An observational cohort study to determine the impact of research capacity building strategies implemented in an Australian metropolitan hospital occupational therapy department

INTRODUCTION

Research capacity building enhances the abilities of individuals and is critical within health systems for quality patient care and promotes a culture of excellence within the occupational therapy profession. A research capacity building toolkit was proposed identifying strategies to support allied health professionals to undertake research. This study evaluated participant-reported outcomes of research capacity building toolkit implementation in an occupational therapy department.

METHODS

An observational pre-post-cohort study at a tertiary hospital with volunteer occupational therapists using the standardised Research Capacity in Context Tool (RCCT) and an author-designed quality improvement (QI) survey was employed. The RCCT measures research capacity and culture at organisation, team and individual levels. Semi-structured interviews were used to elicit reflections regarding participant experience.

RESULTS

All levels of the toolkit were implemented successfully. The response rate was 59% (n = 36) at baseline and 49.1% (n = 26) at follow-up. Eighty-five percent of participants held direct clinical roles. Nine clinicians participated in the interviews. There were significant improvements in the estimate mean for the organisation (6.51 [2019] compared with 8.13 [2020], p = <0.001) and the team (5.52 [2019] compared with 7.15 [2020], p = 0.001). The individual level did not significantly change with an estimate mean of 4.20 in 2019 increasing slightly to 4.84 in 2020 (p = 0.128). This was supported by the QI survey where improvements were noted in the department but not at an individual level. The qualitative findings verified the components of the toolkit including 'supporting clinicians in research', 'working together', 'valuing research for excellence' and reflected the importance of 'individual attributes'.

CONCLUSION

The toolkit supported the implementation of specific strategies to enhance research capacity and culture. Improvements within the organisation and team were evident; however, these were not seen at an individual level. Further research about the contribution of individual-related factors and processes to the building of research capacity is required.

Implementing Evidence-Based Practice: Factors That Influence the Use of Research Evidence by Occupational Therapists

Developing a professional and organisational culture within National Health Service (NHS) trusts that is supportive of improving evidence-based practice will require both the generation and the use of research evidence. This article reports the findings of a study that explored the factors that inhibit and facilitate the use of research evidence by occupational therapists. The sample of 100 occupational therapists was drawn from across seven acute NHS trusts, in one NHS region, including two teaching hospitals. The postal survey achieved a 78% response rate.

The findings illustrate that whilst occupational therapists have a positive attitude towards the use of research and are keen to make use of that evidence in practice, workload pressures are a major inhibiting factor. The challenge for practitioners and managers alike is to create organisational conditions that are supportive of the NHS policy objectives to enhance the use of evidence-based practice.

Occupational Therapy and Clinical Research in Mental Health Rehabilitation

Practitioners working in Australian mental health services are faced with the challenge of providing appropriate evidence-based interventions that lead to measurable improvement and good outcomes. Current government policy is committed to the development of strategic mental health research. One focus has been on under-researched practice areas, which include the development of psychosocial rehabilitation systems and models that facilitate recovery.

To meet this challenge, an Australian rehabilitation service formed a collaborative partnership with a university. The purposes of the collaboration were to implement new forms of service delivery based on consumer need and evidence and to design research projects to evaluate components of the rehabilitation programme. This article examines the process of developing the collaboration and provides examples of how research projects have been used to inform practice and improve the effectiveness of service delivery. Challenges to the sustainability of this kind of collaboration are considered.

The Journal Club: A Method for Occupational Therapists to Bridge the Theory-Practice Gap

There are still major problems being encountered by occupational therapists when they attempt to access relevant research material. One of the main reasons for this is that there are currently relatively few occupational therapists who are involved in any form of research on a regular basis.

This article highlights the potential of the journal club as a means of introducing occupational therapists to research that will both be relevant to their work area and form a substantial part of their continuing professional development. A brief overview of the format and content of journal clubs both in occupational therapy and in other health care professions is intended to encourage occupational therapists to initiate their own journal clubs as a method of bridging the theory-practice gap that still exists in their profession.

Implementation interventions to improve the management of non-specific low back pain: a systematic review

BACKGROUND

Recommendations in clinical practice guidelines for non-specific low back pain (NSLBP) are not necessarily translated into practice. Multiple studies have investigated different interventions to implement best evidence into clinical practice yet no synthesis of these studies has been carried out to date. The aim of this study was to systematically review available studies to determine whether implementation interventions in this field have been effective and to identify which strategies have been most successful in changing healthcare practitioner behaviours and improving patient outcomes.

