Evaluation of a community of practice for speech-language pathologists in aphasia rehabilitation: a logic analysis

Factors influencing knowledge sharing between scientific specialists in knowledge networks and communities of practice: A systematic literature review

Knowledge sharing is a competitive advantage and necessity for the success of any organization. Meanwhile, knowledge networks have been introduced as a way to enhance knowledge sharing between individuals and as an effective tool to facilitate knowledge exchange in clinical, educational, and commercial fields. The purpose of this paper is to identify the factors that can affect the level of knowledge sharing and exchange between academic and scientific specialists in knowledge networks and Communities of Practice (COP). A systematic literature review was conducted using the PRISMA guidelines. Four databases were searched, including Scopus, Web of Science, PubMed, and ProQuest. Google Scholar search was conducted to complete the search and ensure the tracking of the gray literature. Also, relevant sources, references, and reference lists of the related articles were reviewed. The studies were searched from April until August 2022 and finally the content analysis of the findings was done. Two reviewers independently assessed the quality of included studies. Data were extracted using the Joanna Briggs Institute (JBI) checklist tool. Of the 1439 records, 13 studies met the inclusion criteria. This study identified three main categories of factors affecting knowledge sharing in knowledge networks and COPs as individual factors, organizational, and structural. The results showed that knowledge networks provide opportunities to overcome professional barriers and complex systemic challenges and lead to knowledge sharing and exchange among scientific specialists. This article has important implications for managers, health policymakers, and academics who wish to expand knowledge sharing of scientific specialists through knowledge networks and CoPs in knowledge-based organizations.

Understanding needs and expectations to start effective communities of practice

BACKGROUND

Communities of practice (CoPs) are frequently used in health settings to enhance knowledge and support action around public health issues. Yet, most are ineffective and often at risk of not delivering on this promise. To prevent loss of time and resources by organisations, facilitators, and members, this paper argues for a reliable assessment of the needs of people who intend to join and to set realistic expectations to assure effective communities of practice. This research proposes a valid and reliable needs assessment and analysis tool for starting communities of practice, by presenting the results of using such a tool.

METHODS

Inception needs assessments were developed, tested and administered to 246 respondents entering five communities of practice that focused on one of three public health issues: health literacy, mental health literacy and trauma-informed care. One community of practice had a global audience, four were based in Australia. Data from the needs assessments were analysed qualitatively and supplemented with descriptive statistics. Results were used to develop an analysis tool to support future communities of practice.

RESULTS

The short-term expectations of respondents included seeking to increase their knowledge and getting to know other members of the community of practice. Long-term expectations shifted towards undertaking action, collaborating and improving health outcomes. While respondents learning expectations included a wide range of topics, they articulated very specific knowledge they expected to share with others. There were high expectations of receiving practical support from the facilitator and a strong preference for meetings with synchronous interaction. Most respondents who planned to join focused initially on the direct and individual benefits and participation they expected from others, whereas they indicated limited intention to actively contribute to the learning needs of other community members. Respondents appeared to need to take time to build self-confidence and trust, and frequently applied a wait-and-see attitude.

CONCLUSIONS

The findings of this study suggest that an inception needs assessment allows members to express their needs and expectations, which directly informs the direction and structure of a community of practice, gives voice to members, and supports facilitators in managing expectations.

Factors that influence the provision of home-based rehabilitation services for people needing rehabilitation: a qualitative evidence synthesis

BACKGROUND

To increase people's access to rehabilitation services, particularly in the context of the COVID-19 pandemic, we need to explore how the delivery of these services can be adapted. This includes the use of home-based rehabilitation and telerehabilitation. Home-based rehabilitation services may become frequently used options in the recovery process of patients, not only as a solution to accessibility barriers, but as a complement to the usual in-person inpatient rehabilitation provision. Telerehabilitation is also becoming more viable as the usability and availability of communication technologies improve.

OBJECTIVES

To identify factors that influence the organisation and delivery of in-person home-based rehabilitation and home-based telerehabilitation for people needing rehabilitation.

