Evidence based practice and knowledge translation: A survey of Australian occupational therapy practice with clients experiencing neurocognitive impairments

Enhancing evidence-based practice into healthcare: Exploring the role of scientific skills in occupational therapists

BACKGROUND

Research utilization and evidence-based practice (EBP) in occupational therapy rely on essential scientific skills. Despite prior research exploring factors influencing EBP, a gap remains in understanding the specific scientific competencies crucial for effective EBP application.

OBJECTIVES

To (1) describe the level of scientific skills for EBP and research application, and (2) investigate the factors influencing higher scientific competence among 1159 Spanish-speaking occupational therapists.

MATERIAL AND METHODS

We assessed the scientific skills using the HACTO-Screen online survey. Recruitment was conducted through a non-probability convenience sampling method between April to June 2020, using social networks and email dissemination to education and professional organizations in Spain and Spanish-speaking Latin American countries.

RESULTS

Out of a total score of 115 points, participants showed a moderate level of scientific skills (mean: 62.7, SD: 21.6), with literature searching skills ranking the highest and scientific writing skills ranking the lowest. Associations were found between greater scientific competence and advanced degrees, ongoing research training, and on-the-job research.

CONCLUSIONS

Continuous research training, higher academic degrees, and active research engagement are essential for enhancing scientific competence among occupational therapists.

SIGNIFICANCE

Targeted training to enhance scientific skills and promote research utilization are crucial in advancing EBP in occupational therapy.

Capacity building for providers of cognitive rehabilitation in Queensland: a needs analysis survey

Background Cognitive rehabilitation of people with traumatic brain injury is a complex and challenging area of practice. Practitioners working in cognitive rehabilitation require ongoing training to stay abreast of new research and best practice interventions. A needs analysis was conducted to inform the development of a capacity building program for cognitive rehabilitation providers. Methods A cross-sectional online survey of providers of cognitive rehabilitation services in Queensland collected data on demographic information, perceptions of knowledge, skills and confidence in cognitive rehabilitation, previously completed training, desired training opportunities and delivery methods, and barriers and facilitators to engaging in training. Results The 103 respondents included 67 occupational therapists, 17 speech pathologists, 12 psychologists and seven social workers with a broad range of practice experience. Participants perceived a need for further training, with executive function and functional cognition the most desired topics. The number of topics previously trained on was significantly correlated with levels of knowledge, skills and confidence (P   Conclusion Cognitive rehabilitation providers in Queensland reported a need for further training, delivered flexibly, with a focus on managing complex cognitive impairments.

[Trouble neurocognitif majeur et méthodes optimisant l'apprentissage]

Les difficultés cognitives consécutives aux troubles neurocognitifs majeurs (TNCM) engendrent des enjeux dans la réalisation d'activités de la vie quotidienne. Ce projet visait à identifier auprès des proches aidants et des intervenants des situations nécessitant des méthodes optimisant l'apprentissage pour faciliter l'engagement de personnes vivant avec un TNCM dans leurs activités de la vie quotidienne. Des entrevues individuelles semi-dirigées, d'une durée de 60 à 90 minutes, ont été menées auprès de proches aidants et d'intervenants. Les résultats montrent que les activités quotidiennes et domestiques sont notamment affectées par les difficultés à repérer ou à utiliser les objets, à garder en tête la tâche en cours, à mettre en séquences des étapes, à ne pas se laisser distraire par autre chose et à constater ses difficultés pour s'y adapter. Les proches aidants souhaitent du soutien dans l'application des méthodes optimisant l'apprentissage pour contribuer au maintien de l'autonomie des personnes vivant avec un TNCM.

Task and ecologically based assessment of upper-limb passive function before and after botulinum injections in adults with stroke using the Upper-Limb Performance Assessment: French cross-cultural adaptation and feasibility pilot study

PURPOSE

To test feasibility of a French translation and cross-cultural adaptation of the Upper-Limb Performance Assessment (ULPA) for task and ecologically based assessment of individualized passive function of upper-limb (UL) performance in adults treated with botulinum toxin-A.

MATERIALS AND METHODS

A case series with seven adults with stroke (29-74 years) for spastic hypertonia management with passive use objectives (hygiene or positioning) established through Goal Attainment Scaling (GAS). Scores on ULPA Task Performance Mastery (TPM) were obtained through clinical and home-based performances before and after treatment.

RESULTS

Time administration per task ranged from 5-10 min. Median (range) ULPA, Task Performance Mastery (ULPA-TPM) scores pre-intervention of 58 mastery (35-71) improved to 75 (58-88). Tau-U demonstrated significant large effect sizes (≥.65) for five participants. Complementary measures demonstrated improvement of passive performance for five participants and improvements in GAS for six participants. Testing indicates excellent intra-rater (ICC = 0.90) and moderate inter-rater (ICC = 0.64) reliability, with SDC of 10.16 and 18.23%, respectively.

