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Cormican A, Hirani SP, McKeown E. Healthcare professionals' perceived barriers and facilitators of implementing clinical practice guidelines for stroke rehabilitation: A systematic review. Clin Rehabil 2023; 37:701-712. [PMID: 36475911 PMCID: PMC10041573 DOI: 10.1177/02692155221141036] [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: 12/06/2020] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify healthcare professionals' perceived barriers and facilitators to clinical practice guideline implementation within stroke rehabilitation. DATA SOURCES CINAHL, MEDLINE, EMBASE, AMED, Cochrane library, Academic Search Complete and Scopus. Additional papers were identified through hand searching. REVIEW METHODS The review followed the Preferred Reporting Item for Systematic Reviews and Meta-Analysis Protocols systematic review approach. Any empirical research that provided qualitative data on healthcare professionals' perceived factors influencing clinical guideline implementation in stroke rehabilitation was included. One reviewer screened all titles and abstract reviews (n = 669). Another two reviewers independently screened 30% of title and abstract reviews, followed by full-text reviews (n = 61). Study quality was assessed using the mixed-method appraisal tool. RESULTS Data from 10 qualitative, six quantitative and six mixed-method studies published between 2000 and 2022, involving 1576 participants in total, were analysed and synthesised using modified thematic synthesis approach. The majority of participants were therapists n = 1297 (occupational therapists, physiotherapists, speech and language therapists). Organisational factors (time constraints, resources) alongside healthcare professionals' lack of knowledge and skills were the most cited barriers to guideline implementation. Contradictory attitudes and beliefs towards stroke guidelines applicability to real-life clinical practice and their evidence base were reported. Organisational support in the form of training, local protocols, performance monitoring and leadership were reported as perceived facilitators. CONCLUSION Barriers and facilitators are multifactorial and were identified at guideline, individual, team and organisational levels. There is a need to translate perceived barriers and facilitators into implementation interventions especially addressing organisational-level barriers.
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Affiliation(s)
| | | | - Eamonn McKeown
- Health Services Research & Management Division, School of Health Sciences City, University of London, London, UK
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Windfeld-Lund C, Sturt R, Pham C, Lannin NA, Graco M. Systematic Review of the Effectiveness of Allied Health Clinical Education Programs. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:109-116. [PMID: 36988438 DOI: 10.1097/ceh.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Continuing allied health professional (AHP) clinical education is essential to ensure high-quality patient care; however, the effectiveness of current education programs is unclear. This review aimed to determine whether AHP education programs improve the knowledge of AHPs, change their clinical practice behavior, and/or improve patient-related clinical outcome and to identify important components of these programs. METHODS Four electronic databases were searched. Controlled clinical trials investigating the effectiveness of clinical education programs were included. Education programs were diverse, varying in design, delivery mode, and intensity. Only therapy-specific AHPs were included. Effectiveness was determined by differences in group outcomes in the domains of AHP knowledge, AHP clinical practice behavior, and patient-related clinical outcomes. RESULTS Forty-four studies were identified, of which 26 included physiotherapists only. Most control groups were waitlist, passive dissemination of information, or usual care, limiting comparisons between programs. Changes in AHP knowledge was investigated in 20 trials, with 13 showing an improvement. Thirty studies investigated changes in AHP clinical practice behavior, with half demonstrating a difference between groups. Seventeen studies investigated a patient-related clinical outcome, with five finding a difference between groups. Where improvements in outcomes were demonstrated, programs tended to incorporate self-selection and cater to the learner's contextual needs. DISCUSSION AHP knowledge is effectively improved through targeted education programs. To change AHP behavior and patient outcomes, it seems important to incorporate self-selection for the program and consider the learner's individual needs and contexts through mentoring, outreach visits, reflection, and incorporating patient participation in the learning.
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Affiliation(s)
- Cristie Windfeld-Lund
- Ms Windfeld-Lund: Senior Physiotherapist, Alfred Health, Melbourne, Australia, Mr Sturt : Allied Health Clinical Education Lead, Alfred Health, Melbourne, Australia. Ms Pham: Senior Physiotherapist, Alfred Health, Melbourne, Australia. Dr. Lannin: Professor, Department of Neuroscience, Monash University, Melbourne, Australia; and Clinical Chair (Occupational Therapy), Alfred Health, Melbourne, Australia. Dr Graco: Implementation Scientist, Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
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King O, West E, Lee S, Glenister K, Quilliam C, Wong Shee A, Beks H. Research education and training for nurses and allied health professionals: a systematic scoping review. BMC MEDICAL EDUCATION 2022; 22:385. [PMID: 35590359 PMCID: PMC9121620 DOI: 10.1186/s12909-022-03406-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/22/2022] [Indexed: 05/06/2023]
Abstract
BACKGROUND Research capacity building (RCB) initiatives have gained steady momentum in health settings across the globe to reduce the gap between research evidence and health practice and policy. RCB strategies are typically multidimensional, comprising several initiatives targeted at different levels within health organisations. Research education and training is a mainstay strategy targeted at the individual level and yet, the evidence for research education in health settings is unclear. This review scopes the literature on research education programs for nurses and allied health professionals, delivered and evaluated in healthcare settings in high-income countries. METHODS The review was conducted systematically in accordance with the Joanna Briggs Institute scoping review methodology. Eleven academic databases and numerous grey literature platforms were searched. Data were extracted from the included full texts in accordance with the aims of the scoping review. A narrative approach was used to synthesise findings. Program characteristics, approaches to program evaluation and the outcomes reported were extracted and summarised. RESULTS Database searches for peer-reviewed and grey literature yielded 12,457 unique records. Following abstract and title screening, 207 full texts were reviewed. Of these, 60 records were included. Nine additional records were identified on forward and backward citation searching for the included records, resulting in a total of 69 papers describing 68 research education programs. Research education programs were implemented in fourteen different high-income countries over five decades. Programs were multifaceted, often encompassed experiential learning, with half including a mentoring component. Outcome measures largely reflected lower levels of Barr and colleagues' modified Kirkpatrick educational outcomes typology (e.g., satisfaction, improved research knowledge and confidence), with few evaluated objectively using traditional research milestones (e.g., protocol completion, manuscript preparation, poster, conference presentation). Few programs were evaluated using organisational and practice outcomes. Overall, evaluation methods were poorly described. CONCLUSION Research education remains a key strategy to build research capacity for nurses and allied health professionals working in healthcare settings. Evaluation of research education programs needs to be rigorous and, although targeted at the individual, must consider longer-term and broader organisation-level outcomes and impacts. Examining this is critical to improving clinician-led health research and the translation of research into clinical practice.
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Affiliation(s)
- Olivia King
- Western Alliance, 25 Ryot St, Warrnambool, 3280, VIC, Australia.
- Barwon Health, Geelong, VIC, Australia.