SEARCH METHODS

We searched PubMed, Global Health, the VHL Regional Portal, Epistemonikos, Health Systems Evidence, and EBM Reviews as well as preprints, regional repositories, and rehabilitation organisations websites for eligible studies, from database inception to search date in June 2022.  SELECTION CRITERIA: We included studies that used qualitative methods for data collection and analysis; and that explored patients, caregivers, healthcare providers and other stakeholders' experiences, perceptions and behaviours about the provision of in-person home-based rehabilitation and home-based telerehabilitation services responding to patients' needs in different phases of their health conditions.   DATA COLLECTION AND ANALYSIS: We used a purposive sampling approach and applied maximum variation sampling in a four-step sampling frame. We conducted a framework thematic analysis using the CFIR (Consolidated Framework for Implementation Research) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach.  MAIN RESULTS: We included 223 studies in the review and sampled 53 of these for our analysis. Forty-five studies were conducted in high-income countries, and eight in low-and middle-income countries. Twenty studies addressed in-person home-based rehabilitation, 28 studies addressed home-based telerehabilitation services, and five studies addressed both modes of delivery. The studies mainly explored the perspectives of healthcare providers, patients with a range of different health conditions, and their informal caregivers and family members.  Based on our GRADE-CERQual assessments, we had high confidence in eight of the findings, and moderate confidence in five, indicating that it is highly likely or likely respectively that these findings are a reasonable representation of the phenomenon of interest. There were two findings with low confidence. High and moderate confidence findings Home-based rehabilitation services delivered in-person or through telerehabilitation  Patients experience home-based services as convenient and less disruptive of their everyday activities. Patients and providers also suggest that these services can encourage patients' self-management and can make them feel empowered about the rehabilitation process. But patients, family members, and providers describe privacy and confidentiality issues when services are provided at home. These include the increased privacy of being able to exercise at home but also the loss of privacy when one's home life is visible to others.  Patients and providers also describe other factors that can affect the success of home-based rehabilitation services. These include support from providers and family members, good communication with providers, the requirements made of patients and their surroundings, and the transition from hospital to home-based services. Telerehabilitation specifically Patients, family members and providers see telerehabilitation as an opportunity to make services more available. But providers point to practical problems when assessing whether patients are performing their exercises correctly. Providers and patients also describe interruptions from family members.  In addition, providers complain of a lack of equipment, infrastructure and maintenance and patients refer to usability issues and frustration with digital technology. Providers have different opinions about whether telerehabilitation is cost-efficient for them. But many patients see telerehabilitation as affordable and cost-saving if the equipment and infrastructure have been provided. Patients and providers suggest that telerehabilitation can change the nature of their relationship. For instance, some patients describe how telerehabilitation leads to easier and more relaxed communication. Other patients describe feeling abandoned when receiving telerehabilitation services.  Patients, family members and providers call for easy-to-use technologies and more training and support. They also suggest that at least some in-person sessions with the provider are necessary. They feel that telerehabilitation services alone can make it difficult to make meaningful connections. They also explain that some services need the provider's hands. Providers highlight the importance of personalising the services to each person's needs and circumstances.

AUTHORS' CONCLUSIONS

This synthesis identified several factors that can influence the successful implementation of in-person home-based rehabilitation and telerehabilitation services. These included factors that facilitate implementation, but also factors that can challenge this process. Healthcare providers, program planners and policymakers might benefit from considering these factors when designing and implementing programmes.

Therapists' perspectives on using brain-computer interface-triggered functional electrical stimulation therapy for individuals living with upper extremity paralysis: a qualitative case series study

BACKGROUND

Brain computer interface-triggered functional electrical stimulation therapy (BCI-FEST) has shown promise as a therapy to improve upper extremity function for individuals who have had a stroke or spinal cord injury. The next step is to determine whether BCI-FEST could be used clinically as part of broader therapy practice. To do this, we need to understand therapists' opinions on using the BCI-FEST and what limitations potentially exist. Therefore, we conducted a qualitative exploratory study to understand the perspectives of therapists on their experiences delivering BCI-FEST and the feasibility of large-scale clinical implementation.

METHODS

Semi-structured interviews were conducted with physical therapists (PTs) and occupational therapists (OTs) who have delivered BCI-FEST. Interview questions were developed using the COM-B (Capability, Opportunity, Motivation-Behaviour) model of behaviour change. COM-B components were used to inform deductive content analysis while other subthemes were detected using an inductive approach.

RESULTS

We interviewed PTs (n = 3) and OTs (n = 3), with 360 combined hours of experience delivering BCI-FEST. Components and subcomponents of the COM-B determined deductively included: (1) Capability (physical, psychological), (2) Opportunity (physical, social), and (3) Motivation (automatic, reflective). Under each deductive subcomponent, one to two inductive subthemes were identified (n = 8). Capability and Motivation were perceived as strengths, and therefore supported therapists' decisions to use BCI-FEST. Under Opportunity, for both subcomponents (physical, social), therapists recognized the need for more support to clinically implement BCI-FEST.