METHODS

A systematic review was undertaken, searching electronic databases until end of December 2012 plus hand searching, writing to key authors and using prior knowledge of the field to identify papers. Included studies evaluated an implementation intervention to improve the management of NSLBP in clinical practice, measured key outcomes regarding change in practitioner behaviour and/or patient outcomes and subjected their data to statistical analysis. The Cochrane Effective Practice and Organisation of Care (EPOC) recommendations about systematic review conduct were followed. Study inclusion, data extraction and study risk of bias assessments were conducted independently by two review authors.

RESULTS

Of 7654 potentially eligible citations, 17 papers reporting on 14 studies were included. Risk of bias of included studies was highly variable with 7 of 17 papers rated at high risk. Single intervention or one-off implementation efforts were consistently ineffective in changing clinical practice. Increasing the frequency and duration of implementation interventions led to greater success with those continuously ongoing over time the most successful in improving clinical practice in line with best evidence recommendations.

CONCLUSIONS

Single intervention or one-off implementation interventions may seem attractive but are largely unsuccessful in effecting meaningful change in clinical practice for NSLBP. Increasing frequency and duration of implementation interventions seems to lead to greater success and the most successful implementation interventions used consistently sustained strategies.

Research Knowledge, Attitudes, Practices and Barriers among Paediatric Occupational Therapists in the United Kingdom

Evidence-based practice and research utilisation are promoted to enable clients to receive the most current care; however, there is limited research evaluating the use of these approaches within the occupational therapy profession. This study aimed to investigate the knowledge, attitudes, practices and barriers to evidence-based practice and research utilisation of a group of paediatric occupational therapists in the United Kingdom. Questionnaires were received from 145 participants (response rate 30%), who completed the Research Knowledge, Attitudes and Practices of Research Survey (KAP Survey), the Edmonton Research Orientation Survey (EROS) and the Barriers to Research Utilisation Scale (BARRIERS).

The results indicated that the respondents held positive attitudes towards research and were willing to access new information and implement research findings to guide clinical practice. However, they were less confident in their research knowledge and practices, and perceived multiple barriers associated with the organisation, accessibility and quality of research. The respondents reported limited engagement in conducting research studies; however, the majority of the sample reported implementing the findings of research in their clinical practice to some extent.

Additional research education and support within organisations would be beneficial to ensure that children and families are receiving occupational therapy services that are based on sound research evidence.

Predictors of Research Utilization among Pediatric Occupational Therapists

Evidence-based practice and research utilization activities by clinicians enable clients to receive the best, most current health care available. This study investigated the factors predicting pediatric occupational therapists' attitudes toward evidence-based practice and research utilization in Australia, the United Kingdom, and Taiwan. Questionnaires were received from 696 participants (response rate = 56.58%) who completed the Edmonton Research Orientation Survey (EROS), the Research Knowledge, Attitudes and Practices of Research Survey (KAP Survey), and the Barriers to Research Utilization Scale (BARRIERS). The results of the multiple linear regression analysis indicated the strongest predictor of research utilization was “level of academic occupational therapy qualification,” which was found to be predictive of all of the EROS subscales. The second EROS subscale, “research involvement,” had the largest number of predictive factors. To increase research utilization among pediatric occupational therapists, it is important to be mindful of which aspects of research require improvement so that strategies with the greatest impact and influence can be implemented.

The synthesis: An innovative approach to student research

Background

Although there is an expectation for health practitioners to be able to use research to inform their practice, opportunities for students to actually plan, conduct and report a research project are diminishing. Students are less able to gain first-hand experience of research as a result of demands to include more in curricula, and increasingly rigorous and time-consuming ethical review procedures. It is important, therefore, for health educators to explore different research methods and approaches.

Content

This article proposes the synthesis, an entirely literature-based approach, as a method to enable students to plan and conduct a research project. It is more than a literature review in that it requires students to synthesize material from two previously unrelated fields. As a result it is possible to shine a new light on issues facing health-care professionals and their patients/clients, by bringing new ways of thinking to issues.

Conclusions

Although the synthesis is a nascent concept in student health professional education, it has the potential to offer students first-hand experience of the research process, and so contribute to their development as research aware professionals.

