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Haladay D, Morris Z, Tilson J, Fitzgerald C, Applebaum D, Flom-Meland C, DeWaay D, Manal TJ, Gravano T, Anderson S, Miro R, Russ D, Klein A. Development of a Novel Evidence-Based Practice-Specific Competency for Doctor of Physical Therapy Students in Clinical Education: A Modified Delphi Approach. JOURNAL, PHYSICAL THERAPY EDUCATION 2024:00001416-990000000-00112. [PMID: 38814571 DOI: 10.1097/jte.0000000000000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 03/04/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Evidence-based practice (EBP) results in high-quality care and decreases unwarranted variation in practice. REVIEW OF THE LITERATURE Few performance criteria related to EBP are included in physical therapy clinical education (CE) performance measures, despite EBP requirements in Doctor of Physical Therapy education. The purpose of this study was to develop EBP-specific competencies that may be used for Doctor of Physical Therapy students for use throughout CE. SUBJECTS Thirteen subject matter experts (SME) participated in this study. METHODS Subject matter experts were asked to rank each core EBP competency, from a previously described framework, using a 3-point Likert scale, which included "Not Essential," "Essential," and "Not Sure." A consensus of 70% or greater for the "Essential" rating advanced the competency to the final Delphi round, whereas a consensus of 70% or greater for the "Not Essential" rating was required for competency elimination. Subject matter experts voted to either "Accept" or "Modify" the competencies that had reached the inclusion consensus threshold. All competencies that reached consensus for inclusion after all 3 rounds were included in the final EBP Domain of Competence. RESULTS Consensus was achieved in round one for 38% (n = 26) of items. In round 2, a consensus was achieved for 20% (n = 8) of items. Of the items remaining after rounds 1 and 2, 6 overarching competencies were identified, and all remaining items served as descriptions and specifications in the final EBP Domain of Competence. DISCUSSION AND CONCLUSIONS The 6 competencies developed from this study constitute the EBP Domain of Competence and may be used throughout CE to assess students' EBP competency in clinical practice.
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Affiliation(s)
- Douglas Haladay
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Zoe Morris
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Julie Tilson
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Caitlin Fitzgerald
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Donna Applebaum
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Cindy Flom-Meland
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Deborah DeWaay
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Tara Jo Manal
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Tamara Gravano
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Stephanie Anderson
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Rebecca Miro
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - David Russ
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
| | - Aimee Klein
- Douglas Haladay is an emeritus board-certified specialist in Orthopaedic Physical Therapy and professor and director for the School of Physical Therapy & Rehabilitation Sciences within the Morsani College of Medicine at the University of South Florida, 12901 North Bruce B. Downs Blvd., MDC 077, Tampa, FL 33612-4766 . Please address all correspondence to Douglas Haladay
- Zoe Morris is a research coordinator for the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida
- Julie Tilson is a board-certified specialist in Neurologic Physical Therapy and DPT Program director and professor of Clinical Physical Therapy at the University of Southern California
- Caitlin Fitzgerald is the associate director of clinical education and assistant professor in the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Donna Applebaum is assistant professor and the director of clinical education at the Department of Physical Therapy in the School of Health and Rehabilitation Sciences at MGH Institute of Health Professions
- Cindy Flom-Meland is a board-certified specialist in Neurologic Physical Therapy and professor and chair for the Department of Physical Therapy at the University of North Dakota
- Deborah DeWaay is a board-certified in Internal Medicine and serves as the associate dean and professor for Undergraduate Medical Education at the University of South Florida
- Tara Jo Manal is the senior vice president of scientific affairs with the American Physical Therapy Association
- Tamara Gravano is a board-certified specialist in Geriatric Physical Therapy and an associate professor and assistant director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Stephanie Anderson is a board-certified in Orthopaedic Physical Therapy and assistance clinical professor at Graceland University
- Rebecca Miro is a research administrator for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- David Russ is an associate professor and assistant director of research for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
- Aimee Klein is a board-certified specialist in Orthopaedic Physical Therapy and professor and assistant school director for the School of Physical Therapy and Rehabilitation Sciences at the University of South Florida
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Gaid D, Eilayyan O, Ahmed S, Bussières A. Enrollment, adherence and retention rates among musculoskeletal disorders rehabilitation practitioners in knowledge translation studies: a systematic review and meta-regression. Implement Sci Commun 2024; 5:51. [PMID: 38702833 PMCID: PMC11069130 DOI: 10.1186/s43058-024-00585-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/10/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Practitioners' enrollment, adherence, and retention rates influence estimates of effectiveness in knowledge translation (KT) studies and remain important concerns for implementation researchers. This review aimed to systematically summarize the current evidence on feasibility measures as gauged by enrollment, adherence, and retention rates in KT evaluation studies targeting rehabilitation practitioners treating musculoskeletal disorders (MSDs). METHODS We searched five electronic databases from the inception to October 2022. We included KT studies that 1) had designs recommended by the Effective Practice and Organisation of Care, 2) targeted rehabilitation practitioners managing patients with MSDs, 3) delivered KT interventions according to the Expert Recommendations for Implementing Change classification, and 4) reported on the feasibility measures (e.g., enrollment, adherence, and retention). Descriptive statistics were conducted to report on study-, practitioners- and intervention-related factors influencing enrollment, adherence, and retention rates. Meta-regression weighted by the sample size of included studies was used to estimate the effect of factors on overall enrollment, adherence, and retention rates. RESULTS Findings from 33 KT studies reported weighted enrolment, adherence, and retention rate of 82% (range: 32%-100%), 74% (range: 44%-100%), and 65% (range: 36%-100%) respectively for both intervention and control groups. Factors positively influencing enrollment, adherence, and retention rates included designing short study period with short duration intervention. CONCLUSIONS Intense (e.g., high frequency, short duration) single KT intervention was more appealing for practitioners. Future evaluation studies should clearly report follow-up data, and practitioners' prior training, Results may not apply to non-MSD healthcare providers.
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Affiliation(s)
- D Gaid
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
| | - O Eilayyan
- Department of Physical Therapy, Al-Ahliyya Amman University, Amman, Jordan
| | - S Ahmed
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC, Canada
| | - A Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Département Chiropratique, Université du Québec à Trois Rivières (UQTR), Trois-Rivières, QC, Canada
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Gustavsson C, Nordqvist M, Bruhn ÅB, Bröms K, Jerdén L, Kallings LV, Wallin L. Process evaluation of an implementation intervention to facilitate the use of the Swedish Physical Activity on Prescription in primary healthcare. BMC Health Serv Res 2023; 23:996. [PMID: 37715160 PMCID: PMC10504760 DOI: 10.1186/s12913-023-09974-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/27/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The Swedish Physical Activity on Prescription (PAP-S) is a method for healthcare to promote physical activity for prevention and treatment of health disorders. Despite scientific support and education campaigns, the use has been low. The aim of this study was to perform a process evaluation of an implementation intervention targeting the use of the PAP-S method in primary healthcare (PHC). Specifically, we wanted to evaluate feasibility of the implementation intervention, and its effect on the implementation process and the outcome (number of PAP-S prescriptions). METHODS This was a longitudinal study using the Medical Research Council guidance for process evaluation of a 9-month implementation intervention among healthcare staff at three PHC centres in Sweden. Data was collected by: participatory observations of the implementation process; questionnaires to the staff before, after and 6 months after the implementation intervention; interviews after the implementation intervention; and number of PAP-S prescriptions. RESULTS During the implementation intervention, the workplaces' readiness-to-change and the healthcare staff's confidence in using the PAP-S method were favourably influenced, as was the number of PAP-S prescriptions. After the implementation intervention, the number of PAP-S prescriptions decreased to about the same number as before the implementation intervention, at two out of three PHC centres. Four of the six implementation strategies appeared to impact on the implementation process: external facilitation; leadership engagement by a committed workplace management; local PAP-S coordinator taking a leading role and acting as local champion; educational outreach concerning how to use the PAP-S method. CONCLUSION The implementation intervention was not sufficient to produce sustained change of the healthcare staff's behaviour, nor did it achieve favourable long-term outcome on the number of PAP-S prescriptions. The healthcare staffs' sparse knowledge of the PAP-S method prior to the implementation intervention hampered the implementation. More hands-on education in how to use the PAP-S method introduced early in the implementation process is imperative for successful implementation of the PAP-S method. The findings also suggest that committed workplace management and local PAP-S coordinators, taking leading roles and acting as local champions, need to be firmly established at the PHC centres before the external facilitator withdraws. TRIAL REGISTRATION Registered in the ISRCTN registry with study registration number: ISRCTN15551042 (Registration date: 12/01/2016).
