Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review

INTRODUCTION

Paediatric occupational therapy seeks to improve children's engagement and participation in life roles. A wide variety of intervention approaches exist. Our aim was to summarise the best-available intervention evidence for children with disabilities, to assist families and therapists choose effective care.

METHODS

We conducted a systematic review (SR) using the Cochrane methodology, and reported findings according to PRISMA. CINAHL, Cochrane Library, MEDLINE, OTSeeker, PEDro, PsycINFO were searched. Two independent reviewers: (i) determined whether studies met inclusion: SR or randomised controlled trial (RCT); an occupational therapy intervention for children with a disability; (ii) categorised interventions based on name, core components and diagnostic population; (iii) rated quality of evidence and determined the strength of recommendation using GRADE criteria; and (iv) made recommendations using the Evidence Alert Traffic Light System.

RESULTS

129 articles met inclusion (n = 75 (58%) SRs; n = 54 (42%)) RCTs, measuring the effectiveness of 52 interventions, across 22 diagnoses, enabling analysis of 135 intervention indications. Thirty percent of the indications assessed (n = 40/135) were graded 'do it' (Green Go); 56% (75/135) 'probably do it' (Yellow Measure); 10% (n = 14/135) 'probably don't do it' (Yellow Measure); and 4% (n = 6/135) 'don't do it' (Red Stop). Green lights were: Behavioural Interventions; Bimanual; Coaching; Cognitive Cog-Fun & CAPS; CO-OP; CIMT; CIMT plus Bimanual; Context-Focused; Ditto; Early Intervention (ABA, Developmental Care); Family Centred Care; Feeding interventions; Goal Directed Training; Handwriting Task-Specific Practice; Home Programs; Joint Attention; Mental Health Interventions; occupational therapy after toxin; Kinesiotape; Pain Management; Parent Education; PECS; Positioning; Pressure Care; Social Skills Training; Treadmill Training and Weight Loss 'Mighty Moves'.

CONCLUSION

Evidence supports 40 intervention indications, with the greatest number at the activities-level of the International Classification of Function. Yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions could be discontinued because effective alternatives existed.

Implementing Evidence-Based Interventions With Community-Dwelling Older Adults: A Scoping Review

OBJECTIVE

With the rapid growth of the community-dwelling older adult population, evidence-based occupational therapy interventions targeting older clients need to be effectively implemented. However, little is understood about the factors influencing effective intervention implementation into practice.

METHOD

We performed a scoping review to explore what strategies and factors relate to the uptake of older adult interventions into practice. Concepts from implementation science literature guided our review.

RESULTS

Our review yielded 13 articles that met our search criteria. Study designs examined barriers, facilitators, and strategies related to the implementation of evidence-based older adult interventions into practice. Effective implementation strategies included training sessions, workshops, consultations, and outreach meetings.

CONCLUSION

Our findings suggest that practitioners, administrators, and researchers should adopt strategies such as workshops, consultations, fidelity vignettes, peer mentoring, and standardized training to effectively implement research into practice with older adults.

Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials

OBJECTIVE

The aim of this study was to investigate the effectiveness of interventions aimed at moving research evidence into stroke rehabilitation practice through changing the practice of clinicians.

DATA SOURCES

EMBASE, CINAHL, Cochrane and MEDLINE databases were searched from 1980 to April 2019. International trial registries and reference lists of included studies completed our search.

REVIEW METHODS

Randomized controlled trials that involved interventions aiming to change the practice of clinicians working in stroke rehabilitation were included. Bias was evaluated using RevMan to generate a risk of bias table. Evidence quality was evaluated using GRADE criteria.

RESULTS

A total of 16 trials were included (250 sites, 14,689 patients), evaluating a range of interventions including facilitation, audit and feedback, education and reminders. Of which, 11 studies included multicomponent interventions (using a combination of interventions). Four used educational interventions alone, and one used electronic reminders. Risk of bias was generally low. Overall, the GRADE criteria indicated that this body of literature was of low quality. This review found higher efficacy of trials which targeted fewer outcomes. Subgroup analysis indicated moderate-level GRADE evidence (103 sites, 10,877 patients) that trials which included both site facilitation and tailoring for local factors were effective in changing clinical practice. The effect size of these varied (odds ratio: 1.63-4.9). Education interventions alone were not effective.

CONCLUSION

A large range of interventions are used to facilitate clinical practice change. Education is commonly used, but in isolation is not effective. Multicomponent interventions including facilitation and tailoring to local settings can change clinical practice and are more effective when targeting fewer changes.

