Physiopedia team research explores how tailored CPD supported stroke rehabilitation in Myanmar

Members of the Physiopedia team have co-authored a new open access study in BMC Health Services Research looking at whether a continuing professional development programme built around real-world constraints could help physiotherapists in Myanmar strengthen evidence-based stroke rehabilitation. Shala Cunningham, Martina Lukin, Hsu Wai Mon Oo and Rachael Lowe contributed to the work, which found that participants improved their knowledge and skills and, six months on, were adapting what they had learned into everyday practice despite significant resource and infrastructure challenges.

Stroke is one of the leading causes of disability worldwide, and most stroke-related disability occurs in low- and middle-income countries where access to acute care is limited. That places even greater weight on rehabilitation as a route to recovery, yet the physiotherapists delivering it often work with few specialists, limited equipment and, in Myanmar, ongoing disruption to the health system. This study set out to answer a question that matters to continuing professional development everywhere. Can training designed around a specific context actually change what clinicians do once they return to practice?

To explore this, the team evaluated a four-week blended learning programme that combined online coursework, live mentoring and hands-on in-person clinical skills training. Seventeen rehabilitation professionals took part in the online component and sixteen physiotherapists completed the in-person training. They used the Kirkpatrick model to evaluate the programme, which looks beyond whether learners enjoyed a course to whether their knowledge, behaviour and practice genuinely shifted. Surveys were gathered before, during and six months after the training, alongside follow-up focus groups.

Participants reported meaningful improvements in their knowledge and confidence, with the largest gains in techniques that need little or no equipment. Six months later they described putting that learning to use, from differentiating between types of stroke and choosing appropriate outcome measures to applying clinical guidelines and selecting suitable treatments. The focus groups surfaced four themes: shifting perceptions of rehabilitation among families and referrers, a need for stronger training in fine motor rehabilitation, resourceful adaptation of techniques for low-resource settings and the importance of a supportive learning community. Some adaptations were remarkably inventive, with therapists recreating mirror therapy using sand and shadows, or improvising orthotic support from elastic bandages, once they understood the principle behind the technique.

So why is this of interest to you? If you design or take part in CPD, the study is a useful reminder that transferable clinical reasoning often travels further than resource-heavy protocols. Understanding why a technique works allowed these clinicians to adapt it to their own setting, and in some cases to apply it to entirely different patient groups. The findings also show how much peer learning and a sense of community contribute to sustaining professional development, particularly for clinicians who work in relative isolation. There is something here for anyone interested in workforce development, global health or simply how learning translates into practice.

The authors are clear about the limitations. This was a small, single-country study that relied on self-reported outcomes, so it points to promising approaches rather than firm proof of what works. Even so, it adds valuable insight to a growing evidence base on how to make rehabilitation education effective in fragile and resource-constrained settings, and how communities of practice can help learning last.

A big shout out to Shala, Martina, Hsu Wai and Rachael from our Physiopedia team, whose work on this sits alongside co-authors Daniel Miner and Abdulgafoor M Bachani. You can read the full paper, Continuing professional development to strengthen stroke rehabilitation: learning outcomes from Myanmar, which is available open access in BMC Health Services Research.