- Monash University, Clayton, VIC, Australia.
| | - Emma West
- Western Alliance, 25 Ryot St, Warrnambool, 3280, VIC, Australia
- Deakin University, Geelong, VIC, Australia
| | - Sarah Lee
- Monash University, Clayton, VIC, Australia
| | - Kristen Glenister
- The University of Melbourne, Wangaratta and Shepparton, VIC, Australia
| | - Claire Quilliam
- The University of Melbourne, Wangaratta and Shepparton, VIC, Australia
| | - Anna Wong Shee
- Deakin University, Geelong, VIC, Australia
- Grampians Health, Ballarat, VIC, Australia
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Douglas NF, Feuerstein JL, Oshita JY, Schliep ME, Danowski ML. Implementation Science Research in Communication Sciences and Disorders: A Scoping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1054-1083. [PMID: 35104415 PMCID: PMC10721253 DOI: 10.1044/2021_ajslp-21-00126] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/30/2021] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study was to complete a scoping review of implementation science (IS) research in communication sciences and disorders (CSD) over time and to determine characteristics of IS research in CSD. METHOD A scoping review was conducted of PubMed and Education Resources Information Center for sources published in English that (a) included CSD practitioners, (b) addressed IS research, and (c) identified a specific evidence-based practice. Resulting sources were systematically examined for study aim, patient populations, implementation framework utilized, setting of the study, implementation strategy examined, and implementation outcome measured. RESULTS The majority of the 82 studies that underwent a full-text review (80.5%) were published in 2014 or later. One fourth of the studies were concept papers, and another one fourth focused on context assessment (25.6% of studies, each), 11% focused on designing implementation strategies, and 36.6% focused on testing implementation strategies. The patient population most frequently represented aphasia (21.3%), and most studies (34.4%) were conducted in inpatient medical settings. Nearly half (42.6%) of the nonconcept studies lacked an IS framework. Among implementation strategies identified, approximately one third of studies focused on education and/or training plus another strategy and one fourth focused on education and/or training alone. Implementation outcomes measured typically represented early stages of implementation. CONCLUSIONS This scoping review of IS research in CSD described the landscape of IS studies in CSD. IS is intersecting with CSD at a rapid rate, especially since 2014. Future IS research in CSD should adopt an implementation framework a priori and consider the broad range of implementation strategies and outcomes to support the uptake of research into typical practice settings.
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Day SD, Nguyen KH, Comans T, Clemson L, Laver K. Professional development training preferences of occupational therapists working with older adults in Australia: A discrete choice experiment. Aust Occup Ther J 2021; 68:327-335. [PMID: 33864267 DOI: 10.1111/1440-1630.12731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/21/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Members of the public expect occupational therapists to provide evidence-based practice. Participation in professional development activities is essential to update knowledge and acquire skills to enable delivery of evidence-based assessment and intervention. Therapists commonly choose to participate in professional development through attending training workshops. Little is known about occupational therapists' preference of how continuing professional development training programmes should be designed and delivered. METHODS An online quantitative survey of occupational therapists working with older people in Australia, conducted June to September 2018, incorporated a discrete choice experiment to elicit and estimate preferences for professional development training when acquiring skills in delivering an evidence-based intervention. A series of questions asked participants to choose one of two options for training, each differing in terms of attributes (level of recognition, mode of learning, follow-up post-training and cost to establish willingness to pay). Statistical analyses were conducted according to recommended practice in the field of choice-modelling. RESULTS A total of 108 responses were received from occupational therapists practicing around Australia. Therapists reported a strong preference for receiving post-training support to implement their new skills in practice and would be willing to pay an additional A$200 for training that included this option. They also highly regarded achieving 'certification' in their new skill (willing to pay an additional A$100) and having the opportunity to become a 'Master Trainer' in the future (willing to pay an additional A$200). DISCUSSION This study generates new knowledge about aspects of a professional development training programme that occupational therapists' value and aspects that they are willing to compromise on when acquiring new skills that they intend to use in their practice. These findings can influence the training programme design utilised by those working in implementation research and providers of continuing professional development for health professionals.
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Affiliation(s)
- Sally D Day
- Faculty Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Kim-Huong Nguyen
- Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
| | - Lindy Clemson
- Faculty Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Goorts K, Dizon J, Milanese S. The effectiveness of implementation strategies for promoting evidence informed interventions in allied healthcare: a systematic review. BMC Health Serv Res 2021; 21:241. [PMID: 33736631 PMCID: PMC7977260 DOI: 10.1186/s12913-021-06190-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Evidence based practice in health care has become increasingly popular over the last decades. Many guidelines have been developed to improve evidence informed decision making in health care organisations, however it is often overlooked that the actual implementation strategies for these guidelines are as important as the guidelines themselves. The effectiveness of these strategies is rarely ever tested specifically for the allied health therapy group. METHODS Cochrane, Medline, Embase and Scopus databases were searched from 2000 to October 2019. Level I and II studies were included if an evidence informed implementation strategy was tested in allied health personnel. The SIGN method was used to evaluate risk of bias. The evidence was synthesised using a narrative synthesis. The National Health and Medical Research Council (NHMRC) model was applied to evaluate the grade for recommendation. RESULTS A total of 490 unique articles were identified, with 6 primary studies meeting the inclusion criteria. Three different implementation strategies and three multi-faceted components strategies were described. We found moderate evidence for educational meetings, local opinion leaders and patient mediated interventions. We found stronger evidence for multi-faceted components strategies. CONCLUSION Few studies describe the effectiveness of implementation strategies for allied healthcare, but evidence was found for multi-faceted components for implementing research in an allied health therapy group population. When considering implementation of evidence informed interventions in allied health a multi-pronged approach appears to be more successful.
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Affiliation(s)
- Kaat Goorts
- Department of Public Health and Primary Care, Environment and Health, KU Leuven, Leuven, Belgium
| | - Janine Dizon
- International Centre for Allied Health Evidence, University of South Australia, City East Campus, North Terrace, Adelaide, Australia
| | - Steve Milanese
- International Centre for Allied Health Evidence, University of South Australia, City East Campus, North Terrace, Adelaide, Australia.
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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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Salbach NM, MacKay-Lyons M, Solomon P, Howe JA, McDonald A, Bayley MT, Veitch S, Sivarajah L, Cacoilo J, Mihailidis A. The role of theory to develop and evaluate a toolkit to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke. Disabil Rehabil 2021; 44:3719-3735. [PMID: 33459080 DOI: 10.1080/09638288.2020.1867653] [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] [Indexed: 10/22/2022]
Abstract
PURPOSE The iWalk study showed that 10-meter walk test (10mWT) and 6-minute walk test (6MWT) administration post-stroke increased among physical therapists (PTs) following introduction of a toolkit comprising an educational guide, mobile app, and video. We describe the use of theory guiding toolkit development and a process evaluation. MATERIALS AND METHODS We used the knowledge-to-action framework to identify research steps; and a guideline implementability framework, self-efficacy theory, and the transtheoretical model to design and evaluate the toolkit and implementation process (three learning sessions). In a before-and-after study, 37 of the 49 participating PTs completed online questionnaires to evaluate engagement with learning sessions, and rate self-efficacy to perform recommended practices pre- and post-intervention. Thirty-three PTs and 7 professional leaders participated in post-intervention focus groups and interviews, respectively. RESULTS All sites conducted learning sessions; attendance was 50-78%. Self-efficacy ratings for recommended practices increased and were significant for the 10mWT (p ≤ 0.004). Qualitative findings highlighted that theory-based toolkit features and implementation strategies likely facilitated engagement with toolkit components, contributing to observed improvements in PTs' knowledge, attitudes, skill, self-efficacy, and clinical practice. CONCLUSIONS The approach may help to inform toolkit development to advance other rehabilitation practices of similar complexity.Implications for RehabilitationToolkits are an emerging knowledge translation intervention used to support widespread implementation of clinical practice guideline recommendations.Although experts recommend using theory to inform the development of knowledge translation interventions, there is little guidance on a suitable approach.This study describes an approach to using theories, models and frameworks to design a toolkit and implementation strategy, and a process evaluation of toolkit implementation.Theory-based features of the toolkit and implementation strategy may have facilitated toolkit implementation and practice change to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke.