Therapy interventions for children with neurodisabilities: a qualitative scoping study

BACKGROUND

Therapy interventions emerged four times in the top 10 research priorities in a James Lind Alliance research prioritisation exercise for children with neurodisabilities (Morris C, Simkiss D, Busk M, Morris M, Allard A, Denness J, et al. Setting research priorities to improve the health of children and young people with neurodisability: a British Academy of Childhood Disability-James Lind Alliance Research Priority Setting Partnership. BMJ Open 2015;5:e006233). The National Institute for Health Research (NIHR) commissioned this study as part of an information-gathering exercise in response to this.

OBJECTIVES

The objectives were to (1) describe the current practice, approaches and schools of thought in relation to physiotherapy, occupational therapy and speech and language therapy for children with neurodisability; (2) explore clinical decision-making; (3) investigate views on outcomes and their measurement, particularly participation as an outcome, that is, the child's ability to have the opportunity to be involved in life situations and activities (e.g. communication, mobility, interpersonal interactions, self-care, learning and applying knowledge); (4) seek views on the aspects of therapy interventions that have an impact on outcomes; and (5) elicit stakeholder views on research needs and priorities.

DESIGN, SETTING AND PARTICIPANTS

More than 70 professionals (therapists, service leads, paediatricians and education staff) and 25 parents participated in a qualitative interview (either individually or as part of a focus group).

RESULTS

Professional thinking and models of service delivery are in a state of flux and development. There is a move towards goals-focused, family-centred approaches. Work tends to be highly individualised, with few protocols. Parents are certain of the value of therapies, although they may experience difficulties with provision and may seek (additional) private provision. Therapy interventions are conceived as three components: the therapist, the procedures/equipment, etc., and the wider therapeutic environment. They are believed to be highly complex and poorly understood. Although participation is widely endorsed as a core intervention objective of therapy interventions, its suitability, or appropriateness, as an outcome measure was questioned. Other child and/or parent outcomes were identified as more or equally important. Notions of intermediate outcomes - in terms of body structure/function, and the achievement of activities - were regarded as important and not counter to participation-focused approaches. Among therapists, research on intervention effectiveness was (cautiously) welcomed. A number of methodological challenges were identified. A portfolio of study designs - quantitative and qualitative, experimental and observational - was called for, and which included economic evaluation and clear pathways to impact.

LIMITATIONS

The study was not successful in recruiting children and young people. Further work is required to elucidate the views of this key stakeholder group.

CONCLUSIONS

Therapy interventions are poorly understood. There was strong support, tempered a little by concerns among some about the feasibility of demonstrating impact, for investment in research.

FUTURE WORK

The identification of research priorities was a core study objective, and a wide-ranging research agenda was identified. It included 'foundational' research into neurodisability, the active components of therapy interventions and the concept of participation. Three areas of evaluation were identified: overall approaches to therapy, service organisation and delivery issues, and the evaluation of specific techniques. Parents regarded evaluations of approaches to therapy (e.g. goals-focused; supporting family-self management) as priorities, along with evaluations of models of service provision. Professionals' views were broadly similar, with an additional emphasis on methodological research. In terms of specific techniques, there was no shared agreement regarding priorities, with views informed by personal interests and experiences.

FUNDING

The NIHR Health Technology Assessment programme.

Occupational Therapists' Self-Reported Research Utilization and Use of Online Evidence Sources

Research utilization of occupational therapists may positively influence the quality and cost-effectiveness of service delivery; however, previous studies suggest that therapists' overall use of research in clinical practice is limited. This cross-sectional study used survey methodology to investigate the research utilization behaviors of occupational therapists and examine the differences in behaviors between those who had and had not used the Navigator^®. The Navigator^® online competence assessment platform supports research utilization through recommended readings and access to online databases with full-text articles. Findings showed a low level of research utilization overall, with Navigator^® users more likely to use online databases than non-users. Future research should examine if access to online platforms, such as the Navigator^®, combined with context-specific training that integrates active learning approaches could improve occupational therapists' research utilization for increased implementation of evidence-based practice.

Attitudes, skills and use of evidence-based practice among UK osteopaths: a national cross-sectional survey

BACKGROUND

Evidence-based practice (EBP) is a clinical decision-making framework that supports quality improvement in healthcare. While osteopaths are key providers of musculoskeletal healthcare, the extent to which osteopaths engage in EBP is unclear. Thus, the aim of this cross-sectional study was to investigate UK osteopaths' attitudes, skills and use of EBP, and perceived barriers and facilitators of EBP uptake.

METHODS

UK-registered osteopaths were invited to complete the Evidence-Based Practice Attitude and Utilisation Survey (EBASE) online.