Integrating an evidenced-based research intervention in the discharge of mental health clients

The purpose of this Canadian qualitative study was to explore the experiences of clinical staff who implemented a research intervention: the Transitional Discharge Model (TDM). The TDM provided mental health clients who were hospitalized with peer support and an inpatient staff member to bridge the therapeutic transitioning from hospital staff to the community care provider. Staff from three tertiary care mental health facilities in Canada identified their learning needs in regard to providing the intervention. An educational program was developed and delivered to the clinical staff to support and facilitate the implementation of the new TDM. The extent of the utilization of knowledge and implementation of the TDM varied across the three tertiary care mental health facilities. Focus groups (N=49) with clinical staff were conducted to explore various factors related to the training process as well as the challenges and benefits of implementing the TDM. Data were analyzed using Leininger's Phases of Ethnonursing Qualitative Data Analysis [Leininger, M. (2002). The theory of culture care and the ethnonursing research method. In M. Leininger & M. McFarland (eds.), Transcultural nursing: Concepts, theories, research, and practice (3rd ed.). New York: McGraw-Hill]. Findings revealed that clinical staff experienced challenges in roles and responsibilities, relationships with others, values and beliefs of clients, staff and community, resources, and the processes of care. From the findings, strategies were identified to support the integration of knowledge about the TDM into practice and to increase clinical staff's skills in implementing research interventions. These included support from others, as well as support of practice, policy, and education.

Occupational therapists' assessments of adults with long-term pain: the Swedish experience

The purposes of this study were to describe the needs for occupational therapy among people of working age with long-term pain, and to describe treatment interventions based on these assessments. Occupational therapists working in primary health care and/or with special interest in pain management (n=109) assessed 113 people aged 18-58 years with long-term pain with the Occupational Therapy Needs Assessment--Pain (OTNA--P) questionnaire. The occupational therapists recommended treatment interventions where appropriate. The results generated categories of needs that have implications for interventions: 1) need for patient education, 2) needs due to limitations in activity performance, 3) needs due to patient's discouragement, 4) need as a result of patient's dependency and 5) needs related to work. The suggested interventions focused on increased knowledge of how to handle daily occupations, mainly categorized as education and stress management' and behavioural' interventions. Significant correlations were found between the assessed needs and the suggested interventions. The results of this study could assist in developing guidelines for practitioners working in occupational therapy pain management programmes. It is recommended that further research is done on the effectiveness of occupational therapy interventions with patients with long-term pain.

Research utilization among pediatric health professionals

The present study investigated research use and attitudes toward research among pediatric health professionals. All nurses and allied health professionals in a pediatric teaching hospital were surveyed using previously tested and published measures. Over half of the participants had some formal education in research but, for some participants, that education was many years ago. Most participants reported poor or very poor understanding of research design. Two variables were independently associated with a positive attitude towards research: (i) better understanding of how to conduct a literature search; and (ii) higher level of education. Five variables were independently associated with research use: better understanding of research design; having presented at a conference in the past two years; sense of calling to the profession; better understanding of how to conduct a literature search; and attending rounds. A small proportion of variance in both research use and a positive attitude towards research was explained by the independent predicator variables. Further research is required to identify characteristics of the workplace environment that support research use.

How rehabilitation therapists gather, evaluate, and implement new knowledge

INTRODUCTION

Rehabilitation therapists are strongly encouraged to apply research to their practices, but relatively little is known about the processes therapists use for continuing their education. This study examines the strategies used by a sample of therapists to gather new knowledge, evaluate its appropriateness to their clinical problems, and implement new learning into their practices.

METHODS

Twenty-four randomly selected occupational therapists and physical therapists from a large metropolitan area participated in in-depth interviews. Descriptive codes within interview transcripts described participants' individual approaches to continuing education (CE). Themes derived from comparative analysis across interviews were interpreted, building on prior understandings and suggesting strategies for CE research and programs.

RESULTS

Participants valued formal CE highly and expressed frustration concerning its limited availability. Most participants relied on informal consultations with peers as their first educational resource. Peers also supported participants' evaluation and implementation of new knowledge. Although seven participants reported use of systematic methods to access, evaluate, and implement new knowledge, others described more haphazard approaches toward evaluation and application of their learning. Participants identified economic, administrative, and interprofessional barriers to integration of new knowledge into their practices.

DISCUSSION

There is a need to develop and incorporate guidelines for evaluating and implementing learning within formal and informal CE programs. The appeal of formal CE suggests that more efficient strategies for continuing rehabilitation are required. Therapists' heavy reliance on peers suggests that educationally influential therapists may be effective media for informal CE interventions. CE targeted to policy makers should focus on promoting organizational change to enhance therapists' translation of research into practice.