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Affiliation(s)
- Catharina Gustavsson
- Center for Clinical Research Dalarna, Uppsala University, Nissers Vag 3, 79182 Falun, Sweden
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22 Uppsala, Sweden
| | - Maria Nordqvist
- Center for Clinical Research Dalarna, Uppsala University, Nissers Vag 3, 79182 Falun, Sweden
| | - Åsa Bergman Bruhn
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
| | - Kristina Bröms
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22 Uppsala, Sweden
| | - Lars Jerdén
- Center for Clinical Research Dalarna, Uppsala University, Nissers Vag 3, 79182 Falun, Sweden
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
| | - Lena V. Kallings
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22 Uppsala, Sweden
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences (GIH), Box 5626, 114 86 Stockholm, Sweden
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
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Wayop IYA, de Vet E, Wagenaar JA, Speksnijder DC. Why Veterinarians (Do Not) Adhere to the Clinical Practice Streptococcus suis in Weaned Pigs Guideline: A Qualitative Study. Antibiotics (Basel) 2023; 12:antibiotics12020320. [PMID: 36830232 PMCID: PMC9952329 DOI: 10.3390/antibiotics12020320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
The Netherlands has been very successful in the last decade in reducing antimicrobial use in animals. On about a quarter of farms, antimicrobial use in weaned pigs remains relatively high. As Streptococcus suis (S. suis) infections are responsible for a high consumption of antimicrobials, a specific veterinary guideline to control S. suis was developed, but seemed to be poorly adopted by veterinarians. Guided by the theoretical domains framework, the aim of this study was to identify determinants influencing veterinarians' adherence to this guideline. We interviewed 13 pig veterinarians. Interviewees described multiple approaches to managing S. suis problems and adherence to the guideline. Mentioned determinants could be categorized into 12 theoretical domains. The following six domains were mentioned in all interviews: knowledge, skills, beliefs about capabilities, beliefs about consequences, social influences, and environmental context and resources. The insights derived from this study are relevant for understanding factors influencing veterinarians' adoption of scientific evidence and guidelines and can be used to develop evidence-based implementation strategies for veterinary guidelines.
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Affiliation(s)
- Isaura Y. A. Wayop
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands
| | - Emely de Vet
- Consumption and Healthy Lifestyles Group, Wageningen University and Research, 6700 EW Wageningen, The Netherlands
| | - Jaap A. Wagenaar
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands
- Wageningen Bioveterinary Research, Houtribweg 39, 8221 RA Lelystad, The Netherlands
| | - David C. Speksnijder
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands
- University Farm Animal Clinic ULP, Reijerscopse Overgang 1, 3481 LZ Harmelen, The Netherlands
- Correspondence:
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Alatawi SF. How Can We Use the Promoting Action on Research in Health Services (PARIHS) Framework to Move from What We Know to What We Should Do for the Rehabilitation of a Painful Hemiplegic Shoulder (PHS)? J Multidiscip Healthc 2022; 15:2831-2843. [DOI: 10.2147/jmdh.s392376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
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Paus A, Grafe M, Stenzel R, Heitmann S, Brümmer W. Eine theoriegeleitete Implementierung von Messinstrumenten in der physiotherapeutischen Versorgung einer Stroke Unit. PHYSIOSCIENCE 2022. [DOI: 10.1055/a-1748-3069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Hintergrund Der Einsatz von Messinstrumenten objektiviert und unterstützt die klinische Entscheidungsfindung von Physiotherapierenden bei Planung, Durchführung und Evaluation einer Therapie. Die dadurch erhaltenen Informationen ermöglichen eine patientenzentrierte Versorgung und haben das Potential, die interprofessionelle Kommunikation zu verbessern. Trotz der genannten Vorteile findet die Nutzung von Messinstrumenten im klinischen Alltag bislang keine ausreichende Anwendung.
Ziel Systematische Implementierung von Messinstrumenten in die physiotherapeutische Versorgung der Stroke Unit des Universitätsklinikums Münster mithilfe des „Implementation of Change Model“. Zudem wird evaluiert, ob durch eine Anwendung des Modells eine gesteigerte Nutzung der Messinstrumente festgestellt werden kann.
Methode Zur Implementierung von Messinstrumenten wurde das Implementation of Change Model schrittweise mit diversen Methoden umgesetzt. Zur Ergebnisevaluation wurden quantitative (Fragebogenerhebung) und qualitative Forschungsmethoden (Fokusgruppendiskussion) angewandt.
Ergebnisse Nach Abschluss der Erprobungsphase, Auswertung der Dokumentation, der Befragungen sowie einer Diskussion zeigte sich, dass durch Anwendung des Implementation of Change Models die Nutzung von Messinstrumenten bei Patient*innen mit Schlaganfall gesteigert werden konnte. Aus Sicht der Befragten nahm die Überzeugung über den klinischen Nutzen von Messinstrumenten zu. Es konnte auch eine subjektive Verbesserung der Qualität der Behandlung festgestellt werden.
Schlussfolgerung Das Implementation of Change Model eignet sich zur systematischen Anwendung durch eine Gruppe von Physiotherapierenden in der Akutversorgung, wodurch sich die Nutzung von Messinstrumenten bei Patient*innen mit Schlaganfall steigerte. Es wird empfohlen, weitere Erkenntnisse mit einer größeren Gruppe von Therapierenden und in anderen Versorgungsbereichen durchzuführen.
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Affiliation(s)
- Annalena Paus
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
| | - Marion Grafe
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
| | - Romina Stenzel
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
| | - Steffen Heitmann
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
| | - Werner Brümmer
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
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Fillipo R, Pruka K, Carvalho M, Horn ME, Moore J, Ramger B, Clewley D. Does the implementation of clinical practice guidelines for low back and neck pain by physical therapists improve patient outcomes? A systematic review. Implement Sci Commun 2022; 3:57. [PMID: 35659117 PMCID: PMC9164354 DOI: 10.1186/s43058-022-00305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical therapy for neck and low back pain is highly variable despite the availability of clinical practice guidelines (CPG). This review aimed to determine the impact of CPG implementation on patient-level outcomes for spinal pain. Implementation strategies were also examined to determine prevalence and potential impact. METHODS Multiple databases were searched through April 2021 for studies assessing CPG implementation in physical therapy for neck and low back pain. Articles were screened for eligibility. The Modified Downs and Black checklist was utilized to determine study quality. Due to the heterogeneity between studies, a meta-analysis was not performed. RESULTS Twenty-one studies were included in this review. Implementation strategies were significantly varied between studies. Outcomes pertaining to healthcare utilization, pain, and physical functioning were assessed in relation to the implementation of CPGs. Multiple implementation strategies were identified, with Managing Quality as the most frequently utilized key implementation process. Findings indicate CPG implementation decreased healthcare utilization, but inconsistent results were found with physical functioning and pain outcomes. CONCLUSIONS CPG implementation appears to have a beneficial effect on healthcare utilization outcomes, but may not impact pain and physical functioning outcomes. Effective CPG implementation strategies remain unknown, though utilizing implementation framework may improve outcomes. More research is needed to determine the most effective implementation strategies and effects on pain and physical function outcomes.