RESULTS

Of the 5200 registered osteopaths in the UK, 9.9% (517/5200) responded to the invitation, and 7.2% (375/5200) completed the EBASE (< 20% incomplete answers). The demographic characteristics of the survey sample were largely similar to those of the UK osteopathy workforce. The osteopaths reported overall positive attitudes towards EBP, with most agreeing that EBP improves the quality of patient care (69.3%) and is necessary for osteopathy practice (76.5%). The majority reported moderate-level skills in EBP, and most (80.8%) were interested in improving these skills. Participating osteopaths typically engaged in EBP activities 1-5 times over the last month. Barriers to EBP uptake included a lack of time and clinical evidence in osteopathy. Main facilitators of EBP included having access to online databases, internet at work, full-text articles, and EBP education materials.

CONCLUSIONS

UK osteopaths were generally supportive of evidence-based practice, had moderate-level skills in EBP and engaged in EBP activities infrequently. The development of effective interventions that improve osteopaths' skills and the incorporation of EBP into clinical practice should be the focus of future research.

Evidence-Based Practice in Primary Care Occupational Therapy: A Cross-Sectional Survey in Sweden

Introduction

Understanding of attitudes, knowledge, and behaviour related to evidence-based practice (EBP) and guidelines in Swedish occupational therapy is limited. The study aims were to investigate attitudes, knowledge, and behaviour related to evidence-based practice and guidelines of Swedish occupational therapists in primary care.

Methods

A web-based survey of 94 Swedish primary care occupational therapists (response rate 53.7%). Data were analysed using logistic regressions.

Results

Attitudes towards EBP and guidelines were highly positive (97%–98%). About half of the respondents reported confidence in finding and using evidence. Almost two-thirds reported being aware of guidelines and 47% knowing where to find guidelines. Four-fifths stated that they had easy access to guidelines and 75% that they used guidelines frequently. Men were more likely to feel confident to find research (OR 8.58, 95% CI 1.03 to 71.66; p = 0.047) and have easy access to guidelines (OR 9.10, 95% CI 1.94 to 42.83; p = 0.005). Occupational therapists older than 50 years were more likely to integrate patient preferences with guideline use (OR 6.44, 95% CI 1.14 to 36.57; p = 0.035). Few reported reading scientific articles, and many expressed uncertainty in finding research. The main barrier for using guidelines was reported to be lack of time.

Conclusion

Although attitudes among primary care occupational therapists towards EBP are positive and a large proportion report using guidelines, many state that they want to learn more and improve their evidence-based practice skills. The findings suggest that education measures need to be taken to address the identified shortcomings.

Evidence-based practice profiles among bachelor students in four health disciplines: a cross-sectional study

BACKGROUND

Despite the recognition of integrating evidence-based practice (EBP) in educational programs, there is limited research about bachelor students' EBP profiles (EBP knowledge, attitudes and behaviour) in the health disciplines nursing, occupational therapy, physiotherapy and radiography. The aim of this study was to assess EBP profiles among bachelor students in health disciplines, and explore differences between health disciplines, educational institutions, students' assessment of EBP teaching and expectations of EBP performance.

METHODS

A survey using the 'Evidence-Based Practice Profile - Norwegian version' (EBP²-N) was conducted among final year bachelor students in health disciplines from four educational institutions. The questionnaire consisted of five domains (Relevance, Terminology, Confidence, Practice and Sympathy) and assessed the five steps of EBP. We performed regression analyses to analyse mean differences in domain scores between health disciplines, Cohen's d to illustrate the magnitude of the largest difference in each domain, Omega squared to describe portion of variance in domain scores, and Spearman's rho (r_s) to assess the monotonic relationship between EBP²-N domains and assessment of EBP teaching and expectations of EBP performance, respectively.

RESULTS

Students reported highest overall mean score for Relevance, with an estimated standardized mean of 81.2 (CI 95% = 80.4-82.0). The other EBP²-N domains had estimated standardized means of 54 and less. Statistically significant differences (p < 0.03) between health disciplines were observed for all domains. The largest mean difference was found for Relevance with highest score for occupational therapy and lowest for radiography, with an estimated Cohen's d of 1.11. Moderate positive associations were observed between Relevance scores and students' assessment of EBP teaching (r_s = 0.31), and expectations of EBP performance from teachers (r_s = 0.36). We also observed a moderate positive correlation between Confidence and students' assessment of EBP teaching (r_s = 0.46).

CONCLUSION

Bachelor students in health disciplines found EBP relevant, but revealed low understanding of EBP terminology, low confidence with EBP skills, and low use of EBP in clinical situations. We observed differences in EBP profiles between health disciplines and between educational institutions. The differences in scores raise questions about the understanding of EBP within disciplines, and the complexity of EBP in educational settings.

Implementing evidence-based practice: A context analysis to examine use of task-based approaches to upper-limb rehabilitation

Statement of context

Many occupational therapists experience challenges in implementing evidence-based practice, which may be best approached as a context-specific enterprise.

Critical reflection on practice

This practice analysis article reports the results of analyzing 24 home programs that occupational therapists issued to rehabilitation inpatients with stroke upon their discharge home. Home programs did not reflect a task-based approach to upper-limb recovery, even though this is supported by established evidence. Examination of contextual factors provides a framework to facilitate evidence implementation.