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Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | | | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Jo-Anne Howe
- Department of Physical Therapy, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | | | - Mark T Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Surabhi Veitch
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Lavan Sivarajah
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Joseph Cacoilo
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Alex Mihailidis
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Cahill LS, Carey LM, Lannin NA, Turville M, Neilson CL, Lynch EA, McKinstry CE, Han JX, O'Connor D. Implementation interventions to promote the uptake of evidence-based practices in stroke rehabilitation. Cochrane Database Syst Rev 2020; 10:CD012575. [PMID: 33058172 PMCID: PMC8095062 DOI: 10.1002/14651858.cd012575.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rehabilitation based upon research evidence gives stroke survivors the best chance of recovery. There is substantial research to guide practice in stroke rehabilitation, yet uptake of evidence by healthcare professionals is typically slow and patients often do not receive evidence-based care. Implementation interventions are an important means to translate knowledge from research to practice and thus optimise the care and outcomes for stroke survivors. A synthesis of research evidence is required to guide the selection and use of implementation interventions in stroke rehabilitation. OBJECTIVES To assess the effects of implementation interventions to promote the uptake of evidence-based practices (including clinical assessments and treatments recommended in evidence-based guidelines) in stroke rehabilitation and to assess the effects of implementation interventions tailored to address identified barriers to change compared to non-tailored interventions in stroke rehabilitation. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and eight other databases to 17 October 2019. We searched OpenGrey, performed citation tracking and reference checking for included studies and contacted authors of included studies to obtain further information and identify potentially relevant studies. SELECTION CRITERIA We included individual and cluster randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies comparing an implementation intervention to no intervention or to another implementation approach in stroke rehabilitation. Participants were qualified healthcare professionals working in stroke rehabilitation and the patients they cared for. Studies were considered for inclusion regardless of date, language or publication status. Main outcomes were healthcare professional adherence to recommended treatment, patient adherence to recommended treatment, patient health status and well-being, healthcare professional intention and satisfaction, resource use outcomes and adverse effects. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. The primary comparison was any implementation intervention compared to no intervention. MAIN RESULTS Nine cluster randomised trials (12,428 patient participants) and three ongoing trials met our selection criteria. Five trials (8865 participants) compared an implementation intervention to no intervention, three trials (3150 participants) compared one implementation intervention to another implementation intervention, and one three-arm trial (413 participants) compared two different implementation interventions to no intervention. Eight trials investigated multifaceted interventions; educational meetings and educational materials were the most common components. Six trials described tailoring the intervention content to identified barriers to change. Two trials focused on evidence-based stroke rehabilitation in the acute setting, four focused on the subacute inpatient setting and three trials focused on stroke rehabilitation in the community setting. We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence was very low (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.53 to 2.64; 2 trials, 39 clusters, 1455 patient participants; I2 = 0%). Low-certainty evidence indicates implementation interventions in stroke rehabilitation may lead to little or no difference in patient adherence to recommended treatment (number of recommended performed outdoor journeys adjusted mean difference (MD) 0.5, 95% CI -1.8 to 2.8; 1 trial, 21 clusters, 100 participants) and patient psychological well-being (standardised mean difference (SMD) -0.02, 95% CI -0.54 to 0.50; 2 trials, 65 clusters, 1273 participants; I2 = 0%) compared with no intervention. Moderate-certainty evidence indicates implementation interventions in stroke rehabilitation probably lead to little or no difference in patient health-related quality of life (MD 0.01, 95% CI -0.02 to 0.05; 2 trials, 65 clusters, 1242 participants; I2 = 0%) and activities of daily living (MD 0.29, 95% CI -0.16 to 0.73; 2 trials, 65 clusters, 1272 participants; I2 = 0%) compared with no intervention. No studies reported the effects of implementation interventions in stroke rehabilitation on healthcare professional intention to change behaviour or satisfaction. Five studies reported economic outcomes, with one study reporting cost-effectiveness of the implementation intervention. However, this was assessed at high risk of bias. The other four studies did not demonstrate the cost-effectiveness of interventions. Tailoring interventions to identified barriers did not alter results. We are uncertain of the effect of one implementation intervention versus another given the limited very low-certainty evidence. AUTHORS' CONCLUSIONS We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence is very low.
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Affiliation(s)
- Liana S Cahill
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Neurorehabilitation and Recovery, Stroke, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
- Department of Occupational Therapy, School of Allied Health, Australian Catholic University, Fitzroy, Australia
| | - Leeanne M Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Neurorehabilitation and Recovery, Stroke, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Allied Health, Alfred Health, Melbourne, Australia
| | - Megan Turville
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Neurorehabilitation and Recovery, Stroke, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Cheryl L Neilson
- Rural Department of Allied Health, Rural Health School, La Trobe University, Bendigo, Australia
| | - Elizabeth A Lynch
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research Institute, Melbourne and Newcastle, Australia
| | - Carol E McKinstry
- Rural Department of Allied Health, Rural Health School, La Trobe University, Bendigo, Australia
| | - Jia Xi Han
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Denise O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Bird ML, Miller T, Connell LA, Eng JJ. Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials. Clin Rehabil 2019; 33:1586-1595. [PMID: 31066289 DOI: 10.1177/0269215519847253] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effectiveness of interventions aimed at moving research evidence into stroke rehabilitation practice through changing the practice of clinicians. DATA SOURCES EMBASE, CINAHL, Cochrane and MEDLINE databases were searched from 1980 to April 2019. International trial registries and reference lists of included studies completed our search. REVIEW METHODS Randomized controlled trials that involved interventions aiming to change the practice of clinicians working in stroke rehabilitation were included. Bias was evaluated using RevMan to generate a risk of bias table. Evidence quality was evaluated using GRADE criteria. RESULTS A total of 16 trials were included (250 sites, 14,689 patients), evaluating a range of interventions including facilitation, audit and feedback, education and reminders. Of which, 11 studies included multicomponent interventions (using a combination of interventions). Four used educational interventions alone, and one used electronic reminders. Risk of bias was generally low. Overall, the GRADE criteria indicated that this body of literature was of low quality. This review found higher efficacy of trials which targeted fewer outcomes. Subgroup analysis indicated moderate-level GRADE evidence (103 sites, 10,877 patients) that trials which included both site facilitation and tailoring for local factors were effective in changing clinical practice. The effect size of these varied (odds ratio: 1.63-4.9). Education interventions alone were not effective. CONCLUSION A large range of interventions are used to facilitate clinical practice change. Education is commonly used, but in isolation is not effective. Multicomponent interventions including facilitation and tailoring to local settings can change clinical practice and are more effective when targeting fewer changes.
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Affiliation(s)
| | - Tiev Miller
- Hong Kong Polytechnic University, Hong Kong, China
| | | | - Janice J Eng
- University of British Columbia, Vancouver, BC, Canada
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11
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Salbach NM, Wood-Dauphinee S, Desrosiers J, Eng JJ, Graham ID, Jaglal SB, Korner-Bitensky N, MacKay-Lyons M, Mayo NE, Richards CL, Teasell RW, Zwarenstein M, Bayley MT. Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial. Implement Sci 2017; 12:100. [PMID: 28764752 PMCID: PMC5539742 DOI: 10.1186/s13012-017-0631-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT) showed that a facilitated knowledge translation (KT) approach to implementing a stroke rehabilitation guideline was more likely than passive strategies to improve functional walking capacity, but not gross manual dexterity, among patients in rehabilitation hospitals. This paper presents the results of a planned process evaluation designed to assess whether the type and number of recommended treatments implemented by stroke teams in each group would help to explain the results related to patient outcomes. Methods As part of a cluster randomized trial, 20 rehabilitation units were stratified by language and allocated to a facilitated or passive KT intervention group. Sites in the facilitated group received the guideline with treatment protocols and funding for a part-time nurse and therapist facilitator who attended a 2-day training workshop and promoted guideline implementation for 16 months. Sites in the passive group received the guideline excluding treatment protocols. As part of a process evaluation, nurses, and occupational and physical therapists, blinded to study hypotheses, were asked to record their implementation of 18 recommended treatments targeting motor function, postural control and mobility using individualized patient checklists after treatment sessions for 2 weeks pre- and post-intervention. The percentage of patients receiving each treatment pre- and post-intervention and between groups was compared after adjusting for clustering and covariates in a random-effects logistic regression analysis. Results Data on treatment implementation from nine and eight sites in the facilitated and passive KT group, respectively, were available for analysis. The facilitated KT intervention was associated with improved implementation of sit-to-stand (p = 0.028) and walking (p = 0.043) training while the passive KT intervention was associated with improved implementation of standing balance training (p = 0.037), after adjusting for clustering at patient and provider levels and covariates. Conclusions Despite multiple strategies and resources, the facilitated KT intervention was unsuccessful in improving integration of 18 treatments concurrently. The facilitated approach may not have adequately addressed barriers to integrating numerous treatments simultaneously and complex treatments that were unfamiliar to providers. Trial registration Unique identifier-NCT00359593 Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0631-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada. .,Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, room 3-131 (3-East) 3rd Floor University Wing, Toronto, ON, M5G 2A2, Canada.