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Affiliation(s)
- Rebecca Fillipo
- Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, USA.
| | - Katie Pruka
- Department of Outpatient Rehabilitation, Duke University Health System, Durham, North Carolina, USA
| | - Marissa Carvalho
- Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, USA
| | - Maggie E Horn
- Division of Doctor of Physical Therapy, Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Jordan Moore
- Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, USA
| | - Benjamin Ramger
- Department of Outpatient Rehabilitation, Duke University Health System, Durham, North Carolina, USA
| | - Derek Clewley
- Division of Doctor of Physical Therapy, Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
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American Physical Therapy Association Clinical Practice Guideline Implementation for Neck and Low Back Pain in Outpatient Physical Therapy: A Nonrandomized, Cross-sectional Stepped-Wedge Pilot Study. J Orthop Sports Phys Ther 2022; 52:113-123. [PMID: 35100820 DOI: 10.2519/jospt.2022.10545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether a multifaceted implementation strategy for American Physical Therapy Association neck and low back pain clinical practice guidelines (CPGs) was associated with changes in clinician and patient outcomes. DESIGN Cross-sectional stepped-wedge pilot study. METHODS Physical therapy clinics (n = 9) were allocated to 1 of 4 clusters that varied by CPG implementation timing. Clinics crossed over from usual care (control) to CPG implementation (intervention) every 8 weeks and ended with a 24-week follow-up period. Implementation outcomes were measured at the clinician (perspectives and behaviors) and patient (pain and disability outcomes) levels. Descriptive statistics were used to summarize clinician perspectives and behaviors. Generalized linear mixed models were used to analyze patient-level outcomes data (pain and disability) and total number of physical therapy visits. RESULTS Improvements in several clinician perspectives about CPGs were observed 8 weeks after training and sustained at 16 weeks (P<.05), although it is unclear whether these changes were meaningful. Training on CPGs was relevant to physical therapists and more acceptable at 16 weeks (P<.05). In a random sample (n = 764/1994, 38.3%), the overall rate of CPG classification was 65.0% (n = 497/764), and CPG intervention concordance was 71.2% (n = 354/497). Implementation of a CPG was not associated with final pain and disability scores (P>.05) but was associated with an approximate increase of 8% in total visits. CONCLUSION Our multifaceted implementation strategy was associated with statistical changes in clinician perspectives and behaviors, but not in patient outcomes. J Orthop Sports Phys Ther 2022;52(2):113-123. doi:10.2519/jospt.2022.10545.
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Romero B, Fry M, Roche M. Measuring sustainable practice change of the sepsis guideline in one emergency department: A retrospective health care record audit. Int Emerg Nurs 2021; 60:101108. [PMID: 34952484 DOI: 10.1016/j.ienj.2021.101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/07/2021] [Accepted: 10/22/2021] [Indexed: 11/05/2022]
Abstract
AIMS AND OBJECTIVES To explore the longitudinal impact of the New South Wales Sepsis guideline on time to antibiotics, triage assessment and emergency management before and four years after guideline implementation. BACKGROUND Globally, sepsis continues to be a significant cause of mortality and morbidity within hospitals. To reduce avoidable adverse patient outcomes the corner stone has been to improve the early recognition and management of sepsis. The New South Wales government in Australia introduced sepsis guidelines into Emergency Departments. However, the longitudinal impact of the sepsis guideline, has never been conducted. METHODS A 12-month retrospective randomised health care record audit of adult patients with a sepsis diagnosis was conducted 12-months before and four years after implementation of the sepsis guideline. RESULTS This study demonstrated sustained improvement in allocation of urgent triage categories in the follow-up group (n = 43; 53.1%) and a reduction in the median time to antibiotics from 189 min to 102 min (p ≤ 0.001) after the implementation of the sepsis guideline. CONCLUSION The study has demonstrated the sepsis guideline has improved a sustained change in early assessment, recognition and management of patients presenting with sepsis in one tertiary referral Emergency Department.
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Affiliation(s)
- Bernadine Romero
- Faculty of Health School of Nursing and Midwifery, University of Technology Sydney, NSW, Australia.
| | - Margaret Fry
- Faculty of Health School of Nursing and Midwifery, University of Technology Sydney, NSW, Australia
| | - Michael Roche
- Faculty of Health, University of Canberra, ACT, Australia
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Promoting Evidence-Based Practice in Acute Respiratory Distress Syndrome: A Systematic Review. Crit Care Explor 2021; 3:e0391. [PMID: 33912832 PMCID: PMC8078296 DOI: 10.1097/cce.0000000000000391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Supplemental Digital Content is available in the text. OBJECTIVE: Low tidal volume ventilation and prone positioning are recommended therapies yet underused in acute respiratory distress syndrome. We aimed to assess the role of interventions focused on implementation of low tidal volume ventilation and prone positioning in mechanically ventilated adult patients with acute respiratory distress syndrome. DATA SOURCES: PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials. STUDY SELECTION: We searched the four databases from January 1, 2001, to January 28, 2021, for studies that met the predefined search criteria. Selected studies focused on interventions to improve implementation of low tidal volume ventilation and prone positioning in mechanically ventilated patients with acute respiratory distress syndrome. DATA EXTRACTION: Two authors independently performed study selection and data extraction using a standardized form. DATA SYNTHESIS: Due to methodological heterogeneity of included studies, meta-analysis was not feasible; thus, we provided a narrative summary and assessment of the literature. Eight nonrandomized studies met our eligibility criteria. Most studies looked at interventions to improve adherence to low tidal volume ventilation. Most interventions focused on education for providers. Studies were primarily conducted in the ICU and involved trainees, intensivists, respiratory therapists, and critical care nurses. Although overall quality of the studies was very low, the primary outcomes of interest suggest that interventions could improve adherence to or implementation of low tidal volume ventilation and prone positioning in acute respiratory distress syndrome. Measurements and Main Results: Two authors independently performed study selection and data extraction using a standardized form. Due to methodologic heterogeneity of included studies, meta-analysis was not feasible; thus, we provided a narrative summary and assessment of the literature. Eight nonrandomized studies met our eligibility criteria. Most studies looked at interventions to improve adherence to low tidal volume ventilation. Most interventions focused on education for providers. Studies were primarily conducted in the ICU and involved trainees, intensivists, respiratory therapists, and critical care nurses. Although overall quality of the studies was very low, the primary outcomes of interest suggest that interventions could improve adherence to or implementation of low tidal volume ventilation and prone positioning in acute respiratory distress syndrome. Conclusions: There is a dearth of literature addressing interventions to improve implementation of evidence-based practices in acute respiratory distress syndrome. Existing interventions to improve clinician knowledge and facilitate application of low tidal volume ventilation and prone positioning may be effective, but supporting studies have significant limitations.
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Romney W, Bellows DM, Tavernite JP, Salbach N, Deutsch JE. Knowledge Translation Research to Promote Behavior Changes in Rehabilitation: Use of Theoretical Frameworks and Tailored Interventions: A Scoping Review. Arch Phys Med Rehabil 2021; 103:S276-S296. [PMID: 33561438 DOI: 10.1016/j.apmr.2021.01.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/27/2020] [Accepted: 01/01/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To describe knowledge translation (KT) research as a means of changing practice behaviors in rehabilitation. We specifically aimed to explore how theories, models, and frameworks (TMFs) are used to guide KT, guide methods to tailor KT interventions, and evaluate outcomes. We hypothesized these methods would have increased over the past 10 years. DATA SOURCES We identified articles through searches conducted using databases Cumulative Index to Nursing and Allied Health, MEDLINE, PubMed, Academic Search Premier, and previous reviews from January 2000 to April 2020. Search terms included physical therapy, occupational therapy, speech-language pathology, knowledge translation, and knowledge-to-action (KTA). STUDY SELECTION Two authors interpedently screened titles, abstracts, and full-text articles. Studies were included if behavior change of rehabilitation practitioners was measured. Systematic reviews, protocols, and capacity-building interventions were excluded. DATA EXTRACTION Three authors extracted information on study design, theoretical frameworks, intervention strategies, and outcome evaluation. DATA SYNTHESIS Fifty-six studies were included in the review. Sixteen (29%) reported the use of a theoretical framework to guide the KT process. Since 2013, the KTA framework was used 35% of the time. Twenty-two studies (39%) reported barrier assessments to tailor interventions, and 82% were published after 2013. However, barrier assessment in the local context was only conducted 64% of the time. Outcomes of tailored interventions were most frequently measured using chart audits (50%) and questionnaires (41%). Further, the link between KT theory, specific barriers, and selection of intervention strategies was not consistently described. CONCLUSIONS Over the past 7 years, there has been an increase in the use of KT TMFs and tailored interventions. Recommendations for future research include the use of TMFs to guide local barrier assessment, KT strategy selection, intervention development, and overall KT process and mapping barriers to selected intervention strategies.