Implications for practice

Occupational therapists may optimize evidence-based practice implementation by first evaluating and addressing practice-specific contextual factors.

Evidence based practice in traditional & complementary medicine: An agenda for policy, practice, education and research

OBJECTIVE

To develop a policy, practice, education and research agenda for evidence-based practice (EBP) in traditional and complementary medicine (T&CM).

METHODS

The study was a secondary analysis of qualitative data, using the method of roundtable discussion. The sample comprised seventeen experts in EBP and T&CM. The discussion was audio-recorded, and the transcript analysed using thematic analysis.

RESULTS

Four central themes emerged from the data; understanding evidence and EBP, drivers of change, interpersonal interaction, and moving forward. Captured within these themes were fifteen sub-themes. These themes/sub-themes translated into three broad calls to action: (1) defining terminology, (2) defining the EBP approach, and (3) fostering social movement. These calls to action formed the framework of the agenda.

CONCLUSIONS

This analysis presents a potential framework for an agenda to improve EBP implementation in T&CM. The fundamental elements of this action plan seek clarification, leadership and unification on the issue of EBP in T&CM.

Integrating Occupational Therapy Specific Assessments in Practice: Exploring Practitioner Experiences

BACKGROUND

Occupational therapists sometimes find it challenging to integrate client-centered and occupational therapy specific assessments in practice. The aim of this study was to explore the use of occupational therapy specific assessments such as the Assessment of Motor and Process Skills (AMPS) among occupational therapists in Sweden and Japan.

METHODS

Interviews and qualitative thematic analyses were utilized.

FINDINGS

Four themes are reported: (1) use it or lose it, (2) simply no space until after hours, (3) biggest barriers can be colleagues, and (4) being more specific: communication.

CONCLUSION

In keeping with previous studies, occupational therapists often find it challenging to implement client-centered and occupation-based assessment tools into practice. However, more work is needed to understand how best practices can be incorporated into a changing occupational therapy daily practice.

Assessing occupational performance in special housing in Sweden

BACKGROUND

Assessing occupational performance is commonly done by occupational therapists [OTs] working in special housing in municipal elder care. Assessments should be relevant and evidence-based. Even so, we know little about how assessment of occupational performance is conducted in special housing.

AIM

The aim of this study was to identify OTs' use and perceptions of different methods to assess occupational performance for elderly clients living in special housing.

METHOD

An email questionnaire was sent to OTs working in special housing in Sweden. Data was analyzed using descriptive and parametric statistics.

RESULTS

The findings, based on data from 660 respondents, showed that OTs regularly assessed occupational performance but did not use standardized assessment instruments or structured methods to any great extent. In general, OTs reported that they were not pleased with their ability to assess their clients; however, OTs with higher education and with responsibility for fewer clients were more pleased with their assessments and stated that they had more knowledge about assessment methods.

CONCLUSIONS

To support OTs in using structured assessments of occupational performance in everyday practice, organization as well as structures in the work environment and educational development need to be taken into consideration.

Beliefs, Knowledge, Implementation, and Integration of Evidence-Based Practice Among Primary Health Care Providers: Protocol for a Scoping Review

BACKGROUND

The adoption of evidence-based practice (EBP) is promoted because it is widely recognized for improving the quality and safety of health care for patients, and reducing avoidable costs. Providers of primary care face numerous challenges to ensuring the effectiveness of their daily practices. Primary health care is defined as: the entry level into a health care services system, providing a first point of contact for all new needs and problems; patient-focused (not disease-oriented) care over time; care for all but the most uncommon or unusual conditions; and coordination or integration of care, regardless of where or by whom that care is delivered. Primary health care is the principal means by which to approach the main goal of any health care services system: optimization of health status.

OBJECTIVE

This review aims to scope publications examining beliefs, knowledge, implementation, and integration of EBPs among primary health care providers (HCPs).

METHODS

We will conduct a systematic scoping review of published articles in the following electronic databases, from their start dates until March 31, 2017: Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed (from 1946), Embase (from 1947), Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1937), the Cochrane Central Register of Controlled Trials (CENTRAL; from 1992), PsycINFO (from 1806), Web of Science (from 1900), Joanna Briggs Institute (JBI) database (from 1998), Database of Abstracts of Reviews of Effects (DARE; from 1996), Trip medical database (from 1997), and relevant professional scientific journals (from their start dates). We will use the predefined search terms of, "evidence-based practice" and, "primary health care" combined with other terms, such as, "beliefs", "knowledge", "implementation", and "integration". We will also conduct a hand search of the bibliographies of all relevant articles and a search for unpublished studies using Google Scholar, ProQuest, Mednar, and WorldCat. We will consider publications in English, French, Spanish, and Portuguese.