CONCLUSIONS

We identified facilitating and limiting factors to BCI-FEST delivery in a clinical setting according to clinicians. These factors implied that education, training, a support network or mentors, and restructuring the physical environment (e.g., scheduling) should be targeted as interventions. The results of this study may help to inform future development of new technologies and interventions.

Implementation of Virtual Communities of Practice in Healthcare to Improve Capability and Capacity: A 10-Year Scoping Review

Virtual communities of practice consist of individuals who use a common online platform to share professional expertise and experiences. In healthcare settings a virtual community of practice (VCoP) can optimise knowledge, skills, and the implementation of evidence-based practice. To ensure effective knowledge synthesis and translation into practice, it is essential to clarify the best methods for designing and implementing VCoPs within healthcare organisations. This scoping review aimed to identify the methods used to establish and facilitate online or digitally enabled communities of practice within healthcare organisations across the globe. Six online databases identified papers published from January 2010 to October 2020. Papers were independently screened by two reviewers using Covidence. Data were captured and analysed using a data extraction chart in Covidence. Twenty-four publications that detail methods for establishing a VCoP in healthcare were included. Few studies used a framework to establish a VCoP. It was difficult to identify details regarding methods of development and key elements such as roles, how they were coordinated, and types of technology used. Healthcare organisations can benefit from using a standardised framework for the establishment, implementation and evaluation of VCoPs to improve practice, staff engagement, and knowledge sharing.

Exploring attitudes about evidence-based practice among speech-language pathologists: A survey of Japan and Malaysia

Purpose: To investigate speech-language pathologists' current perceptions, previous training experiences, resources, barriers, and training needs in terms of evidence-based practices (EBPs) in two Asian countries.Method: Their knowledge and attitudes about EBP were explored using an online questionnaire. A descriptive analysis was conducted with consideration of the effect of demographic variables on knowledge and attitudes about EBP.Result: Malaysian speech-language pathologists (n = 98) displayed more positive attitudes toward EBPs, with a significantly higher (t (143) = 5.91, p < .01) total mean score (Mean = 120.7, SD = 11) compared to the Japanese speech-language pathologists (n = 47, Mean = 107.8, SD = 13.5). Malaysian practitioners who were female, worked full-time, and worked in government settings reported higher motivation to develop EBP skills. Japanese practitioners who worked in private sectors reported higher EBPs training needs than those in government settings. In both countries, speech-language pathologists with higher education levels tended to express fewer perceived barriers towards EBP.Conclusion: Findings could help local governance and speech-language pathologist associations to understand the current practices and professional development needs of speech-language pathologists, leading to more effective training programs and educating employers and managers who can reinforce EBP among practitioners.

Individual and organizational factors associated with evidence-based practice among physical and occupational therapy recent graduates: A cross-sectional national study

BACKGROUND

Occupational therapy (OT) and physical therapy (PT) programs in Canada have moved to graduate-level entry education to address graduates' readiness for evidence-based practice (EBP). Whether rehabilitation professionals with advanced training in EBP are meeting their responsibilities as evidence-based professionals upon entry into practice and the factors that influence the use of evidence is unclear. The aim of this study was to examine the individual and organizational factors associated with the use of EBP and supporting evidence-based activities among graduates of professional OT and PT master's programs.

METHODS

A cross-sectional design using a survey of recent graduates of the 29 OT and PT programs in Canada. The survey measured six constructs supportive of EBP (ie, knowledge, attitudes, confidence, organizational resources, actual use of EBP, and evidence-based activities). Analyses consisted of descriptive statistics to characterize the sample and the different variables and ordinal multivariate regression analysis.

RESULTS

257 graduates (15%) completed the survey. Attitudes towards EBP was positively associated both with evidence-based activities (odds ratio = 1.36 with a 95% CI: 1.22 to 1.52) and use of EBP (odds ratio = 1.23 with a 95% CI: 1.12 to 1.36); greater confidence was related to greater use of EBP (OR = 1.12, 95% CI: 1.01 to 1.24); and working in a private practice setting was found to be related to performing more evidence-based activities (odds ratio = 3.15, 95% CI: 1.40 to 7.12).

CONCLUSIONS

Despite a greater focus on EBP knowledge in these curricula across Canada, knowledge was not related to EBP use nor evidence-based activities upon entry into practice. On the other hand, attitudes, confidence and working in private practice were. University programs should consider curricular strategies that increase the use of EBP, provide opportunities to engage in evidence-based activities with an emphasis on promoting the development of positive attitudes towards EBP and increasing learners' confidence in their ability to be evidence-based professionals.