| | - Sharon Wood-Dauphinee
- School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada
| | - Johanne Desrosiers
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue nord, Bureau FM-2208, Sherbrooke, QC, J1H 5N4, Canada
| | - Janice J Eng
- University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Ottawa, K1G 5Z3, Canada
| | - Susan B Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Nicol Korner-Bitensky
- School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada
| | - Marilyn MacKay-Lyons
- School of Physiotherapy, Dalhousie University, Office 405 Forrest Building, 5869 University Avenue, PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Nancy E Mayo
- Division of Clinical Epidemiology, Division of Geriatrics, McGill University Health Center, Royal Victoria Hospital Site, Ross Pavilion R4.29, 687 Pine Ave W, Montreal, QC, H3A 1A1, Canada
| | - Carol L Richards
- Department of Rehabilitation, Faculty of Medicine, Université Laval and Centre de recherche en réadaptation et intégration sociale (CIRRIS), Institut de réadaptation en déficience physique de Québec (IRDPQ) Site Hamel, 525 Boul. Wilfrid-Hamel Est, Québec, QC, G1M 2S8, Canada
| | - Robert W Teasell
- Parkwood Institute, 550 Wellington Road, London, ON, N6C 0A7, Canada
| | - Merrick Zwarenstein
- Schulich School of Medicine and Dentistry, Western University, Western Centre for Public Health and Family Medicine, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Mark T Bayley
- Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, room 3-131 (3-East) 3rd Floor University Wing, Toronto, ON, M5G 2A2, Canada
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Cunningham BJ, Hidecker MJC, Thomas-Stonell N, Rosenbaum P. Moving research tools into practice: the successes and challenges in promoting uptake of classification tools. Disabil Rehabil 2017; 40:1099-1107. [DOI: 10.1080/09638288.2017.1280544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Mary Jo Cooley Hidecker
- Division of Communication Disorders, Health Science Center, University of Wyoming, Laramie, WY, USA
| | - Nancy Thomas-Stonell
- Graduate Department of Speech-Language Pathology Rehabilitation Sciences Building, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Mayo NE, Kaur N, Barbic SP, Fiore J, Barclay R, Finch L, Kuspinar A, Asano M, Figueiredo S, Aburub AS, Alzoubi F, Arafah A, Askari S, Bakhshi B, Bouchard V, Higgins J, Hum S, Inceer M, Letellier ME, Lourenco C, Mate K, Salbach NM, Moriello C. How have research questions and methods used in clinical trials published in Clinical Rehabilitation changed over the last 30 years? Clin Rehabil 2016; 30:847-64. [PMID: 27496695 PMCID: PMC4976657 DOI: 10.1177/0269215516658939] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/20/2016] [Indexed: 12/19/2022]
Abstract
Research in rehabilitation has grown from a rare phenomenon to a mature science and clinical trials are now common. The purpose of this study is to estimate the extent to which questions posed and methods applied in clinical trials published in Clinical Rehabilitation have evolved over three decades with respect to accepted standards of scientific rigour. Studies were identified by journal, database, and hand searching for the years 1986 to 2016.A total of 390 articles whose titles suggested a clinical trial of an intervention, with or without randomization to form groups, were reviewed. Questions often still focused on methods to be used (57%) rather than what knowledge was to be gained. Less than half (43%) of the studies delineated between primary and secondary outcomes; multiple outcomes were common; and sample sizes were relatively small (mean 83, range 5 to 3312). Blinding of assessors was common (72%); blinding of study subjects was rare (19%). In less than one-third of studies was intention-to-treat analysis done correctly; power was reported in 43%. There is evidence of publication bias as 83% of studies reported either a between-group or a within-group effect. Over time, there was an increase in the use of parameter estimation rather than hypothesis testing and there was evidence that methodological rigour improved.Rehabilitation trialists are answering important questions about their interventions. Outcomes need to be more patient-centred and a measurement framework needs to be explicit. More advanced statistical methods are needed as interventions are complex. Suggestions for moving forward over the next decades are given.
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Affiliation(s)
- Nancy E Mayo
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Navaldeep Kaur
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Skye P Barbic
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julio Fiore
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Ruth Barclay
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lois Finch
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ayse Kuspinar
- School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Miho Asano
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Sabrina Figueiredo
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Ala' Sami Aburub
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Fadi Alzoubi
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Alaa Arafah
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Sorayya Askari
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Behtash Bakhshi
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Vanessa Bouchard
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Johanne Higgins
- École de réadaptation, Université de Montréal, Montreal, Quebec, Canada
| | - Stanley Hum
- Montreal Neurological Institute and Hospital, Multiple Sclerosis Clinic, Montreal, Quebec, Canada
| | - Mehmet Inceer
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Marie Eve Letellier
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Christiane Lourenco
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo, Brazil Department of Physical Therapy, University of Toronto, Toronto, Ontario
| | - Kedar Mate
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, Toronto, Ontario
| | - Carolina Moriello
- Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Translating knowledge in rehabilitation: systematic review. Phys Ther 2015; 95:663-77. [PMID: 24903114 PMCID: PMC4384053 DOI: 10.2522/ptj.20130512] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 05/18/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clinicians are faced with using the current best evidence to make treatment decisions, yet synthesis of knowledge translation (KT) strategies that influence professional practice behaviors in rehabilitation disciplines remains largely unknown. PURPOSE The purposes of this study were: (1) to examine the state of science for KT strategies used in the rehabilitation professions (physical therapy, occupational therapy, speech-language pathology), (2) to identify the methodological approaches utilized in studies exploring KT strategies, and (3) to report the extent that KT interventions are described. DATA SOURCES Eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, and CENTRAL) were searched from January 1985 to May 2013 using language (English) restriction. STUDY SELECTION Eligibility criteria specified articles evaluating interventions or strategies with a primary purpose of translating research or enhancing research uptake into clinical practice. DATA EXTRACTION Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. The published descriptions of the KT interventions were compared with the Workgroup for Intervention Development and Evaluation Research's (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions. DATA SYNTHESIS Of a total of 2,793 articles located and titles and abstracts screened, 26 studies were included in the systematic review. Eighteen articles reported interventions that used a multicomponent KT strategy. Education-related components were the predominant KT intervention regardless of whether it was a single or multicomponent intervention. Few studies used reminders or audit and feedback intervention (n=3). Only one study's primary outcome measure was an economic evaluation. No clear delineation of the effect on KT strategies was seen. LIMITATIONS Diverse studies were included; however, the heterogeneity of the studies was not conducive to pooling the data. CONCLUSIONS The modest-to-low methodological quality assessed in the studies underscores the gaps in KT strategies used in rehabilitation and highlights the need for rigorously designed studies that are well reported.