RESULTS

The electronic database searches were completed in April 2017. Retrieved articles are currently being screened, and the entire study is expected to be completed by November 2017.

CONCLUSIONS

This systematic scoping review will provide a greater understanding of the beliefs, knowledge, implementation, and integration of EBPs among primary HCPs. The findings will inform clinical practice and help to draw a global picture of the EBP research topics that are relevant to primary care providers.

Supporting evidence-based practice: Changes in service provision and practitioners’ attitudes following EBP Service Centre consultation – a qualitative study / Evidenzbasierte Praxis unterstützen: Veränderungen der Arbeitsweise und der Einstellungen von Ergotherapeuten/-innen durch die Nutzung eines EBP Service Centers - eine qualitative Studie

Evidence-based practice (EBP) aims at optimal fulfilment of clients´ needs, but also plays an essential role in establishing an effective and efficient health care system. It is no longer a question whether EBP is essential and valued, but rather how to sustainably implement it into clinical practice. A new implementation strategy of an EBP workshop in combination with a CAT (critically appraised topic) service was established and investigated.

The aim of this study was to explore post EBP Service Centre consultation effects regarding occupational therapists’ changes in service provision, professional viewpoints and attitudes and job satisfaction. The second aim was receiving feedback on the EBP Service Centre for its further development.

For the evaluation of the EBP Service Centre the qualitative approach of content analysis by Gläser and Laudel was chosen. Two focus group discussions with 13 participants were conducted.

The combination of an EBP workshop and a CAT service, as provided by the EBP Service Centre, seems to be an effective tool to facilitate EBP implementation. The service was used intensively. Participants reported changes in service provision, e.g. increased client-centredness and occupation-based practice and changed professional attitudes like increased reflection and critical questioning.

A division of resources and strengths between research staff and practitioners seems to be reasonable. Hence research staff takes over literature search and appraisal and produces CATs, whereas practitioners focus on asking clinical questions and integrating the knowledge from the CAT into their clinical decisions.

Fostering Full Implementation of Evidence-Based Practice

Evidence-based practice (EBP) is a widely endorsed concept, but many occupational therapy practitioners would like to be more informed and supported in its full implementation. They need information on the evolving definitions and concepts of EBP, encouragement to develop and adopt EBP models that link to occupational therapy's professional values, and methods that translate evidence into answers for clinical questions. This column discusses these needs and makes recommendations to the American Occupational Therapy Association for addressing them.

Mental health education in occupational therapy professional preparation programs: Alignment between clinician priorities and coverage in university curricula

BACKGROUND/AIM

Occupational therapy programs must prepare graduates for work in mental health. However, this area of practice is complex and rapidly changing. This study explored the alignment between educational priorities identified by occupational therapists practising in mental health and level of coverage of these topics in occupational therapy programs in Australia and New Zealand.

METHODS

Surveys were distributed to heads of all occupational therapy programs across Australia and New Zealand. The survey included educational priorities identified by occupational therapists in mental health from a previous study. Respondents were requested to identify the level of coverage given to each of these priorities within their curriculum. These data were analysed to determine a ranking of educational topics in terms of level of coverage in university programs.

RESULTS

Responses were received for 19 programs from 16 universities. Thirty-four topics were given 'High-level coverage' in university programs, and these were compared against the 29 topics classified as 'Essential priorities' by clinicians. Twenty topics were included in both the 'Essential priorities' and 'High-level coverage' categories. Topics considered to be 'Essential priorities' by clinicians which were not given 'High-level coverage' in university programs included the following: mental health fieldwork experiences; risk assessment and management; professional self-care resilience and sensory approaches.

CONCLUSION

While there appears to be overall good alignment between mental health curricula and priorities identified by practising occupational therapists, there are some discrepancies. These discrepancies are described and establish a strong foundation for further discussion between clinicians, academics and university administration to support curriculum review and revision.

Evidence-based interventions involving occupational therapists are needed in re-ablement for older community-living people: A systematic review

Introduction

Re-ablement services are in a period of strong development, but the terms and definitions used remain unclear, and the scientific evidence is still weak. The aim of this systematic review was to obtain an overview of the scientific literature in this evolving research area, and investigate whether there is scientific evidence for positive effects of re-ablement services for older community-living people.

Method

The systematic literature search was conducted in the databases CINAHL, PubMed and Svemed+(Swemed) and covered the years 2000–2014. Owing to the heterogeneity in the included studies, a narrative synthesis was performed.

Results

Eight original publications were found eligible and included in the systematic review. When addressed, terms and definitions varied among the papers. Effects such as less use of home care, higher likelihood to live at home, improved activities of daily living (ADL) skills, quality of life and physical health, increased physical activity and lower costs compared to conventional home care were reported.

