD)	47.0 ± 10.1
Gender: male/female†	7/22
Type of qualification: first-time healthcare worker training/welfare worker†	8/21
Career: years (mean ± SD)	15.8 ± 8.8

^†Gender and job category are indicated by number of persons. SD: standard deviation.

Table 2 presents the survey results at the three time points. Significant differences were observed for all six items compared with the baseline at 1 week before, 3 days after, and 1 month after training (p<0.01). Effect sizes (r) after 3 days and 1 month of training ranged from 0.62 to 0.74 for all six items. In the free response, 72.4% of the respondents expressed anxiety about transferring patients 1 week before the training, including responses such as “I am not good at transfers” and “I am worried about how I should handle transfers”. In contrast, After one month of training, 86.2% of the respondents had positive comments, such as we are now able to exchange opinions based on the training “I can now exchange opinions based on the content of the training”, “I confirm the cooperative movements of the patient and try to utilize the remaining functions”, and “The physical burden of the patient and caregiver has been reduced by introducing a sliding board”.

Table 2. Median (1st–3rd quartile) and effect size at 3 time points for each survey.

Item		Questionnaire survey	1 week before training	Results at 3 days			Results at 1 months
			(Baseline)
			Median	Median	p-value	Effect sizer	Median	p-value	Effect sizer
			(1st–3rd quartile)	(1st–3rd quartile)		at 3days	(1st–3rd quartile)		at 1 months
Reducing the burden of nursing care, daily living care	Ⅰ.	Safe and comfortable positioning is considered and practiced	7 (6−8)	8 (7−10)	**	0.66	8 (7.5−9)	**	0.64
	Ⅱ.	Assist patients with minimal physical and mental burden	7 (6−8)	8 (7−9.5)	**	0.62	8 (7.5−9)	**	0.70
	Ⅲ.	Select and use appropriate welfare equipment for patients	7 (5−8)	9 (6.5−9.5)	**	0.74	8 (6.5−9)	**	0.69
Rehabilitation	Ⅳ.	Use assistance methods that maximize patients residual functions	7 (5−8)	8 (7.5−9.5)	**	0.63	8 (8−9)	**	0.68
	Ⅴ.	Conscious of talking to the patients to motivate them	7 (6−8.5)	9 (7.5−10)	**	0.65	9 (7−9.5)	**	0.70
	Ⅵ.	Encourage patient participation through motivational interactions	6 (5−8)	8 (7−10)	**	0.65	8 (7−9)	**	0.63

**p<0.01: Multiple comparisons adjusted by Bonferroni method.

DISCUSSION

The results of our questionnaire survey revealed significant differences in all six items at 3 days and 1 month after the training compared with the baseline at 1 week before the training, suggesting that the transfer movement training using the case study was effective. In particular, our finding that the questionnaires on assessment skills of the caregivers remained at a high level until 1 month after the training suggesting a positive impact of the active-learning-type training.

The effect size (r) of each item in the questionnaire survey was ≥0.6 in all patients, owing to the caregivers are becoming more aware and learning from case studies through their proactive participation in the group discussions. Notably, the effect size for the response “(Ⅱ) assist patients with minimal physical and mental burden” and “(V) Conscious of talking to the patients to motivate them” were 0.7, even after 1 month of training, suggesting that appropriate quality and quantity of assistance could be provided therefore the patient’s task performance level in daily life assistance. This may be due to the fact that the survey results were positively influenced by the fact that the carers were able to review videos of patients with transfer difficulties and discuss the physical functions and body mechanics of the assistance with other carers. A previous study did not report any change in caregivers’ performance when only lecture-style training was used¹⁷⁾. Therefore, practical training in this field should be considered.

This study has some limitations. First, our study only enrolled caregivers working in residential care homes. Therefore, our findings may not apply to caregivers working in geriatric insurance facilities or hospitals where physical therapists are also present as staff. Second, although the facilities that participated in the training had not previously had the opportunity for physical therapists to provide common training to caregivers, the presence or absence of experience working together in home rehabilitation is a point where the sampling vice could not be ruled out. Third, subjective data from caregivers were analyses using questionnaires. This was a subjective survey, and the validity of questionnaire items is yet to be verified. In addition, we cannot consider physical burdens such as low back pain, as we did not survey the physical condition of each caregiver. In the future, it will be necessary to clarify the relationship between patient understanding, caregiving, and back pain by observing actual caregiving situations. A qualitative interview study on fatigue and its countermeasures among hospital nurses indicated improving nursing skills through training and education and assigning appropriate jobs can help reduce the physical burden on nurses¹⁸⁾. Therefore, quantitative surveys and surveys on the quality of nursing care that consider the physical burden on caregivers are necessary in the future.

In conclusion, the participants, mainly caregivers, received lectures along with individual awareness and learning and actionable training contents. Notably, the questionnaires on assessment skills of the caregivers working at residential care homes improved after the transfer movement training, and this effect was maintained even 1 month after the training.

Conflict of interest

The authors declare no conflict of interest.