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Affiliation(s)
- Wendy Romney
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT; Department of Rehabilitation and Movement Sciences, RIVERS Lab, Rutgers University, Newark, NJ.
| | | | - Jake P Tavernite
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT
| | - Nancy Salbach
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; KITE-Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Judith E Deutsch
- Department of Rehabilitation and Movement Sciences, RIVERS Lab, Rutgers University, Newark, NJ
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Stander J, Grimmer K, Brink Y. Tailored training for physiotherapists on the use of clinical practice guidelines: A mixed methods study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 26:e2174. [PMID: 33111468 DOI: 10.1002/pri.1883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 09/12/2020] [Accepted: 10/12/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Clinical practice guidelines (CPG) are vehicles for translating evidence into practice, but effective CPG-uptake requires targeted training. This mixed methods research project took a staged evidence-based approach to develop and test a tailored training programme (TTP) that addressed organisational and individual factors influencing CPG-uptake by South African physiotherapists treating patients with low back pain in primary healthcare settings. METHODS This multi-stage mixed methods study reports the development, contextualisation and expert content validation of a TTP to improve CPG-uptake. Finally, the TTP was evaluated for its feasibility and acceptability in its current format. RESULTS The TTP (delivered online and face-to-face) contained minimal theory, and focussing on practical activities, clinical scenarios and discussions. Pre-TTP, physiotherapists expressed skepticism about the relevance of CPG in daily practice. However, post-TTP they demonstrated improved knowledge, confidence, and commitment to CPG-uptake. DISCUSSION The phased-construction of the TTP addressed South African primary healthcare physiotherapists' needs and concerns, using validated evidence-based educational approaches. The TTP content, delivered by podcasts and face-to-face contact, was feasible and acceptable in terms of physiotherapists' time constraints, and it appeared to be effective in improving all outcome domains. This TTP is now ready for intervention to a wider audience.
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Affiliation(s)
- Jessica Stander
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Karen Grimmer
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Yolandi Brink
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
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Zadro JR, Cheng S, O'Keeffe M, Maher CG. What Interventions Do Physical Therapists Provide for Patients With Cardiorespiratory Conditions, Neurological Conditions, and Conditions Requiring Acute Hospital Care? A Systematic Review. Phys Ther 2020; 100:1180-1205. [PMID: 32285118 DOI: 10.1093/ptj/pzaa064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this systematic review was to determine what percentages of physical therapists provide interventions that are of high value, low value, or unknown value for cardiorespiratory conditions, neurological conditions, or conditions requiring acute hospital care. Whether an intervention was considered high or low value was determined by reference to guidelines or systematic reviews. METHODS Searches of numerous databases were performed by combining terms synonymous with "practice patterns" and "physical therapy" until April 2018. Studies that investigated what interventions physical therapists provide for any cardiorespiratory condition, neurological condition, or condition requiring acute hospital care through surveys and audits of clinical notes were included. Through the use of medians and interquartile ranges, the percentages of physical therapists who provided interventions that were of high value, low value, or unknown value were summarized. RESULTS Twenty-six studies were included. The median percentages of physical therapists who provided interventions of high, low, and unknown value for chronic obstructive pulmonary disease ranged from 78% to 96%, 67% to 100%, and 56% to 91%, respectively. These percentages ranged from 61% to 97%, 87% to 98%, and 83% to 98% for adults who were critically ill in intensive care units; 70% to 93%, 38% to 50%, and 8% to 95% before or after cardiac/thoracic surgery; 25% to 96%, 23% to 84%, and 96% for acute stroke; and 11% (high value) and 13% (unknown value) for Parkinson disease, respectively. CONCLUSIONS This review found patterns of physical therapist practice for cardiorespiratory conditions, neurological conditions, and conditions requiring acute hospital care that were both evidence based and not evidence based. A concern is that a substantial percentage of physical therapists provided interventions that were of low or unknown value despite the availability of high-value interventions. IMPACT This systematic review is the first, to our knowledge, to summarize the percentage of physical therapist treatment choices that were high versus low value for cardiorespiratory conditions, neurological conditions, and conditions requiring acute hospital care. The findings highlight areas of practice where low-value care could be replaced with high-value care-such as in the management of patients who have chronic obstructive pulmonary disease or who are in intensive care-and identify an urgent need to develop and test strategies to ensure that patients with these conditions receive the interventions most likely to improve their outcomes.
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Affiliation(s)
- Joshua R Zadro
- Sydney School of Public Health, Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Level 10 N, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - Sonia Cheng
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Mary O'Keeffe
- Sydney School of Public Health, Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney
| | - Christopher G Maher
- Sydney School of Public Health, Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney
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Fritz J, Wallin L, Söderlund A, Almqvist L, Sandborgh M. Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods. Implement Sci 2019; 14:94. [PMID: 31684977 PMCID: PMC6827232 DOI: 10.1186/s13012-019-0942-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022] Open
Abstract
Background In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences. Methods An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists working in primary health care were included in the quasi-experimental trial, and all physiotherapists in the experimental group (n = 15) were included in the current study. A facilitation intervention based mainly on social cognitive theory was tested during a 6-month period. Data were collected during and after the implementation period by self-reports of time allocation regarding participation in different implementation methods, documentation of individual goals, ranking of the most important implementation methods, and semi-structured interviews. Descriptive statistical methods and inductive content analysis were used. Results The physiotherapists participated most frequently in the following implementation methods: outreach visits, peer coaching, educational materials, and individual goal-setting. They also considered these methods to be the most important for implementation, contributing to support for learning, practice, memory, emotions, self-management, and time management. However, time management support from the manager was lacking. Conclusions The findings indicate that different mechanisms govern the initiation and maintenance of clinical behavior change. The impact mechanisms for initiation of clinical behavior change refers to the use of externally initiated multiple methods, such as feedback on practice, time management, and extrinsic motivation. The lack of self-regulation capability, intrinsic motivation, and continued support after the implementation intervention period were interpreted as possible mechanisms for the failure of maintaining the behavioral change over time.
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Affiliation(s)
- Johanna Fritz
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden.
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden
| | - Lena Almqvist
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden
| | - Maria Sandborgh
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden
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15
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Trujillo-Martín MM, Ramallo-Fariña Y, Del Pino-Sedeño T, Rúa-Figueroa Í, Trujillo-Martín E, Vallejo-Torres L, Imaz-Iglesia I, Sánchez-de-Madariaga R, de Pascual-Medina AM, Serrano-Aguilar P. Effectiveness and cost-effectiveness of a multicomponent intervention to implement a clinical practice guideline for systemic lupus erythematosus: protocol for a cluster-randomized controlled trial. BMC Health Serv Res 2019; 19:783. [PMID: 31675957 PMCID: PMC6824022 DOI: 10.1186/s12913-019-4589-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 11/24/2022] Open
Abstract
Background Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with significant potential morbidity and mortality. Substantial gaps have been documented between the development and dissemination of clinical practice guidelines (CPG) and their implementation in practice. The aim of this study is to assess the effectiveness and cost-effectiveness of a multi-component knowledge transfer intervention to implement a CPG for the management of SLE (CPG-SLE). Methods The study is an open, multicentre, controlled trial with random allocation by clusters to intervention or control. Clusters are four public university hospitals of the Canary Islands Health Service where rheumatologists are invited to participate. Patients diagnosed with SLE at least one year prior to recruitment are selected. Rheumatologists in intervention group receive a short educational group programme to both update their knowledge about SLE management according to CPG-SLE recommendations and to acquire knowledge and training on use of the patient-centred approach, a decision support tool embedded in the electronic clinical record and a quarterly feedback report containing information on management of SLE patients. Primary endpoint is change in self-perceived disease activity. Secondary endpoints are adherence of professionals to CPG-SLE recommendations, health-related quality of life, patient perception of their participation in decision making, attitudes of professionals towards shared decision making, knowledge of professionals about SLE and use of healthcare resources. Calculated sample size is 412 patients. Data will be collected from questionnaires and clinical records. Length of follow-up will be 18 months. Multilevel mixed models with repeated time measurements will be used to analyze changes in outcomes over time. Cost-effectiveness, from both social and healthcare services perspectives, will be analyzed by measuring effectiveness in terms of quality-adjusted life years gained. Deterministic and probabilistic sensitivity analyses are planned. Discussion Impact of CPGs in clinical practice could be improved by applying proven value interventions to implement them. The results of this ongoing trial are expected to generate important scientifically valid and reproducible information not only on clinical effectiveness but also on cost-effectiveness of a multi-component intervention for implementation of a CPG based on communication technologies for chronic patients in the hospital setting. Trial registration ClinicalTrial.gov NCT03537638. Registered on 25 May 2018.
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Affiliation(s)
- María M Trujillo-Martín
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Tenerife, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Red Española de Agencias de Evaluación de Tecnologías Sanitarias (RedETS), Madrid, Spain. .,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain.