Conclusion

More high-quality research is needed to strengthen the evidence-base regarding re-ablement services. The specific roles of various professional and staff groups are often insufficiently described, as are the interventions as such, and there is a lack of attention to person-centered aspects such as the meaningfulness of the specific activities.

Beliefs and implementation of evidence-based practice among nurses and allied healthcare providers in the Valais hospital, Switzerland

RATIONALE

Evidence-based practice (EBP) is upheld as a means for patients to receive the most efficient care in a given context. Despite the available evidence and positive beliefs about it, implementing EBP as standard daily practice still faces many obstacles.

AIMS AND OBJECTIVES

This study investigated the beliefs about and implementation of EBP among nurses and allied healthcare providers (AHP) in 9 acute care hospitals in the canton of Valais, Switzerland.

MATERIALS AND METHODS

A cross-sectional descriptive survey was conducted. The target population was composed of 1899 nurses and 126 AHPs. Beliefs about and implementation of EBP were measured using EBP-Beliefs and EBP-Implementation scales of Melnyk et al.

RESULTS

The initial sample consisted in 491 participants (overall response rate 24.2%): 421 nurses (22.4% response rate) and 78 AHPs (61.9% response rate). The final sample, composed only of those who declared previous exposure to EBP, included 391 participants (329 nurses and 62 AHPs). Overall, participants had positive attitudes towards EBP and were willing to increase their knowledge to guide practice. However, they acknowledged poor implementation of EBP in daily practice. A significantly higher level of EBP implementation was declared by those formally trained in it (P = 0.006) and by those occupying more senior professional functions (P = 0.004). EBP-Belief scores predicted 13% of the variance in the EBP-Implementation scores (R²  = 0.13).

DISCUSSION

EBP is poorly implemented despite positive beliefs about it. Continuing education and support on EBP would help to ensure that patients receive the best available care based on high-quality evidence, patient needs, clinical expertise, and a fair distribution of healthcare resources.

CONCLUSION

This study's results will be used to guide institutional strategy to increase the use of EBP in daily practice.

How attention to everyday technology could contribute to modern occupational therapy: A focus group study

Introduction

Everyday technologies such as mobile phones and ticket vending machines have become increasingly indispensable, profoundly influencing daily life activities. Yet this has been given little attention in occupational therapy. The aim of this study was to explore occupational therapists’ views on everyday technologies’ relevance, meaning and potential applicability in practice.

Method

Focus groups were undertaken with 42 occupational therapists who had been introduced to an assessment of people’s ability to use everyday technologies. Data comprised eight focus groups and were analysed with a constant comparative approach.

Findings

The findings show how the participants’ fields of vision expanded when they discovered new ways of using information related to their clients’ everyday technology use, and new roles as therapists that would help make occupational therapy ‘modern’, that is, more timely and up-to-date. However, this also implied a risk of receiving information that was considered potentially unethical if the detected problems could not be dealt with.

Conclusion

Attending to clients as everyday technology users could give occupational therapists new expert roles, and allow clients to be seen as more complete persons. However, as this opportunity also involves priority conflicts and ethical dilemmas, the issue can inspire critical discussion about client-centred occupational therapy.

Research-based evidence in stroke rehabilitation: an investigation of its implementation by physiotherapists and occupational therapists

PURPOSE

Stroke rehabilitation is a multidimensional process that is designed to facilitate restoration of and/or adaptation to loss of functioning. The use of research-based evidence in informed decision-making is insufficient. Occupational therapy and physiotherapy constitute important contributions to rehabilitation. The study aim was to investigate characteristics of the implementation of research-based evidence in stroke rehabilitation by occupational therapists and physiotherapists, using the International Classification of Functioning, Disability and Health as a conceptual framework.

METHOD

A prospective cohort study, including all service levels within stroke rehabilitation. Consecutive patients with stroke admitted to a university hospital between May and December 2012 were enrolled by 13 therapists. Documentation of daily practice was collected from medical records. Analysis compared the therapists' documentation with the national clinical guidelines for physiotherapy and occupational therapy in the rehabilitation of adults with brain injury.

RESULTS

The study included 131 patients. The therapists' praxis was seen to be in agreement with the majority of the national clinical guidelines. However, joint goal-setting and evaluation using standardized measures were seldom documented.

CONCLUSIONS

Although the therapists recognize evidence-based practice as a framework for achieving quality in rehabilitation, findings suggest that they do not employ research-based evidence to the fullest extent. Implications for Rehabilitation In order to individualize the rehabilitation offered, more attention and focus on involving and giving words to patients' expectations, perceptions, experiences, and perspectives is needed. With the intention of enabling meaningful participation the health professionals need to pay more attention to the importance of environmental factors. Both guidelines and clinical practice should consider all components of the International Classification of Functioning, Disability and Health when formulating, and implementing, recommendations in rehabilitation praxis in order to aim for rehabilitation that is based both on evidence and a holistic approach.