Intensive Comprehensive Aphasia Programmes: a systematic scoping review and analysis using the TIDieR checklist for reporting interventions

PURPOSE

Aphasia is an acquired language disorder that typically occurs as a result of a stroke. People with aphasia experience communication difficulties and risk secondary impacts, for example, affecting social and work life and mental health. Intensive Comprehensive Aphasia Programmes (ICAPs) aims to address the multiple consequences of aphasia using intensive intervention and a wide range of therapy approaches. Although basic parameters of ICAP intervention have been defined, a fuller characterisation is needed. This systematic scoping review aimed to determine what constitutes an ICAP.

METHODS

Peer-reviewed and Grey databases were searched for articles on ICAPs using Joanna Brigg's Institute methodology. Data was extracted following the Template for Intervention Description and Replication (TIDieR) checklist for reporting interventions and synthesised using a narrative synthesis.

RESULTS AND CONCLUSIONS

17 ICAPs were reported in 20 peer-reviewed literature sources (9 ICAPs supplemented by Grey literature sources). There were high degrees of variation in dose, professionals involved, and no qualitative data from participants. Of note, ICAP intervention was highly tailored to individual participants on the same ICAP, and intervention content varied between ICAPs. ICAPs appear to be rationalised as intensive impairment-based programmes with other components added for comprehensiveness. Stronger rationale and a logic model are required to justify the core components of ICAPs. The input of stakeholders into designing future ICAP interventions is recommended.IMPLICATIONS FOR REHABILITATIONThe ICAP model is in its infancy when it comes to mainstream clinical application as only the intensity component of the ICAP has clear theoretical underpinning as reported in the peer-reviewed literature.There have been clinical uptakes of the ICAP model which is likely to continue and is valid in the context of an under-researched area of aphasia therapy and on a background of a less than perfect relationship between evidence base and practice.Aspects of the ICAP model are valid for clinicians to implement, for example, intensive evidence-based aphasia therapy in combination with therapy which addresses some of the broader implications of aphasia, for example, social isolation.Clinicians can use the ICAP model to review their existing service provision and explore whether their service provides aphasia therapy that addresses the multiple aspects of aphasia (i.e., ensuring the focus is not only on impairment-based therapy).

Are communities of practice a way to support health literacy: a study protocol for a realist review

INTRODUCTION

Communities of practice are used for knowledge sharing and learning in health settings. However, more needs to be known to understand how they work, if they work different in different settings and what outcomes they might generate. Of particular interest is their potential role in health literacy development.

METHODS AND ANALYSIS

This realist review will be undertaken in seven stages, aiming to develop a framework to show how the various contexts of communities of practice in health settings trigger mechanisms that lead to improved health literacy outcomes. The first stage of a realist review is considered important as it clarifies the scope of the review, yet it is rarely elaborated in detail. This paper describes this first stage in detail and shows how scoping techniques can support drafting an initial framework which can guide the rest of the review. After the initial scoping review, the subsequent stages follow an iterative and recurring process (until saturation is reached) that includes searching and appraising evidence, extracting and organising results, and analysing and summarising. The review will then generate conclusions and recommendations for stakeholders seeking to use communities of practice for their health literacy challenges. Findings of the scoping review are presented in this paper as part of the methods description to show the relevance of conducting a scoping review prior to a realist review.

ETHICS AND DISSEMINATION

Ethical review is not required for this review. Experts and stakeholders will be involved in the process after the first stage to increase the quality of the process and to ensure practical relevance and uptake. This review focuses on communities of practice and health literacy, yet findings will likely be relevant for other health settings. Findings will be disseminated through stakeholders, publications, presentations and formal and informal reports.

Predicting Communicative Participation in Adults Across Communication Disorders

Purpose The purpose of this study was to explore the extent to which communicative participation differs across diagnoses and if there are common predictor variables for communicative participation across diagnoses. Method Survey data on self-report variables including communicative participation were collected from 141 community-dwelling adults with communication disorders due to Parkinson's disease, cerebrovascular accident, spasmodic dysphonia, or vocal fold immobility (VFI). Analysis of covariance was used to determine communicative participation differences between diagnoses, with age, sex, and hearing status as covariates. Sequential entry linear regression was used to examine associations between communicative participation and variables representing a range of psychosocial constructs across diagnoses. Results The VFI group had the least favorable communicative participation differing significantly from Parkinson's disease and spasmodic dysphonia groups. Self-rated speech/voice severity, self-rated effort, mental health, perceived social support, and resilience contributed to variance in communicative participation when pooled across diagnoses. The relationship between communicative participation and the variables of effort and resilience differed significantly when diagnosis was considered. Conclusions The findings suggest that communicative participation restrictions may vary across some diagnoses but not others. People with VFI appear to differ from other diagnosis groups in the extent of participation restrictions. Effort and resilience may play different roles in contributing to communicative participation in different disorders, but constructs such as social support, severity, and mental health appear to have consistent relationships with communicative participation across diagnoses. The findings can help clinicians identify psychosocial factors beyond the impairment that impact clients' communication in daily situations.