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Miao M, Power E, O'Halloran R. Factors affecting speech pathologists' implementation of stroke management guidelines: a thematic analysis. Disabil Rehabil 2014; 37:674-85. [PMID: 25003482 DOI: 10.3109/09638288.2014.932444] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Although clinical practice guidelines can facilitate evidence-based practice and improve the health outcomes of stroke patients, they continue to be underutilised. There is limited research into the reasons for this, especially in speech pathology. This study provides the first in-depth, qualitative examination of the barriers and facilitators that speech pathologists perceive and experience when implementing guidelines. METHODS A maximum variation sample of eight speech pathologists participated in a semi-structured interview concerning the implementation of the National Stroke Foundation's Clinical Guidelines for Stroke Management 2010. Interviews were transcribed, thematically analysed and member checked before overall themes were identified. RESULTS Three main themes and ten subthemes were identified. The first main theme, making implementation explicit, reflected the necessity of accessing and understanding guideline recommendations, and focussing specifically on implementation in context. In the second theme, demand versus ability to change, the size of changes required was compared with available resources and collaboration. The final theme, Speech pathologist motivation to implement guidelines, demonstrated the influence of individual perception of the guidelines and personal commitment to improved practice. CONCLUSIONS Factors affecting implementation are complex, and are not exclusively barriers or facilitators. Some potential implementation strategies are suggested. Further research is recommended. IMPLICATIONS FOR REHABILITATION In most Western nations, stroke remains the single greatest cause of disability, including communication and swallowing disabilities. Although adherence to stroke clinical practice guidelines improves stroke patient outcomes, guidelines continue to be underutilised, and the reasons for this are not well understood. This is the first in-depth qualitative study identifying the complex barriers and facilitators to guideline implementation as experienced by speech pathologists in stroke care. Suggested implementation strategies include local monitoring of guideline implementation (e.g. team meetings, audits), increasing collaboration on implementation projects (e.g. managerial involvement, networking), and seeking speech pathologist input into guideline development.
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Affiliation(s)
- Melissa Miao
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney , Cumberland Campus C43S, Lidcombe New South Wales , Australia
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16
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Campbell L, Novak I, McIntyre S, Lord S. A KT intervention including the evidence alert system to improve clinician's evidence-based practice behavior--a cluster randomized controlled trial. Implement Sci 2013; 8:132. [PMID: 24220660 PMCID: PMC3831589 DOI: 10.1186/1748-5908-8-132] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 11/04/2013] [Indexed: 11/10/2022] Open
Abstract
Background It is difficult to foster research utilization among allied health professionals (AHPs). Tailored, multifaceted knowledge translation (KT) strategies are now recommended but are resource intensive to implement. Employers need effective KT solutions but little is known about; the impact and viability of multifaceted KT strategies using an online KT tool, their effectiveness with AHPs and their effect on evidence-based practice (EBP) decision-making behavior. The study aim was to measure the effectiveness of a multifaceted KT intervention including a customized KT tool, to change EBP behavior, knowledge, and attitudes of AHPs. Methods This is an evaluator-blinded, cluster randomized controlled trial conducted in an Australian community-based cerebral palsy service. 135 AHPs (physiotherapists, occupational therapists, speech pathologists, psychologists and social workers) from four regions were cluster randomized (n = 4), to either the KT intervention group (n = 73 AHPs) or the control group (n = 62 AHPs), using computer-generated random numbers, concealed in opaque envelopes, by an independent officer. The KT intervention included three-day skills training workshop and multifaceted workplace supports to redress barriers (paid EBP time, mentoring, system changes and access to an online research synthesis tool). Primary outcome (self- and peer-rated EBP behavior) was measured using the Goal Attainment Scale (individual level). Secondary outcomes (knowledge and attitudes) were measured using exams and the Evidence Based Practice Attitude Scale. Results The intervention group’s primary outcome scores improved relative to the control group, however when clustering was taken into account, the findings were non-significant: self-rated EBP behavior [effect size 4.97 (95% CI -10.47, 20.41) (p = 0.52)]; peer-rated EBP behavior [effect size 5.86 (95% CI -17.77, 29.50) (p = 0.62)]. Statistically significant improvements in EBP knowledge were detected [effect size 2.97 (95% CI 1.97, 3.97 (p < 0.0001)]. Change in EBP attitudes was not statistically significant. Conclusions Improvement in EBP behavior was not statistically significant after adjusting for cluster effect, however similar improvements from peer-ratings suggest behaviorally meaningful gains. The large variability in behavior observed between clusters suggests barrier assessments and subsequent KT interventions may need to target subgroups within an organization. Trial registration Registered on the Australian New Zealand Clinical Trials Registry (ACTRN12611000529943).
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Affiliation(s)
- Lanie Campbell
- School of Medicine, University of Notre Dame Australia, corner Oxford Street and Victoria Street, Darlinghurst, NSW 2010, Australia.
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17
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Communities of Practice: A Knowledge Translation Tool for Rehabilitation Professionals. REHABILITATION RESEARCH POLICY AND EDUCATION 2013. [DOI: 10.1891/2168-6653.27.2.89] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Increased attention to evidence-based practice (EBP) among rehabilitation professionals closely corresponds to recent interest in knowledge translation, which connects quality research to rehabilitation practice aimed at improving the lives of people with disabilities. Despite the importance of knowledge translation for rehabilitation professionals, the concept is often overlooked or misunderstood. This article provides a brief review of knowledge translation to clarify potential misconceptions. In addition, communities of practice (CoPs) are introduced as a specific tool for knowledge translation. An overview of CoPs and guidelines for design, development, and use are reviewed. The flexibility and common ownership of CoPs provide an ideal approach for rehabilitation researchers, practitioners, and consumers to work together to develop knowledge and effective practice guidelines.
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Sutton CJ, Watkins CL, Dey P. Illustrating Problems Faced by Stroke Researchers: A Review of Cluster-Randomized Controlled Trials. Int J Stroke 2012; 8:566-74. [DOI: 10.1111/j.1747-4949.2012.00915.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The cluster-randomized controlled trial is a design increasingly used in prevention and health care evaluation studies and is highly relevant to stroke research. However, there are methodological issues that make it complex to implement. These are not always fully appreciated, with reviews continuing to reveal deficiencies. We searched PUBMED and CENTRAL databases to March 31, 2011 for cluster-randomized controlled trials in stroke. Two investigators independently reviewed citations for eligibility and extracted data on key aspects of each trial. Fifteen trials met the eligibility criteria. No trial fully met CONSORT cluster-randomized controlled trial guidelines, although good design and reporting practice were usually present. Twelve trials included the term ‘cluster-randomized’ (or ‘group-randomized’) in the title, and 12 trials stated the intraclass correlation coefficient used to plan the number of clusters and cluster size. However, few provided a clear, evidence-based justification for the choice of intraclass correlation coefficient, and only two-thirds reported the intraclass correlation coefficient for primary outcomes. Several trials appeared underpowered because of problems in determining an appropriate sample size, defining appropriate clusters, and recruiting and retaining clusters and patients. Cluster-randomized controlled trials are difficult to design and perform due to the combination of methodological and practical difficulties. It is important that further improvements are made to reporting cluster-randomized trials and intraclass correlation coefficients should be estimated using a standardized approach and reported consistently; this would be beneficial for stroke researchers when designing future cluster-randomized trials.