Results of a School-Based Evidence-Based Practice Initiative

OBJECTIVE

To investigate the effects of a 17-mo initiative designed to increase practitioners' knowledge and skills related to evidence-based practice (EBP) in the schools.

METHOD

We evaluated participants' EBP knowledge and skills at pretest and posttest using the Adapted Fresno Test (AFT) and collected their perceptions through a survey.

RESULTS

Participants demonstrated significant improvements in their EBP knowledge and skills after participating in this initiative as measured by changes in AFT scores. A significant difference was noted in scores between pretest (μ=43.9, SD=32.67) and posttest (μ=74.66, SD=33.99), t(28)=-5.645, p<.001.

CONCLUSION

This initiative was influential in increasing school-based practitioners' EBP knowledge and skills.

New graduates’ experience of evidence-based practice: An action research study

Introduction

The aim of this project was to explore how occupational therapy graduates in New Zealand engaged with evidence-based practice.

Method

The study adopted an action research approach. Five new graduates were recruited and worked with the researcher to identify practical problems related to using evidence-based practice and to propose solutions. Surveys, email and discussion groups were used to collect data over three action research cycles.

Findings

The main findings from this study were that new graduates are more likely to use research evidence when prompted to do this by their supervisor (or another external source) and that senior occupational therapists are identified as essential to both demonstrate and motivate evidence-based behaviours. New graduates used evidence to justify their practice to others, increase self-confidence and to inform themselves. The evidence used was commonly based on the expertise of senior therapists.

Conclusion

For new graduates the tasks of searching and evaluating evidence are secondary to developing and clarifying their clinical knowledge and skills. The expectations of the workplace and the partnership between new graduate and experienced clinician are highly influential in establishing regular habits related to evidence-based practice.

Maintaining occupation-based practice in Australian mental health practice: A critical stance

Introduction

This paper explores the way dominant discourses, and their associated practice knowledge dimensions, shape personal paradigms and occupation-based practice in mental health workplaces.

Method

Narrative inquiry methods and narrative thematic analysis was used to explore the career stories of nine occupational therapists who had worked in mental health practice for more than five years.

Findings

The main narrative themes to emerge were (i) living with the biomedical practice knowledge discourse, (ii) living with the psychological practice knowledge discourse and (iii) reflection as a strategy for maintaining occupation-based practice. These discourses created the need to reflect on practice and adopt strategies to avoid the marginalisation of occupational perspectives and occupation-based practice. The strategies used to cope with these discourses varied from acceptance and embracing of other discourses to resistance and rejection.

Conclusion

This paper demonstrates that in some mental health workplaces there is a danger that occupational perspectives and occupation-based practice can become marginalised. Making visible the different discourses in mental health practice allows occupational therapists to analyse, better understand, and live with the tensions in their professional lives. This requires professional support strategies to be in place to maintain occupation-based practices and retain practitioners in the workforce.

Attitudes of mental health occupational therapists toward evidence-based practice

Background.

Evidence-based practice is an important driver in modern health care and has become a priority in mental health occupational therapy in recent years.

Purpose.

The aim of this study was to measure the attitudes of a cohort of mental health occupational therapists toward evidence-based practice.

Method.

Forty-one mental health occupational therapists were surveyed using the Evidence-Based Practice Attitude Scale (EBPAS). Mann-Whitney U tests and Spearman’s rho were used to analyze the data.

Findings.

The occupational therapy respondents had generally positive attitudes toward evidence-based practices comparable to established norms. Respondents with further qualifications beyond their professional degree were significantly more likely to try new interventions ( p = .31). Significant negative correlations were found also for the subscales of Appeal and Openness in relation to years of occupational therapy practice (rho = –.354, p = .023; rho = –.344, p = 0.28) and mental health experience (rho = –.390, p = 0.12; rho = –.386, p = .013).

Implications.

Therapist factors can significantly impact attitudes toward evidence-based practice.

Turning evidence into practice: Barriers to research use among occupational therapists

Introduction

Research has demonstrated that occupational therapists generally have a positive attitude regarding the use of evidence in their daily practice and decision-making. In addition, occupational therapists are expected to implement evidence-based practice, which is often understood as equivalent to research. However, evidence-based practice might be difficult to reconcile with occupational therapy from a client-centred focus. This study examines what occupational therapists perceive as barriers to research use and discusses the challenge of clinical implementation.

Method

This study uses a descriptive cross-sectional design. The Barriers to Research Utilization Scale questionnaire was mailed to 807 randomly selected Swedish occupational therapists. The response rate was 59%.