Characterising the impact of BRAINSPaN: a multidisciplinary community of practice for clinicians and researchers in the brain impairment field

Background:

Communities of practice can facilitate the sharing and translation of knowledge. BRAINSPaN is a multidisciplinary community of practice of clinicians, researchers and students in the brain impairment field that was launched in Australia in June 2017. We aimed to investigate the impact of BRAINSPaN on multidisciplinary collaboration and on knowledge, skills and confidence in domains of practice of interest to members.

Methods:

We surveyed BRAINSPaN members over three time points at 1-month (n = 117), 7-months (n = 69) and 14-months (n = 46) post-launch. Content analysis of posts to the BRAINSPaN listserv was also conducted to identify their purpose and content.

Results:

Increasing access to new research findings and increasing interaction with others in the brain impairment field were the two main goals for survey respondents’ participation in BRAINSPaN. At 7- and 14-months post-launch, these were also the most commonly achieved goals and most frequently cited benefits of BRAINSPaN participation. Cognitive rehabilitation and behaviour management were the most frequently reported practice domains of interest, as well as being two of the five most common topics of BRAINSPaN posts over the survey period. There was a significant increase in self-reported knowledge for participants’ top two domains of interest, but no change in skills or confidence.

Conclusions:

BRAINSPaN has the potential to serve as a vehicle for the sharing and translation of knowledge in the brain impairment field. Combining other forms of dissemination with communities of practice, such as workshops and clinical mentoring, may be needed to also influence the development of skills and confidence in practice areas.

Transition Task Force: Early efforts towards comprehensive pediatric to adult transition services in an academic medical center

Background

The process of transitioning from a pediatric to adult health models of care is a significant challenge associated with heightened morbidity and mortality, particularly for patients with medical complexity.

Methods

Our institution has no formal standardized transition services for patients transitioning from pediatric to adult models of care. The Transition Task Force was created as a community of practice to support interprofessional teams in creating a standard, yet individualized, approach to pediatric to adult transition across multiple departments of an academic center.

Results

The Transition Task Force has been meeting for approximately 4 years, and almost three-quarters of participants report that participation resulted in changes to their clinical process, in spite of recognition of common barriers to effective transition.

Conclusions

The development of a transition-focused community of practice can effectively support implementation of quality improvement projects collaboratively in both a standardized and individualized fashion.

Participant reported outcomes of a community of practice about social participation for speech-language pathologists in aphasia rehabilitation

Purpose: Because of their communication difficulties, persons with aphasia are at risk of not fully participating in significant activities after rehabilitation. Speech-language pathologists can contribute to support optimal social participation in rehabilitation. A community of practice (CoP) was designed to provide motivated clinicians with opportunities to acquire knowledge and reflect on social participation within aphasia rehabilitation. The aim of this study was to describe the outcomes of this CoP according to the perspectives of speech-language pathologist participants.Methods: Semi-structured individual interviews were conducted 4 to 10 weeks after the end of the CoP with 13 speech-language pathologist participants. Analyses were guided by grounded theory.Results: Participants perceived that the CoP experience contributed to a better alignment of their practice with the ideal end purpose of optimizing social participation. A sense of community emerged among CoP members, who collectively reflected on their practice. Participants stated feeling equipped to adopt new practices, adopting new practices for optimizing social participation, and/or advocating for better services for persons with aphasia. They felt increased confidence, motivation, well-being, and/or energy towards their practice.Conclusions: CoPs can help speech-language pathologists to more confidently practice with the goal of optimizing the social participation of persons with aphasia.Implications for rehabilitationSpeech-language pathologists in aphasia rehabilitation, as a result of being involved in a community of practice (CoP) about social participation, may offer more evidence-based services aiming at optimizing the social participation of persons with aphasia.Markers of a successful CoP may include participants' increased feelings of confidence, motivation, well-being, and/or energy towards their practice.CoPs can be used for continuing education purposes and support the development of clinical expertise among professionals, such as speech-language pathologists in aphasia rehabilitation.