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Tenerife, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Red Española de Agencias de Evaluación de Tecnologías Sanitarias (RedETS), Madrid, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Tasmania Del Pino-Sedeño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Tenerife, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Íñigo Rúa-Figueroa
- Servicio de Reumatología, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | | | - Laura Vallejo-Torres
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Iñaki Imaz-Iglesia
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Agencia de Evaluación de Tecnologías Sanitarias del Instituto de Salud Carlos III, Madrid, Spain
| | - Ricardo Sánchez-de-Madariaga
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Unidad de Investigación en Telemedicina y e-Salud, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana M de Pascual-Medina
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Servicio Canario de la Salud, Santa Cruz de Tenerife, Spain
| | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Red Española de Agencias de Evaluación de Tecnologías Sanitarias (RedETS), Madrid, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain.,Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Servicio Canario de la Salud, Santa Cruz de Tenerife, Spain
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16
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Bernhardsson S, Larsson MEH. Does a tailored guideline implementation strategy have an impact on clinical physiotherapy practice? A nonrandomized controlled study. J Eval Clin Pract 2019; 25:575-584. [PMID: 29806112 DOI: 10.1111/jep.12958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 12/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines are a common strategy for implementing research findings into practice and facilitating evidence-based practice in health care settings. There is a paucity of knowledge about the impact of different guideline implementation strategies on clinical practice in a physiotherapy context. The study aimed to assess the impact of a guideline implementation intervention on clinical physiotherapy practice. METHODS A tailored, multicomponent guideline implementation was compared with usual practice. Clinical practice was evaluated in physiotherapy treatment methods used for 3 common musculoskeletal disorders. Data were collected with a validated web-based questionnaire. RESULTS Postimplementation data were collected from 168 physiotherapists in the intervention group and 88 in the control group. The most frequently reported treatment methods for low back pain were advice on posture (reported by 95% in the intervention group vs 90% in the control group), advice to stay active (93% vs 90%), and stabilization exercise (88% vs 80%). Differences between groups were not significant. Reported use of body awareness training (23% vs 6%, P = .023) and spinal manipulation (9% vs 23%, P = .044) differed between the groups. The most frequently used treatment methods for neck pain were advice on posture (95% vs 92%), advice to stay active (89% vs 87%), and ROM exercise (85% vs 71%) (no significant differences between groups). Reported use of body awareness training (24% vs 7%, P = .023) differed between the groups. The most frequently used treatment methods for subacromial pain were range of motion exercises (reported by 93% in both groups), advice on posture (90% vs 87%), home exercise (77% vs 74%), and stabilization exercise (69% vs 66%) (no significant difference between groups). CONCLUSIONS Treatment methods used were largely in line with evidence already before the guideline implementation, which may explain why the guideline implementation had only little impact on clinical practice.
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Affiliation(s)
- Susanne Bernhardsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Maria E H Larsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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17
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Morris JH, Bernhardsson S, Bird ML, Connell L, Lynch E, Jarvis K, Kayes NM, Miller K, Mudge S, Fisher R. Implementation in rehabilitation: a roadmap for practitioners and researchers. Disabil Rehabil 2019; 42:3265-3274. [PMID: 30978129 DOI: 10.1080/09638288.2019.1587013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Despite growth in rehabilitation research, implementing research findings into rehabilitation practice has been slow. This creates inequities for patients and is an ethical issue. However, methods to investigate and facilitate evidence implementation are being developed. This paper aims to make these methods relevant and accessible for rehabilitation researchers and practitioners.Methods: Rehabilitation practice is varied and complex and occurs within multilevel healthcare systems. Using a "road map" analogy, we describe how implementation concepts and theories can inform implementation strategies in rehabilitation. The roadmap involves a staged journey that considers: the nature of evidence; context for implementation; navigation tools for implementation; strategies to facilitate implementation; evaluation of implementation outcomes; and sustainability of implementation. We have developed a model to illustrate the journey, and four case studies exemplify implementation stages in rehabilitation settings.Results and Conclusions: Effective implementation strategies for the complex world of rehabilitation are urgently required. The journey we describe unpacks that complexity to provide a template for effective implementation, to facilitate translation of the growing evidence base in rehabilitation into improved patient outcomes. It emphasizes the importance of understanding context and application of relevant theory, and highlights areas which should be targeted in new implementation research in rehabilitation.Implications for rehabilitationEffective implementation of research evidence into rehabilitation practice has many interconnected steps and a roadmap analogy is helpful in defining them.Understanding context for implementation is critically important and using theory can facilitate development of understanding.Research methods for implementation in rehabilitation should be carefully selected and outcomes should evaluate implementation success as well as clinical change.Sustainability requires regular revisiting of the interconnected steps.
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Affiliation(s)
- Jacqui H Morris
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Susanne Bernhardsson
- Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden.,The Sahlgrenska Academy Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Marie-Louise Bird
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Louise Connell
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - Elizabeth Lynch
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Victoria, Australia
| | - Kathryn Jarvis
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - Nicola M Kayes
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Kim Miller
- Evidence Centre, Sunny Hill Health Centre for Children, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Suzie Mudge
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Rebecca Fisher
- School of Medicine, University of Nottingham, Nottingham, UK
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18
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Snöljung Å, Gustafsson LK. Physiotherapy: How to work with evidence in daily practice. J Eval Clin Pract 2019; 25:216-223. [PMID: 30259604 DOI: 10.1111/jep.13035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/31/2018] [Indexed: 12/24/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The concept of evidence-based health care has gained increasing currency over the past decades; however, questions persist regarding how to overcome the gap between research and health care practice. The question arises whether this gap derives from a true knowledge deficit or from physiotherapists' perception of working with evidence. The aim of the current study was to illuminate changes to the meaning of working with evidence experienced by a cohort of physiotherapists following an education program. METHODS A phenomenological hermeneutic design with open-ended group interviews was carried out with physiotherapists who had participated in an education program about evidence and how to implement evidence-based practice (EBP) in day-to-day practice. FINDINGS The interviews provided descriptions of working with evidence according to three major themes: "Confidence with the concept of evidence in relation to a way of working"; "Experience of EBP as a duty to seek evidence for individual patients"; and "EBP experienced as an integrated and patient-oriented activity". CONCLUSIONS The physiotherapists' lived experiences demonstrated that the participants' perception of the concept of evidence mainly concerned a broadening of the definition of evidence, and this altered perception of evidence could interpreted as the physiotherapists viewing EBP as a more integrated and patient-oriented activity than before.
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Affiliation(s)
- Åsa Snöljung
- School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Sweden
| | - Lena-Karin Gustafsson
- Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
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19
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Sousa DMDN, Chagas ACMA, Vasconcelos CTM, Stein AT, Oriá MOB. Development of a clinical protocol for detection of cervical cancer precursor lesions. Rev Lat Am Enfermagem 2018; 26:e2999. [PMID: 29791673 PMCID: PMC5969826 DOI: 10.1590/1518-8345.2340.2999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/12/2018] [Indexed: 01/10/2023] Open
Abstract
Objective: to develop and validate the content of a clinical protocol aimed at
prevention of cervical cancer in primary care. Method: technological research according to the steps: (1) submission of the project
to the research ethics committee; (2) bibliographic survey; (3) elaboration
of the clinical protocol; and (4) content validation. In the third step, the
information was collected through bibliographic research and gynecology
specialists were consulted. For the final step, four judges were selected to
evaluate the clinical protocol according to AGREE 2. Domains that reached
the minimum level of agreement of 75% in the scores were considered
validated. Results: the scores obtained in each domain of the instrument were as follows: domain
1 (scope and purpose) = 87.5%; domain 2 (stakeholder involvement) = 83.3%;
domain 3 (development rigor) = 79.7%; domain 4 (clarity of presentation) =
76.3%; domain 5 (applicability) = 78.1%; and domain 6 (editorial
independence) = 85.4. Conclusion: the clinical protocol proved to be a validated material with scores above the
minimum required. The protocol obtained positive recommendations with
modifications and went through adjustments in order to make it more
effective.