Findings

The occupational therapists identified three main barriers to the use of research: insufficient facilities (82%); lack of time to read research (77%); difficulty understanding statistical analyses (75%). Degree of education was shown to affect results; occupational therapists with higher education levels indicated a higher use of research.

Conclusion

Implementing research in clinical practice is a challenge. Occupational therapists are interested but they lack the optimal prerequisites and time.

Mapping allied health evidence-based practice: providing a basis for organisational realignment

Objective Ahead of the convergence of two major paediatric services, we examined evidence-based practice (EBP) self-efficacy, outcome expectancy, knowledge and use among allied health (AH) staff in two major Queensland (Qld) paediatric services. This was to determine whether any differences existed based on organisational affiliation, profession and any previous training to inform a strategy to enhance AH EBP within the new organisational setting. Methods All AH staff from the two Brisbane (Qld) tertiary paediatric hospitals were invited to participate in the survey. Using a cross-sectional design, EBP self-efficacy, outcome expectancy, knowledge and use, as well as previous EBP training, were assessed with an online survey. Background demographic information obtained included professional discipline and hospital. Results One hundred and thirty-eight health practitioners completed the survey (37% response rate). Most practitioners had accessed EBP training. Mean scores for EBP attitudes (self-efficacy and outcome expectancy) and knowledge were higher than for EBP use scores. Greater variation was observed across professional disciplines than organisations. Training impacted positively on EBP measures but explained a small proportion of total variance in regression models. Conclusions The results underscore the need to provide organisational supports to AH staff for EBP implementation. Strategies other than training are required to maximally enhance EBP attitudes. The new organisational structure provides an opportunity for this cultural shift to occur. What is known about the topic? Factors affecting the EBP capabilities of AH professionals are complex and are associated with institutional culture and barriers, personal self-belief and individual experience and ability, and can exist at clinician, team and organisational levels. What does this paper add? The data from the present study confirm the emerging literature examining various AH professional groups’ EBP behaviours and ratings with a large and diverse cohort from a variety of backgrounds and across organisations. Respondents possessed a positive attitude towards EBP and moderate EBP knowledge, with these scores exceeding EBP use scores. Organisational affiliation had little impact on EBP measures. What are the implications for practitioners? Although the results of the present study highlight the importance of training in literature searching, EBP and research design and/or analysis, the findings also indicated that strategies other than training are required to maximally enhance EBP attitudes and use by AH staff. To harness the positive approach AH staff have to EBP, strategies such as incorporation of EBP principles and plans in departmental meetings and strategic reviews, as well as strengthening organisational governance in relation to EBP and research, must be developed within the new organisational structure and context; a powerful, but often overlooked, enabler of EBP.

Making use of research: clinical views on an evaluation of everyday technology use

OBJECTIVE

The study aim was to investigate how and when an evaluation of perceived difficulty in use of everyday technology (Everyday Technology Use Questionnaire, ETUQ) could be used in clinical occupational therapy.

METHOD

Eight focus-group interviews were undertaken with a total of 42 participants (occupational therapists), and data were analysed with a constant comparative approach.

RESULTS

The findings are presented in four main categories, including (i) appropriate purposes and contexts for using ETUQ, (ii) standardization versus individual flexibility, (iii) approaching everyday technology use and occupation as one whole, and (iv) synthesizing and documentation.

CONCLUSIONS

In conclusion, the participants considered ability to use technology to be an important topic for occupational therapy, particularly in investigations of clients with subtle disabilities and in connection with discharge from hospital - but not in inpatient care. They had different views on how to integrate ETUQ with evaluations of occupational performance, and new ideas on how information about clients' ability to use technology could be utilized in interventions. They held standardized evaluations in high regard, but a paradox appeared in that many of them would use ETUQ in a non-standardized way, while simultaneously asking for a standardized output to be used in clients' medical files and to guide interventions.

Sensory impairment after stroke: Exploring therapists' clinical decision making

BACKGROUND

Stroke survivors experience sensory impairments that significantly limit upper-limb functional use. Lack of clear research-based guidelines about their management exacerbates the uncertainty in occupational therapists' decision making to support these clients.

PURPOSE

This study explores occupational therapists' clinical decision making regarding upper-limb, post-stroke sensory impairments that can ultimately inform approaches to support therapists working with such clients.

METHOD

Twelve therapists participated in a qualitative descriptive study. Transcripts of semi-structured interviews were analyzed using content analysis.

FINDINGS

Three overarching categories were identified: deciding on the focus of interventions (describing intervention choices), it all depends (outlining factors considered when choosing interventions), and managing uncertainty in decision making (describing uncertainty and actions taken to resolve it).

IMPLICATIONS

Providing training about post-stroke sensory impairment and decision making may improve therapists' decision making and ultimately improve client outcomes. Further research is needed to understand the impact of uncertainty on occupational therapy decision making and resulting care practices.