Asynchronous Distance Learning Performance and Knowledge Retention of the NIH Stroke Scale among Health Care Professionals using Video or E-learning: A Web-based Randomized Controlled Trial (Preprint)

BACKGROUND Stroke treatment has significantly improved over the last decades, but the complexity of stroke cases requires specialized care especially in the first days after onset. To reliably assess neurological deficits, health care professionals (HCPs) must be highly trained, particularly in the usage of the widely used National Institutes of Health Stroke Scale (NIHSS). Traditional didactic methods may not adequately address certain intricacies of NIHSS nor engage HCPs in continuous learning, leading to suboptimal proficiency. In the context of time-constrained clinical settings, e-learning could be a promising alternative for knowledge dissemination and skill acquisition. OBJECTIVE This study aimed to assess the efficacy of a highly interactive e-learning module compared to a traditional didactic video in improving NIHSS knowledge among previously trained HCPs. METHODS A prospective, multi-centric, triple-blind, web-based randomized controlled trial was conducted involving previously trained HCPs working in three Swiss hospitals. Invitation to participate was sent via email, and participants were randomized to either the e-learning or traditional didactic video group through a fully automated process upon self-registration. Pre- and post-training quizzes were administered to assess knowledge acquisition, with a follow-up quiz after one month to evaluate retention. Subjective assessments of learning methods were also collected. RESULTS Of 174 enrolled participants, 97 completed the study course. Both learning methods significantly improved NIHSS knowledge, with the e-learning group demonstrating higher scores in knowledge acquisition (median score: 39 vs 37, P=.031) and retention (mean score: 38.2 vs. 35.8). Participants in the e-learning group were significantly more likely to recommend the learning method (P=.024). CONCLUSIONS A highly interactive e-learning module was found to be an effective asynchronous method for NIHSS knowledge acquisition and retention, in previously NIHSS-trained HCPs, and should therefore be integrated into NIHSS training programs. INTERNATIONAL REGISTERED REPORT RR2-10.3390/healthcare9111460