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Scott SD, Albrecht L, O’Leary K, Ball GDC, Hartling L, Hofmeyer A, Jones CA, Klassen TP, Burns KK, Newton AS, Thompson D, Dryden DM. Systematic review of knowledge translation strategies in the allied health professions. Implement Sci 2012; 7:70. [PMID: 22831550 PMCID: PMC3780719 DOI: 10.1186/1748-5908-7-70] [Citation(s) in RCA: 202] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 07/04/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) aims to close the research-practice gap in order to realize and maximize the benefits of research within the practice setting. Previous studies have investigated KT strategies in nursing and medicine; however, the present study is the first systematic review of the effectiveness of a variety of KT interventions in five allied health disciplines: dietetics, occupational therapy, pharmacy, physiotherapy, and speech-language pathology. METHODS A health research librarian developed and implemented search strategies in eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, CENTRAL) using language (English) and date restrictions (1985 to March 2010). Other relevant sources were manually searched. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Within each profession, evidence tables were created, grouping and analyzing data by research design, KT strategy, targeted behaviour, and primary outcome. The published descriptions of the KT interventions were compared to the Workgroup for Intervention Development and Evaluation Research (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions. RESULTS A total of 2,638 articles were located and the titles and abstracts were screened. Of those, 1,172 full-text articles were reviewed and subsequently 32 studies were included in the systematic review. A variety of single (n = 15) and multiple (n = 17) KT interventions were identified, with educational meetings being the predominant KT strategy (n = 11). The majority of primary outcomes were identified as professional/process outcomes (n = 25); however, patient outcomes (n = 4), economic outcomes (n = 2), and multiple primary outcomes (n = 1) were also represented. Generally, the studies were of low methodological quality. Outcome reporting bias was common and precluded clear determination of intervention effectiveness. In the majority of studies, the interventions demonstrated mixed effects on primary outcomes, and only four studies demonstrated statistically significant, positive effects on primary outcomes. None of the studies satisfied the four WIDER Recommendations. CONCLUSIONS Across five allied health professions, equivocal results, low methodological quality, and outcome reporting bias limited our ability to recommend one KT strategy over another. Further research employing the WIDER Recommendations is needed to inform the development and implementation of effective KT interventions in allied health.
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Affiliation(s)
- Shannon D Scott
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health
Academy, Edmonton, AB, Canada
| | - Lauren Albrecht
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health
Academy, Edmonton, AB, Canada
| | - Kathy O’Leary
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health
Academy, Edmonton, AB, Canada
| | - Geoff DC Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of
Alberta, 8213 Aberhart Centre, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of
Alberta, 8213 Aberhart Centre, Edmonton, AB, Canada
- Alberta Research Centre for Health Evidence, University of Alberta, Level 4,
Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Anne Hofmeyer
- School of Nursing and Midwifery, University of South Australia, Adelaide, South
Australia, Australia
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of
Alberta, 3-48 Corbett Hall, Edmonton, AB, Canada
| | - Terry P Klassen
- Manitoba Institute of Child Health, Department of Pediatrics and Child Health,
University of Manitoba, Level 5, John Buhler Research Centre, Winnipeg, MB,
Canada
- Winnipeg Regional Health Authority, 650 Main Street, Winnipeg, MB, Canada
| | - Katharina Kovacs Burns
- Health Sciences Council and Interdisciplinary Health Research Academy, University
of Alberta, 3–398 Edmonton Clinic Health Academy, Edmonton, AB, Canada
- Glenrose Rehabilitation Hospital, 10230 111 Avenue, Edmonton, AB, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of
Alberta, 8213 Aberhart Centre, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, University of Alberta,
4–081 Edmonton Clinic Health Academy, Edmonton, AB, Canada
- Stollery Children’s Hospital, 8440 112 Street, Edmonton, AB, Canada
| | - David Thompson
- Northern Ontario School of Medicine, 955 Oliver Road, Thunder Bay, ON, Canada
| | - Donna M Dryden
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of
Alberta, 8213 Aberhart Centre, Edmonton, AB, Canada
- Alberta Research Centre for Health Evidence, University of Alberta, Level 4,
Edmonton Clinic Health Academy, Edmonton, AB, Canada
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McCurtin A, Roddam H. Evidence-based practice: SLTs under siege or opportunity for growth? The use and nature of research evidence in the profession. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2012; 47:11-26. [PMID: 22268898 DOI: 10.1111/j.1460-6984.2011.00074.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Speech and language therapists are encouraged to be evidence-based practitioners in contemporary clinical practice. This apparently signifies their commitment to 'good' practice. An examination of evidence-based practice (EBP) and its adoption in clinical practice is therefore warranted. AIMS This paper aims to explore EBP, specifically research evidence, as related to the field of speech and language therapy (SLT), using profession specific and cross-disciplinary examples. It asks the reader to consider whether research evidence contributes positively to SLT practice, or adds to the demands placed on clinicians? METHODS & PROCEDURES A review of the literature on the nature and use of research evidence in the field of speech and language therapy and related health professions was undertaken using multiple databases (Cochrane, Medline, Cinahal, BioMed, Trip, Dare) and the following up of references provided within texts and articles. This paper asks the reader to consider the topic from the perspective of the nature of research produced, the barriers perceived, and the use of research evidence by SLTs and the allied health professions. OUTCOMES & RESULTS The uptake of research evidence in the profession is similar to other health professions and continues to be problematic. There are multiple reasons why this is so, originating from both the nature and use of research. CONCLUSIONS & IMPLICATIONS Research evidence is one of the pillars of EBP. Despite problems with the nature and use of such evidence, it has a positive contribution to make to clinical practice as it provides for a scientific touchstone. However, it may be that the speech and language therapist and not the research evidence is the primary pivot upon which scientific practice is based.
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Affiliation(s)
- Arlene McCurtin
- Clinical Therapies, University of Limerick, Limerick, Ireland.
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Thomas L, Roddam H, Baker P, French B, Burton C. Indicators facilitating research-based practice in allied health profession departments. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.2.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lois Thomas
- School of Health, University of Central Lancashire
| | - Hazel Roddam
- Research, School of Sport, Tourism and the Outdoors, University of Central Lancashire
| | - Paula Baker
- Pennine Acute Trust, North Manchester General Hospital, Manchester, UK
| | - Beverley French
- in Evidence-Based Health Care School of Health, University of Central Lancashire, UK
| | - Christopher Burton
- in Evidence Based Practice, Centre for Health-Related Research, School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Wales
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Colquhoun HL, Letts LJ, Law MC, MacDermid JC, Missiuna CA. A Scoping Review of the Use of Theory in Studies of Knowledge Translation. The Canadian Journal of Occupational Therapy 2010; 77:270-9. [DOI: 10.2182/cjot.2010.77.5.3] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background. Advancing the science of knowledge translation (KT) in occupational therapy is critical. Explicit application of theory can advance this science; yet, how theory is applied and the degree to which it can guide research remain poorly defined.Purpose. To understand how theory is applied within KT research.Methods. A scoping review was conducted to examine and summarize the extent, range, and nature of the application of three specific KT theories: Diffusion of Innovations, Promoting Action on Research Implementation in Health Services framework, and Theory of Planned Behaviour.Findings. Theory use was seen most frequently in medicine and nursing. Only 3 of 90 articles were in rehabilitation. Five approaches to theory application were found, the most common being the use of to predict success of KT (57/90).Implications. In-depth study of the importance and methods of theory application in KT research is needed, in particular in occupational therapy.