CONCLUSIONS

French use of ULPA is a promising standardized, objective and ecologically based assessment of passive performance in adults with stroke. Preliminary findings after TCCA support feasibility for measurement of individualized goals for UL passive use. Future studies may explore other tasks and environments. Implications for rehabilitationULPA is a performance-based, criterion-referenced and ecological measure of individualized goals based on task-analysis of upper-limb (UL) performance in real-life situations providing an interest for individualized assessment of activity and participation.The measure provides a standardized and quantitative approach, applicable to passive use of UL across environments, promoting ecological validity of assessment.Preliminary data will support clinical interpretation of change before and after botulinum injections of UL passive performance.Access to a transculturally validated French version of ULPA complements standardized assessment of UL impairment, perceived performance and goal attainment.

Effective non-pharmacological interventions for cancer related cognitive impairment in adults (excluding central nervous system or head and neck cancer): systematic review and meta-analysis

INTRODUCTION

Cancer-related cognitive impairment (CRCI) is prevalent in cancer survivors, and impairments affect daily living tasks and overall wellbeing. This review aimed to identify and evaluate published randomized controlled trials (RCTs) of interventions to manage CRCI in adult populations, to analyze their effectiveness and to investigate the quality of the studies.

EVIDENCE ACQUISITION

Seven databases were searched (Medline, Scopus, CINAHL, AMED, PsychINFO, OTseeker, and the Cochrane Database of Systematic Reviews), including years 2005-2020, for randomized controlled trials (RCTs) investigating interventions to address cognition for adults with cancer. The final search was conducted in February 2021. The quality of studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for RCTs. Meta-analysis used comprehensive meta-analysis software. The study protocol was registered with PROSPERO (registration N. CRD42017076868).

EVIDENCE SYNTHESIS

A total of 45 studies involving 4727 participants examined interventions for CRCI and met selection criteria. Categories of interventions included cognitive training-based intervention (N.=15), cognitive behavior therapy (CBT) (N.=4), physical activity (N.=16) and other supportive therapies (N.=10). Meta-analysis indicated beneficial overall effects for all categories of interventions: cognitive training (standardized mean difference [SMD]=0.41, 95% CI: 0.28-0.53, I2=88.87%); CBT (SMD=0.30, 95% CI: 0.14-0.46, I2=44.86%); physical activity (SMD=0.27, 95% CI: 0.20-0.35, I2=37.67%); and supportive therapies (SMD=0.27, 95% CI: 0.16-0.39, I2=64.94%). Studies used self-report cognitive outcome measures and neurocognitive testing, or a mixture.

CONCLUSIONS

Findings suggest that effective intervention for CRCI exist, and cognitive training is consistently supported as an effective intervention; however, a high level of heterogeneity was found. CRCI research is currently dominated by breast cancer survivors, and quality research is also needed to address the broader population of cancer survivors who experience CRCI.

Screening for Scientific Skills in Spanish-Speaking Occupational Therapists (HACTO-Screen): Study Protocol of a Cross-Sectional Survey

The acquisition of scientific competencies for the application of evidence-based practice (EBP) is considered an essential part of healthcare education programs in order to improve clinical effectiveness. An examination of scientific skills in occupational therapists may be helpful in understanding their current practice as well as being useful in providing a basis for applying suitable approaches to the development and implementation of EBP. Hence, this study was designed with a double main objective: (1) to describe the level of acquisition of scientific skills and academic achievement in Spanish-speaking occupational therapists; (2) to examine the factors associated with these skills. The screening for Scientific Skills in Occupational Therapists (HAbilidades Científicas en Terapeutas Ocupacionales), the HACTO-Screen, is an online cross-sectional survey divided into five sections: sociodemographic data, academic and professional background; assessment of scientific skills; research training and development needs; experience as a researcher and/or academic. A total sample of 1159 occupational therapists finally participated. Main associations will be analyzed using multiple linear and/or Poisson regression models with/without robust variance. Our findings will provide valuable insights on the research skills and associated factors in a large sample of Spanish-speaking occupational therapists. The results will also be helpful to enhance research training and research career development in occupational therapy in order to promote the use of EBP.

‘We struggle and muddle.’ A qualitative study exploring community ABI therapists’ experiences of using, training in and implementing behaviour interventions

Objectives:

Individuals with acquired brain injury (ABI) may present with challenging behaviours (CB) that place themselves and others at risk of harm and impact their community integration. It is crucial for community ABI therapists to successfully train in and implement behaviour interventions. The current study aimed to investigate community ABI therapists’ experiences of using, training in and implementing behaviour interventions. An additional aim was to determine these therapists’ understanding of Positive Behaviour Support (PBS), one approach to addressing CB with a focus on improving quality of life.

Methods:

Semi-structured interviews were conducted with 24 Australian community ABI therapists about their experiences of using, training in and implementing behaviour interventions and understanding of PBS. Inductive thematic analysis and content analysis were performed on interview transcripts.

Findings:

The thematic analysis resulted in the generation of six themes which described the difficulties participants faced in training in and delivering behaviour interventions and identified their training and implementation needs. The content analysis resulted in 10 categories that characterised participants’ understanding of PBS, which centred around the absence of consequences, a focus on antecedents, person-centred practice and encouraging prosocial alternatives to CB.

Conclusions:

The findings highlight a need and desire for more practical and interactive clinician training in behaviour interventions for individuals with ABI. Moreover, the findings suggest a limited understanding of PBS amongst community ABI therapists. Important considerations for the development of clinician training in ABI behaviour interventions and subsequent implementation into community practice are discussed.