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20
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Tell J, Olander E, Anderberg P, Berglund JS. Implementation of a web-based national child health-care programme in a local context: A complex facilitator role. Scand J Public Health 2018; 46:80-86. [DOI: 10.1177/1403494817744119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: The aim of this study was to investigate child health-care coordinators’ experiences of being a facilitator for the implementation of a new national child health-care programme in the form of a web-based national guide. Methods: The study was based on eight remote, online focus groups, using Skype for Business. A qualitative content analysis was performed. Results: The analysis generated three categories: adapt to a local context, transition challenges and led by strong incentives. There were eight subcategories. In the latent analysis, the theme ‘Being a facilitator: a complex role’ was formed to express the child health-care coordinators’ experiences. Conclusions: Facilitating a national guideline or decision support in a local context is a complex task that requires an advocating and mediating role. For successful implementation, guidelines and decision support, such as a web-based guide and the new child health-care programme, must match professional consensus and needs and be seen as relevant by all. Participation in the development and a strong bottom-up approach was important, making the web-based guide and the programme relevant to whom it is intended to serve, and for successful implementation. The study contributes valuable knowledge when planning to implement a national web-based decision support and policy programme in a local health-care context.
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Affiliation(s)
- Johanna Tell
- Department of Health, Faculty of Technology,
Blekinge Institute of Technology, Sweden
| | - Ewy Olander
- Department of Health, Faculty of Technology,
Blekinge Institute of Technology, Sweden
| | - Peter Anderberg
- Department of Health, Faculty of Technology,
Blekinge Institute of Technology, Sweden
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21
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Jangi M, Ferandez-de-Las-Penas C, Tara M, Moghbeli F, Ghaderi F, Javanshir K. A systematic review on reminder systems in physical therapy. CASPIAN JOURNAL OF INTERNAL MEDICINE 2018; 9:7-15. [PMID: 29387313 PMCID: PMC5771354 DOI: 10.22088/cjim.9.1.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background The main goal of physical therapy is to help the patient gain a better health status. Several studies have investigated the use of reminders to prevent such failures on the patients' side. This article presents a systematic review of the literature concerning reminders in physical therapy. Methods Databases were searched until May 2017 and literatures were found from April 1992 until 2017. The literature recruitment strategy was based on applying several keywords and Medical Subject Heading (MeSH) combination running against title and abstract, including concepts such as reminder, physical therapy. The finally selected articles were categorized through reminder aspects such as how, who feedback. Data were extracted according to PRISMA guidelines. Results In 47% of studies, the reminder was sent to the patients, 29% to the physical therapists and 12% to the caretaker team. In 24% of the studies, paper-based letters were main medium for reminders while the rest were various types of media like emails and SMS mobile text messages. 35% of the articles showed positive effects of the reminders. Conclusions Many reminder methods consisted of SMS, phone calls, letters, emails and notices on the wall were used in physical therapy. Reminders may be used to improve patients' adherence to exercise programs.
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Affiliation(s)
- Majid Jangi
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Cesar Ferandez-de-Las-Penas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Mahmoud Tara
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fateme Moghbeli
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghaderi
- Department, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khodabakhsh Javanshir
- Mobility Impairment Research Center, Health Research Institate, Babol University of Medical Sciences, Babol Iran
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22
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Štulc T, Lánská V, Šnejdrlová M, Vrablík M, Prusíková M, Češka R. A comprehensive guidelines-based approach reduces cardiovascular risk in everyday practice: the VARO study. Arch Med Sci 2017; 13:705-710. [PMID: 28721135 PMCID: PMC5510513 DOI: 10.5114/aoms.2016.64865] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/24/2016] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The aim of study was to investigate the possibility of cardiovascular risk improvement through systematic identification of high-risk individuals and treatment in accordance with current guidelines using modern therapy in daily clinical practice. MATERIAL AND METHODS Two hundred and sixty-three physicians participated in the study. The physicians were asked to screen for cardiovascular risk factors in patients presenting with unrelated problems and to re-evaluate the attainment of treatment goals in those with already known risk factors. Each physician enrolled up to 20 consecutive patients with hypertension and/or hyperlipidemia. A total of 3015 patients were included. Cardiovascular risk was assessed using the SCORE system. Risk factors were treated in accordance with current national guidelines. The therapy of hyperlipidemia and hypertension was preferentially based on rosuvastatin, amlodipine and valsartan. Further medication was at the discretion of the attending physician. Patients were examined at baseline and after 3 and 6 months. RESULTS The principal result is that global cardiovascular risk decreased by 35% (from 8.9 ±6.4 to 5.9 ±4.4, p < 0.001). Systolic and diastolic blood pressure decreased by 12.5% (from 152 ±18 to 133 ±11, p < 0.001) and 11.4% (from 88 ±11 to 78 ±7, p < 0.001). The level of total cholesterol decreased 21% (from 6.3 ±1.2 to 5.0 ±0.9, p < 0.001) and the concentration of LDL-C decreased 28% (from 3.9 ±1.1 to 2.8 ±0.8, p < 0.001). HDL-C increased by 7% (from 1.43 ±0.58 to 1.53 ±0.56, p < 0.001) and triglycerides decreased by 25% (from 2.4 ±1.3 to 1.8 ±0.9, p < 0.001). Blood pressure and LDL-C target values were reached in 68% and 34%of patients, respectively. CONCLUSIONS The VARO study demonstrates that in daily practice settings, both individual risk factors and global cardiovascular risk are significantly improved through the systematic identification of high-risk individuals and their treatment in accordance with current guidelines using modern pharmacotherapy.
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Affiliation(s)
- Tomáš Štulc
- 3 Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Věra Lánská
- Division of Professional Activities, Quality Assurance and Controlling, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Michaela Šnejdrlová
- 3 Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Vrablík
- 3 Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martina Prusíková
- 3 Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Richard Češka
- 3 Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Strategies to translate knowledge related to common musculoskeletal conditions into physiotherapy practice: a systematic review. Physiotherapy 2017; 104:1-8. [PMID: 28942899 DOI: 10.1016/j.physio.2017.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 05/19/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Many physiotherapists underuse evidence-based practice guidelines or recommendations when treating patients with musculoskeletal disorders, yet synthesis of knowledge translation interventions used within the field of physiotherapy fails to offer clear conclusions to guide the implementation of clinical practice guidelines. OBJECTIVES To evaluate the effectiveness of various knowledge translation interventions used to implement changes in the practice of current physiotherapists treating common musculoskeletal issues. DATA SOURCES A computerized literature search of MEDLINE, CINHAL and ProQuest of systematic reviews (from inception until May 2016) and primary research studies (from January 2010 until June 2016). STUDY SELECTION AND ELIGIBILITY CRITERIA Eligibility criteria specified articles evaluating interventions for translating knowledge into physiotherapy practice. DATA EXTRACTION AND DATA SYNTHESIS Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Of a total of 13014 articles located and titles and abstracts screened, 34 studies met the inclusion criteria, including three overlapping publications, resulting in 31 individual studies. RESULTS Knowledge translation interventions appear to have resulted in a positive change in physiotherapist beliefs, attitudes, skills and guideline awareness. However, no consistent improvement in clinical practice, patient and economic outcomes were observed. LIMITATIONS The studies included had small sample sizes and low methodological quality. The heterogeneity of the studies was not conducive to pooling the data. CONCLUSIONS AND IMPLICATION OF KEY FINDINGS The intensity and type of knowledge translation intervention seem to have an effect on practice change. More research targeting financial, organizational and regulatory knowledge translation interventions is needed.
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Christensen C, Wessells D, Byars M, Marrie J, Coffman S, Gates E, Selhorst M. The impact of a unique knowledge translation programme implemented in a large multisite paediatric hospital. J Eval Clin Pract 2017; 23:344-353. [PMID: 27594577 DOI: 10.1111/jep.12617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Physical therapists (PTs) display positive attitudes toward evidence-based practice (EBP), and implementing it can improve patient outcomes and reduce costs. However, barriers can lead to inconsistent use of EBP. The objectives of this manuscript are to (i) describe the initiation and revisions to a knowledge translation (KT) programme, (ii) assess staff participation in KT, and (iii) evaluate availability, internal use and external dissemination of evidence-based recommendations and research. TARGET SETTING The KT programme was implemented in a large paediatric hospital employing 66 PTs who provide services in the inpatient, outpatient developmental and sports and orthopaedics settings in 15 locations. DEVELOPMENT OF KT PROGRAMME The KT programme was initiated 9 years ago but underwent improvements over the past 3 years. Five key revisions included the subdivision of the EBP and Research Coordinator positions by area of practice, increasing the structure of the KT programme, implementing strategies to encourage use of local recommendations, obtaining leadership support to emphasize KT and providing staff education. OUTCOMES With the revisions, staff participation in local recommendation development increased from 16.3-68.2%. Research involvement increased from 4.1-50%. The number of local recommendations increased from 1 to 9, and an overall compliance rate of 79% was achieved for the recommendations presented in an algorithm format. External dissemination increased from 1 to 44 for presentations and 0 to 7 for publications. DISCUSSION Revisions to a KT programme improved PT engagement in KT activities, increased the availability of local recommendations, encouraged use of EBP and increased external dissemination of information.