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Novak I, McIntyre S. The effect of Education with workplace supports on practitioners’ evidence-based practice knowledge and implementation behaviours. Aust Occup Ther J 2010; 57:386-93. [DOI: 10.1111/j.1440-1630.2010.00861.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McCabe P, Purcell A, Baker∗ E, Madill∗ C, Trembath∗ D. Case-based learning: One route to evidence-based practice. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/17489530903399145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2009; 2009:CD003030. [PMID: 19370580 PMCID: PMC7138253 DOI: 10.1002/14651858.cd003030.pub2] [Citation(s) in RCA: 649] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Educational meetings are widely used for continuing medical education. Previous reviews found that interactive workshops resulted in moderately large improvements in professional practice, whereas didactic sessions did not. OBJECTIVES To assess the effects of educational meetings on professional practice and healthcare outcomes. SEARCH STRATEGY We updated previous searches by searching the Cochrane Effective Practice and Organisation of Care Group Trials Register and pending file, from 1999 to March 2006. SELECTION CRITERIA Randomised controlled trials of educational meetings that reported an objective measure of professional practice or healthcare outcomes. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed study quality. Studies with a low or moderate risk of bias and that reported baseline data were included in the primary analysis. They were weighted according to the number of health professionals participating. For each comparison, we calculated the risk difference (RD) for dichotomous outcomes, adjusted for baseline compliance; and for continuous outcomes the percentage change relative to the control group average after the intervention, adjusted for baseline performance. Professional and patient outcomes were analysed separately. We considered 10 factors to explain heterogeneity of effect estimates using weighted meta-regression supplemented by visual analysis of bubble and box plots. MAIN RESULTS In updating the review, 49 new studies were identified for inclusion. A total of 81 trials involving more than 11,000 health professionals are now included in the review. Based on 30 trials (36 comparisons), the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention. Educational meetings alone had similar effects (median adjusted RD 6%, interquartile range 2.9 to 15.3; based on 21 comparisons in 19 trials). For continuous outcomes the median adjusted percentage change relative to control was 10% (interquartile range 8 to 32%; 5 trials). For patient outcomes the median adjusted RD in achievement of treatment goals was 3.0 (interquartile range 0.1 to 4.0; 5 trials). Based on univariate meta-regression analyses of the 36 comparisons with dichotomous outcomes for professional practice, higher attendance at the educational meetings was associated with larger adjusted RDs (P < 0.01); mixed interactive and didactic education meetings (median adjusted RD 13.6) were more effective than either didactic meetings (RD 6.9) or interactive meetings (RD 3.0). Educational meetings did not appear to be effective for complex behaviours (adjusted RD -0.3) compared to less complex behaviours; they appeared to be less effective for less serious outcomes (RD 2.9) than for more serious outcomes. AUTHORS' CONCLUSIONS Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviours.
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Affiliation(s)
- Louise Forsetlund
- Norwegian Knowledge Centre for the Health Services, PO Box 7004, St Olavs plass, Oslo, Norway, 0130.
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Abstract
BACKGROUND The diagnostic criteria for Childhood Apraxia of Speech (CAS), and the underlying cause(s) for this disorder, remain heavily debated. Some agreement exists that children with CAS may have impairments in one or more of the following domains: non-speech oral motor function, motor speech function, speech sounds and structures (i.e., syllable and word shapes), prosody, language, phonemic awareness / metalinguistic skills, and literacy . Recently consensus has been reached that only three features across these domains have diagnostic validity: (1) inconsistent error production on both consonants and vowels across repeated productions of syllables or words, (2) lengthened and impaired coarticulatory transitions between sounds and syllables, and (3) inappropriate prosody (ASHA 2007). Perhaps due to the ongoing deliberation over aetiology and diagnosis, little evidence on intervention for CAS is published. OBJECTIVES To assess the efficacy of intervention delivered by Speech and Language Pathologists(s)/Speech and Language Therapists targeting CAS in children and adolescents. SEARCH STRATEGY The following databases were searched: CENTRAL (Issue 4, 2006), MEDLINE (1966 to 01/2007), CINAHL (1982 to 12/2006), EMBASE (1980 to 01/2007), ERIC (1965 to 01/2007), Linguistics Abstracts Online (1985 to 01/2007), PsycINFO (1872 to 01/2007). Reference lists of articles thus identified were examined. SELECTION CRITERIA The review considered randomised controlled trials (RCTs) and quasi-randomised studies of children aged 3 to 16 years with CAS, grouped by treatment types (e.g., perceptual and instrumentally-based biofeedback treatment techniques). DATA COLLECTION AND ANALYSIS Two authors independently assessed titles and abstracts identified from the searches and obtained full text versions of all potentially relevant articles. Articles were assessed for design and risk of bias. In addition to outcome data, a range of variables about participant group and outcomes were documented. MAIN RESULTS Of 825 titles and abstracts searched, only 31 abstracts appeared to meet inclusion criteria. The remaining 794 papers were excluded predominantly on the basis of not including participants with CAS (e.g., focused on other developmental speech disorders or adult acquired apraxia of speech), or for not being intervention studies (i.e. being diagnostic or descriptive). All 31 full text articles obtained were excluded following evaluation as they did not meet inclusion criteria on design. . Thus no studies are included in this review. AUTHORS' CONCLUSIONS The review demonstrates a critical lack of well controlled treatment studies addressing treatment efficacy for CAS, making it impossible for conclusions to be drawn about which interventions are most effective for treating CAS in children or adolescents.
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Affiliation(s)
- Angela T Morgan
- Healthy Development [Theme], Language & Literacy, Murdoch Childrens Research Institute, Parkville, Melbourne, Victoria, Australia, 3052.
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Morgan AT, Vogel AP. Intervention for dysarthria associated with acquired brain injury in children and adolescents. Cochrane Database Syst Rev 2008; 2008:CD006279. [PMID: 18646143 PMCID: PMC6492483 DOI: 10.1002/14651858.cd006279.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The term 'acquired brain injury' (ABI) incorporates a range of aetiologies including cerebrovascular accident, brain tumour and traumatic brain injury. ABI is a common cause of disability in the paediatric population, and dysarthria is a common and often persistent sequelae associated with ABI in children. OBJECTIVES To assess the efficacy of intervention delivered by Speech and Language Pathologists/Therapists targeting dysarthric speech in children resulting from acquired brain injury. SEARCH STRATEGY We searched CENTRAL (Issue 4, 2006), MEDLINE (1966 to 02/2007), CINAHL (1982 to 02/2007), EMBASE (1980 to 02/2007), ERIC (1965 to 02/2007), Linguistics Abstracts Online (1985 to 02/07), PsycINFO (1872 to 02/2007). Additional references were also sought from reference lists studies. SELECTION CRITERIA The review considered randomised controlled trials (RCTs) and quasi-experimental design studies of children aged 3-16 years with acquired dysarthria grouped by aetiology (e.g., brain tumour, traumatic brain injury, cerebrovascular accident). DATA COLLECTION AND ANALYSIS Each author independently assessed the titles and abstracts for relevance (100% inter-rater reliability) and the full text version of all potentially relevant articles was obtained. No studies met inclusion criteria. MAIN RESULTS Of 2091 titles and abstracts identified, full text versions of only three (Morgan 2007; Murdoch 1999; Netsell 2001) were obtained. 2088 were excluded, largely on the basis of not including dysarthria, being diagnostic or descriptive papers, and for concerning adults rather than children. Morgan 2007 and Murdoch 1999 were excluded for not employing RCT or quasi-randomised methodology; Netsell 2001 on the basis of being a theoretical review paper, rather than an intervention study. Five references were identified and obtained from the bibliography of the Murdoch 1999 paper. All were excluded due to including populations without ABI, adults with dysarthria, or inappropriate design. Thus, no studies met inclusion criteria. AUTHORS' CONCLUSIONS The review demonstrates a critical lack of studies, let alone RCTs, addressing treatment efficacy for dysarthria in children with ABI. Possible reasons to explain this lack of data include i) a lack of understanding of the characteristics or natural history of dysarthria associated with this population; ii) the lack of a diagnostic classification system for children precluding the development of well targeted intervention programs; and iii) the heterogeneity of both the aetiologies and resultant possible dysarthria types of paediatric ABI. Efforts should first be directed at modest well-controlled studies to identify likely efficacious treatments that may then be trialed in multi-centre collaborations using quasi-randomised or RCT methodology.