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Affiliation(s)
- Catie Christensen
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - David Wessells
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - Michelle Byars
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - James Marrie
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - Shaun Coffman
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - Erin Gates
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mitch Selhorst
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
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Use of theory to plan or evaluate guideline implementation among physicians: a scoping review. Implement Sci 2017; 12:26. [PMID: 28241771 PMCID: PMC5327520 DOI: 10.1186/s13012-017-0557-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/14/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Guidelines support health care decision-making and high quality care and outcomes. However, their implementation is sub-optimal. Theory-informed, tailored implementation is associated with guideline use. Few guideline implementation studies published up to 1998 employed theory. This study aimed to describe if and how theory is now used to plan or evaluate guideline implementation among physicians. METHODS A scoping review was conducted. MEDLINE, EMBASE, and The Cochrane Library were searched from 2006 to April 2016. English language studies that planned or evaluated guideline implementation targeted to physicians based on explicitly named theory were eligible. Screening and data extraction were done in duplicate. Study characteristics and details about theory use were analyzed. RESULTS A total of 1244 published reports were identified, 891 were unique, and 716 were excluded based on title and abstract. Among 175 full-text articles, 89 planned or evaluated guideline implementation targeted to physicians; 42 (47.2%) were based on theory and included. The number of studies using theory increased yearly and represented a wide array of countries, guideline topics and types of physicians. The Theory of Planned Behavior (38.1%) and the Theoretical Domains Framework (23.8%) were used most frequently. Many studies rationalized choice of theory (83.3%), most often by stating that the theory described implementation or its determinants, but most failed to explicitly link barriers with theoretical constructs. The majority of studies used theory to inform surveys or interviews that identified barriers of guideline use as a preliminary step in implementation planning (76.2%). All studies that evaluated interventions reported positive impact on reported physician or patient outcomes. CONCLUSIONS While the use of theory to design or evaluate interventions appears to be increasing over time, this review found that one half of guideline implementation studies were based on theory and many of those provided scant details about how theory was used. This limits interpretation and replication of those interventions, and seems to result in multifaceted interventions, which may not be feasible outside of scientific investigation. Further research is needed to better understand how to employ theory in guideline implementation planning or evaluation.
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Fujimoto S, Kon N, Takasugi J, Nakayama T. Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey. J Phys Ther Sci 2017; 29:198-208. [PMID: 28265139 PMCID: PMC5332970 DOI: 10.1589/jpts.29.198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/27/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate Japanese physical therapists’ attitudes of
evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014,
a cross-sectional postal mail survey using a self-administered questionnaire was
conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical
Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items
pertaining to the attitudes of and behavior toward evidence-based practice and clinical
practice guidelines. It was investigated to reveal the relationship between clinical
practice guidelines/evidence-based practice and therapist characteristics. [Results] The
response rate was 39.6%, and 384 questionnaires were available. The main results were as
follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1%
agree to that evidence-based practice supports clinical decision of physical therapists,
and about 11% agreed to have been educated about evidence-based practice. Then, 29.2%
used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical
practice guidelines. An important factor related mostly to a positive attitude, knowledge
and behavior of evidence-based practice and clinical practice guidelines was participating
in research activities. [Conclusion] Many of physical therapists do not use and understand
the importance of clinical practice guidelines. Participating in research activities may
partially contribute to improving these conditions.
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Affiliation(s)
| | | | - Jun Takasugi
- Chiba Prefectural University of Health Sciences, Japan
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27
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Advancing Evidence-Based Practice in Physical Therapy Settings: Multinational Perspectives on Implementation Strategies and Interventions. Phys Ther 2017; 97:51-60. [PMID: 27515942 DOI: 10.2522/ptj.20160141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/29/2016] [Indexed: 11/17/2022]
Abstract
It is of critical importance that findings from the wealth of clinical physical therapist research are transferred into clinical practice without unnecessary delays. There is a lack of knowledge about strategies that can be used to effectively implement physical therapist research findings and evidence-based practice (EBP) into everyday clinical practice in different national settings and contexts. The purpose of this article is to contribute to knowledge about effective strategies for implementing EBP that have been studied in different national physical therapy settings. The specific aims of this article are to share experiences and provide a current multinational perspective on different approaches and strategies for implementing EBP and to highlight important considerations and implications for both research and practice. Six research studies from various settings in 3 countries are described and synthesized. Key characteristics of the studies and intervention components are tabulated and mapped to the Cochrane Effective Practice and Organisation of Care taxonomy. Commonalities and differences are presented. The implementation strategies described were: a theory-based guideline implementation tailored to identified barriers and facilitators; a multifaceted EBP training package; journal clubs; a multifaceted strategy comprising contextualized procedures, protocols, and standardized resources; barrier identification, education, audit, feedback, and reminders; and contextualized guidelines. Commonalities were the use of a multifaceted approach, educational measures, and clinical guidelines. Key outcomes across the studies were improved attitudes and increased awareness, knowledge, skills, and confidence in EBP; better access to clinical practice guidelines and other EBP resources; identification of barriers that could be targeted in future implementation activities; earlier referrals; and use of recommended outcome measures. The article can serve as a template for other physical therapist researchers in designing implementation studies, as well as to inform policies and practice for health care managers and decision makers who are looking for ways to implement research findings in their organizations.
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De Angelis G, Davies B, King J, McEwan J, Cavallo S, Loew L, Wells GA, Brosseau L. Information and Communication Technologies for the Dissemination of Clinical Practice Guidelines to Health Professionals: A Systematic Review. JMIR MEDICAL EDUCATION 2016; 2:e16. [PMID: 27903488 PMCID: PMC5156823 DOI: 10.2196/mededu.6288] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/09/2016] [Accepted: 11/22/2016] [Indexed: 05/18/2023]
Abstract
BACKGROUND The transfer of research knowledge into clinical practice can be a continuous challenge for researchers. Information and communication technologies, such as websites and email, have emerged as popular tools for the dissemination of evidence to health professionals. OBJECTIVE The objective of this systematic review was to identify research on health professionals' perceived usability and practice behavior change of information and communication technologies for the dissemination of clinical practice guidelines. METHODS We used a systematic approach to retrieve and extract data about relevant studies. We identified 2248 citations, of which 21 studies met criteria for inclusion; 20 studies were randomized controlled trials, and 1 was a controlled clinical trial. The following information and communication technologies were evaluated: websites (5 studies), computer software (3 studies), Web-based workshops (2 studies), computerized decision support systems (2 studies), electronic educational game (1 study), email (2 studies), and multifaceted interventions that consisted of at least one information and communication technology component (6 studies). RESULTS Website studies demonstrated significant improvements in perceived usefulness and perceived ease of use, but not for knowledge, reducing barriers, and intention to use clinical practice guidelines. Computer software studies demonstrated significant improvements in perceived usefulness, but not for knowledge and skills. Web-based workshop and email studies demonstrated significant improvements in knowledge, perceived usefulness, and skills. An electronic educational game intervention demonstrated a significant improvement from baseline in knowledge after 12 and 24 weeks. Computerized decision support system studies demonstrated variable findings for improvement in skills. Multifaceted interventions demonstrated significant improvements in beliefs about capabilities, perceived usefulness, and intention to use clinical practice guidelines, but variable findings for improvements in skills. Most multifaceted studies demonstrated significant improvements in knowledge. CONCLUSIONS The findings suggest that health professionals' perceived usability and practice behavior change vary by type of information and communication technology. Heterogeneity and the paucity of properly conducted studies did not allow for a clear comparison between studies and a conclusion on the effectiveness of information and communication technologies as a knowledge translation strategy for the dissemination of clinical practice guidelines.
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Affiliation(s)
- Gino De Angelis
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Barbara Davies
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Judy King
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Jessica McEwan
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Sabrina Cavallo
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Laurianne Loew
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - George A Wells
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lucie Brosseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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Käll I, Larsson ME, Bernhardsson S. Use of outcome measures improved after a tailored implementation in primary care physiotherapy: a prospective, controlled study. J Eval Clin Pract 2016; 22:668-76. [PMID: 26853076 DOI: 10.1111/jep.12513] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 12/25/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES It is important that physiotherapists routinely use outcome measures to evaluate treatment results. There is limited knowledge about effective ways to increase use of outcome measures. The objectives were to investigate the effect of a tailored implementation of guidelines for evaluation of physiotherapy treatment and to explore differences in outcome subgrouped by demographic variables. METHODS A prospective, controlled study was conducted in primary care physiotherapy in western Sweden. 448 publicly employed physiotherapists participated. The intervention comprised a tailored, multi-component implementation of guidelines for treatment and evaluation of musculoskeletal disorders. The core component was a 3-hour implementation seminar. The control group received no intervention. Self-reported attitudes towards, access to and use of outcome measures were assessed with a web-based questionnaire before and after the implementation. RESULTS After the implementation, a significantly higher proportion of physiotherapists in the intervention group than in the control group reported using outcome measures frequently, 54.8% vs. 35.6%, a 19.2% difference. The proportion of physiotherapists who reported that they considered outcome measures important to use and that they had easy access to outcome measures at their workplace, were similar in both groups at follow-up, 92.8% vs. 93.1%, and 95.2% vs. 90.8%, respectively. At follow-up, no differences related to demographic variables were found in the subgroup analyses. CONCLUSIONS The findings suggest that a tailored, multi-component implementation can be effective in increasing use of outcome measures. Although most physiotherapists considered outcome measures important and reported having easy access to them at their workplace, only a little more than half reported using outcome measures after the intervention.
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Affiliation(s)
- Ingela Käll
- Närhälsan Stenungsund Rehabilitation, Stenungsund, Sweden. .,Umeå University, Department of Community Medicine and Rehabilitation & Physiotherapy, UMEÅ, Sweden.
| | - Maria Eh Larsson
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Research and Development, Primary Health Care, Närhälsan Primary Care Research and Development Centre, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden.,Närhälsan Rehabilitation Hönö/Öckerö, Region Västra Götaland, Hönö, Sweden
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30
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Theodorsson E. Quality Assurance in Clinical Chemistry: A Touch of Statistics and A Lot of Common Sense. J Med Biochem 2016; 35:103-112. [PMID: 28356868 PMCID: PMC5346785 DOI: 10.1515/jomb-2016-0012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 02/23/2016] [Indexed: 12/23/2022] Open
Abstract
Working in laboratories of clinical chemistry, we risk feeling that our personal contribution to quality is small and that statistical models and manufacturers play the major roles. It is seldom sufficiently acknowledged that personal knowledge, skills and common sense are crucial for quality assurance in the interest of patients. The employees, environment and procedures inherent to the laboratory including its interactions with the clients are crucial for the overall result of the total testing chain. As the measurement systems, reagents and procedures are gradually improved, work on the preanalytical, postanalytical and clinical phases is likely to pay the most substantial dividends in accomplishing further quality improvements. This means changing attitudes and behaviour, especially of the users of the laboratory. It requires understanding people and how to engage them in joint improvement processes. We need to use our knowledge and common sense expanded with new skills e.g. from the humanities, management, business and change sciences in order to bring this about together with the users of the laboratory.
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Affiliation(s)
- Elvar Theodorsson
- Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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31
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Perraton L, Machotka Z, Gibbs C, Mahar C, Kennedy K, Grimmer K. Evidence-based Practice Intentions and Long-term Behaviours of Physiotherapy Graduates Following an Intensive Education Programme. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 22. [PMID: 26916106 DOI: 10.1002/pri.1666] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 07/21/2015] [Accepted: 08/28/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Assisting physiotherapists to implement research evidence into clinical practice is essential to ensure the quality of practice and encourage lifelong learning and professional progression. However, many physiotherapists report barriers to implementing research, and there is little evidence regarding the sustainability of intended evidence-based practice (EBP) behaviours following EBP education programmes. This paper reports on intended and actual long-term EBP behaviours of physiotherapy students who completed an intensive EBP training programme embedded within a post-graduate coursework programme. METHODS An intensive 3-week course in quantitative health research methods and EBP was delivered annually from 2007 to 2014 as part of the programme to national and international students. Following the course, students were asked about their intention of using evidence to inform their future clinical practice. An online survey was used to evaluate EBP behaviours of graduates. RESULTS Of a possible total of 202 students, contact details for 193 students were sourced, and 65 students responded to the survey (34% response rate). At course completion, 174 students (86%) indicated that they intended to use research to guide their clinical decisions at least once a week. At follow-up, most graduates reported frequently using research to inform their clinical practice; indicated by a mean score of 6.5 (±1.9) from a possible range of 0 (not at all) to 10 (all the time). On average, students reported spending 2.2 (±2.2) hours accessing and reading research evidence per week. The most common barriers to implementing evidence were lack of time, limited access to evidence sources and a perceived lack of generalizability of research findings to specific patient groups. CONCLUSION Graduates of an intensive EBP training programme embedded within an existing post-graduate physiotherapy programme regularly implemented EBP in clinical practice. Barriers to evidence implementation were time, access to research and perceived lack of generalizability of research findings. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- L Perraton
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, Australia.,School of Exercise Science, Australian Catholic University, Melbourne, Australia
| | - Z Machotka
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, Australia
| | - C Gibbs
- Library, University of South Australia, Adelaide, Australia
| | - C Mahar
- Library, University of South Australia, Adelaide, Australia
| | - K Kennedy
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, Australia
| | - K Grimmer
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, Australia
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Matthews J, Hall AM, Hernon M, Murray A, Jackson B, Taylor I, Toner J, Guerin S, Lonsdale C, Hurley DA. A brief report on the development of a theoretically-grounded intervention to promote patient autonomy and self-management of physiotherapy patients: face validity and feasibility of implementation. BMC Health Serv Res 2015; 15:260. [PMID: 26142483 PMCID: PMC4491218 DOI: 10.1186/s12913-015-0921-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 06/12/2015] [Indexed: 01/20/2023] Open
Abstract
Background Clinical practice guidelines for the treatment of low back pain suggest the inclusion of a biopsychosocial approach in which patient self-management is prioritized. While many physiotherapists recognise the importance of evidence-based practice, there is an evidence practice gap that may in part be due to the fact that promoting self-management necessitates change in clinical behaviours. Evidence suggests that a patient’s motivation and maintenance of self-management behaviours can be positively influenced by the clinician’s use of an autonomy supportive communication style. Therefore, the aim of this study was to develop and pilot-test the feasibility of a theoretically derived implementation intervention to support physiotherapists in using an evidence-based autonomy supportive communication style in practice for promoting patient self-management in clinical practice. Methods A systematic process was used to develop the intervention and pilot-test its feasibility in primary care physiotherapy. The development steps included focus groups to identify barriers and enablers for implementation, the theoretical domains framework to classify determinants of change, a behaviour change technique taxonomy to select appropriate intervention components, and forming a testable theoretical model. Face validity and acceptability of the intervention was pilot-tested with two physiotherapists and monitoring their communication with patients over a three-month timeframe. Results Using the process described above, eight barriers and enablers for implementation were identified. To address these barriers and enablers, a number of intervention components were selected ranging from behaviour change techniques such as, goal-setting, self-monitoring and feedback to appropriate modes of intervention delivery (i.e. continued education meetings and audit and feedback focused coaching). Initial pilot-testing revealed the acceptability of the intervention to recipients and highlighted key areas for refinement prior to scaling up for a definitive trial. Conclusion The development process utilised in this study ensured the intervention was theory-informed and evidence-based, with recipients signalling its relevance and benefit to their clinical practice. Future research should consider additional intervention strategies to address barriers of social support and those beyond the clinician level.
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Affiliation(s)
- James Matthews
- Institute for Sport and Health, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland.
| | - Amanda M Hall
- The George Institute for Global Health, Nuffield Department of Population Health, The University of Oxford, Oxford, UK.
| | - Marian Hernon
- Institute for Sport and Health, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland.
| | - Aileen Murray
- Institute for Sport and Health, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland.
| | - Ben Jackson
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia.
| | - Ian Taylor
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
| | - John Toner
- Department of Sport, Health and Exercise Science, University of Hull, Cottingham Road, Hull, HU6 7RX, UK.
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland.
| | - Chris Lonsdale
- Institute for Positive Psychology and Education Faculty of Health, Australian Catholic University, Strathfield, NSW, Australia.
| | - Deirdre A Hurley
- Institute for Sport and Health, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland.
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