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Affiliation(s)
- Angela T Morgan
- Healthy Development [Theme], Language & Literacy, Murdoch Childrens Research Institute, Parkville, Melbourne, Victoria, Australia, 3052.
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Pennington L, Thomson K. It Takes Two to Talk--The Hanen Program and families of children with motor disorders: a UK perspective. Child Care Health Dev 2007; 33:691-702. [PMID: 17944778 DOI: 10.1111/j.1365-2214.2007.00800.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Speech and language therapy for young children who have motor disorders targets both the children themselves and their parents. Therapy for parents often involves training about communication and how to foster children's development. It Takes Two to Talk--The Hanen Program for Parents has become popular in the UK, but has not been specifically evaluated for this client group. This study, which was part of a larger investigation of the acceptability and potential effects of the programme on the communication patterns of mothers and their young children with motor disorders, investigated therapists' experiences of providing the training in the National Health Service (NHS) and their views on its effectiveness. METHODS Four focus groups, which involved 16 speech and language therapists who provide It Takes Two to Talk in NHS Trusts in England, were analysed using qualitative methods. RESULTS The themes indicated that therapists perceived the training programme to be effective in helping parents to develop a facilitative communication style. Therapists reported secondary outcomes of positive changes in parents' confidence and in relationships between parents and their children and between parents and therapists. Barriers to the provision and success of the programme were thought to relate to resources, parents' apprehensions about the programme's content and delivery and support from key stakeholders. Barriers were seen to be minimized in services where other members of the healthcare teams actively supported the training programme and where the intervention was integrated as part of a care pathway. CONCLUSIONS The information from this study may assist service providers in the marketing, planning and delivery of new intervention methods, to ensure that they are seen as valuable and acceptable by parents.
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Affiliation(s)
- L Pennington
- Clinical Medical Sciences (Child Health), Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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McWilliam CL. Continuing education at the cutting edge: promoting transformative knowledge translation. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2007; 27:72-9. [PMID: 17576632 DOI: 10.1002/chp.102] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
As the evidence-based practice movement gains momentum, continuing education practitioners increasingly confront the challenge of developing and conducting opportunities for achieving research uptake. Recent thinking invites new approaches to continuing education for health professionals, with due consideration of what knowledge merits uptake by practitioners, who should play what role in the knowledge transfer process, and what educational approach should be used. This article presents an innovative theory-based strategy that encompasses this new perspective. Through a facilitated experience of perspective transformation, clinicians are engaged in an on-the-job process of developing a deeply felt interest in research findings relevant to everyday practice, as well as ownership of that knowledge and its application. The strategy becomes a sustainable, integrated part of clinical practice, fitting naturally within its dynamic, unique environment, context, and climate and overcoming the barrier of time. Clinician experience of a top-down push toward prescribed practice change is avoided. With an expanded role encompassing facilitation of active learning partnerships for practice change, the continuing educator fosters a learning organization culture across the institution. The resultant role changes and leadership and accountability issues are elaborated.
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Affiliation(s)
- Carol L McWilliam
- Faculty of Health Sciences, School of Nursing, University of Western Ontario, London, Ontario, Canada.
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Rabadi MH. Randomized Clinical Stroke Rehabilitation Trials in 2005. Neurochem Res 2006; 32:807-21. [PMID: 17191132 DOI: 10.1007/s11064-006-9211-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 10/23/2006] [Indexed: 10/23/2022]
Abstract
This article reviews randomized control trials (RCTs) undertaken in stroke rehabilitation in the year 2005. A Medline search generated 31 RCTs in stroke rehabilitation in the year 2005 in the English language. These trials were primarily efficacy studies of a number of treatments: medications such as folate, vitamin B12 and bisphosphonates in preventing osteoporotic related hip fractures, compression stockings in preventing deep vein thrombosis (DVT), use of mechanical robots and positioning of the upper limb to help improve function; and, transcranial magnetic coil stimulation, acupuncture and neural tissue transplant to enhance motor recovery in post-stroke patients.
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Affiliation(s)
- Meheroz H Rabadi
- Burke Rehabilitation Hospital, Weill Medical College of Cornell University, 785 Mamaroneck Avenue, White Plains, NY 10605, USA.
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Abstract
BACKGROUND AND PURPOSE Stroke care is complex, requiring input from professionals, patients and carers. Identifying and developing appropriate intervention components to meet these complex needs is difficult. The Medical Research Council (MRC) Framework for developing and evaluating 'complex' (nonpharmacological) interventions aims to improve intervention development. This study uses the Framework to review complex interventions in stroke care. METHODS Systematic review with multiple search strategies (electronic databases, recent journals, gray literature) was used. The MRC Framework was used to guide the search strategy and assess study quality. 'Complex interventions' were defined as educational/psychosocial interventions to change knowledge, beliefs or behaviors. RESULTS Sixty-seven studies were included: 39 randomized controlled trials (RCT) and 28 other designs. Complex interventions targeted healthcare professionals (17), and patients, carers and the general population (21 targeting primary or secondary prevention; 30 targeting adjustment and recovery after stroke). Compared with recovery studies, primary and secondary prevention studies were significantly less likely to have been evaluated in RCTs. Interventions evaluated in RCTs were significantly less likely to influence primary outcomes (26%) compared with other designs (44%). Theoretical grounding to support intervention choice was reported in 40 studies but only 14 were theoretically 'well developed'; 21 RCTs listed multiple primary outcome measures, with 10 listing 5 or more. Of these only 3 reported considering statistical power before recruitment and none was sufficiently powered. CONCLUSIONS Few complex interventions in stroke care have been adequately developed or evaluated. This may explain failures to demonstrate efficacy. In future, greater attention is needed to theoretical development and methodological quality.
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Affiliation(s)
- Judith Redfern
- Division of Health & Social Care Research, Kings College London, 7th Floor Capital House, 42 Weston St, London SE1 3QD, UK.
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Burton C, Pennington L, Roddam H, Russell I, Russell D, Krawczyk K, Smith HA. Assessing adherence to the evidence base in the management of poststroke dysphagia. Clin Rehabil 2006; 20:46-51. [PMID: 16502749 DOI: 10.1191/0269215506cr903oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the reliability and responsiveness to change of an audit tool to assess adherence to evidence of effectiveness in the speech and language therapy (SLT) management of poststroke dysphagia. DESIGN The tool was used to review SLT practice as part of a randomized study of different education strategies. Medical records were audited before and after delivery of the trial intervention. SETTING Seventeen SLT departments in the north-west of England participated in the study. SUBJECTS The assessment tool was used to assess the medical records of 753 patients before and 717 patients after delivery of the trial intervention across the 17 departments. A target of 10 records per department per month was sought, using systematic sampling with a random start. ANALYSIS Inter- and intra-rater reliability were explored, together with the tool's internal consistency and responsiveness to change. RESULTS The assessment tool had high face validity, although internal consistency was low (ra = 0.37). Composite scores on the tool were however responsive to differences between SLT departments. Both inter- and intra-rater reliability ranged from 'substantial' to 'near perfect' across all items. CONCLUSIONS The audit tool has high face validity and measurement reliability. The use of a composite adherence score should, however, proceed with caution as internal consistency is low.
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