Stakeholders' priorities in the development of evidence-based practice competencies in rehabilitation students: a nominal group technique study

PURPOSE

Clinically integrated teaching (CIT) is an effective approach for promoting evidence-based practice (EBP) competencies among medical students. Challenges towards the implementation of CIT in rehabilitation curricula include educators' different conceptualizations of EBP, the perceived complexity of EBP and the boundaries between the academic and the clinical setting. This study aimed to identify tailored strategies to implement in rehabilitation programs and their affiliated clinical sites to support the development of EBP competencies among students in occupational therapy (OT), physical therapy (PT) and speech-language pathology (S-LP).

MATERIALS AND METHODS

Nominal group technique (NGT) with stakeholders from three rehabilitation programs in Canada, offering the professional master's in OT and PT (n = 35 participants) and in S-LP (n = 8).

RESULTS

The top two strategies identified in the OT/PT NGT were: 1) Developing a flexible definition of EBP that recognizes its complexity; 2) Providing clinicians with more access to the teaching content by pairing faculty with preceptors. The top two strategies identified in the S-LP NGT were: 1) Providing students with opportunities for decision-making with experienced clinicians; 2) Increasing interactions between faculty and preceptors using formal group meetings.

CONCLUSION

Findings laid foundations for future integrated knowledge translation projects to collaboratively implement, and test identified strategies.

Building evidence-based practice competencies among rehabilitation students: a qualitative exploration of faculty and preceptors' perspectives

Medical education literature suggests clinically-integrated teaching may be the most effective approach to teach evidence-based practice (EBP). Before implementing this educational best practice in rehabilitation curricula, it is imperative to better understand the current context, barriers and facilitators to teach EBP in rehabilitation from the academic to the clinical setting. The aim of this study was to explore faculty and preceptors' experiences and perceptions of teaching EBP in rehabilitation professions, namely occupational therapy, physical therapy and speech-language pathology. We gathered data from seven focus groups and an individual interview with a sample of 24 faculty and 15 preceptors, i.e., clinical supervisors. Data collected were subjected to inductive thematic content analysis. We identified three overarching themes and corresponding strategies. First, "Recognizing EBP as a multifaceted concept" denoted participants' lack of consensus regarding the meaning and scope of EBP, and their awareness of such discrepancies. Second, "Complexity of EBP is at the core of teaching practices and experiences" referred to participants' perception of EBP as a complex process involving high-level cognitive skills, which influenced their teaching practices and challenged students and themselves. Third, "Connections and divides between research and practice" represented the limited and delicate connection between faculty and preceptors, the factors either bridging or maintaining the gap between them, and the impacts of such connections and divides on teaching. Improving collaboration between faculty and preceptors constitutes an essential first step towards more effective EBP training programs in rehabilitation that could be facilitated through online communities of practice or integrated knowledge translation research projects.

French speech-language therapy students' interest in evidence-based practice: A survey

BACKGROUND

Taking into account international studies interested in the development of evidence-based practice (EBP) in the speech and language therapy field, this survey investigated key issues with regard to students' perception of EBP.

AIMS

To determine how final-year students in France conceive EBP; to know if they feel competent in this area; to investigate any barriers to the use of EBP; and to assess their intention of using the EBP approach in their professional practice after graduating.

METHODS & PROCEDURES

Between January and April 2019, 182 advanced French students from 15 French speech-language university training centres (SLUTC) completed an online survey addressing these questions.

OUTCOMES & RESULTS

The results show that 68.7% of students in the sample had a positive perception of the EBP. Between 54.9% and 73.6% of students felt rather competent to apply part of the approach, and 17% were sure to implement it in their own practice later on. Step 3 'Critically evaluating the evidence' was the most difficult. Regardless of the different EBP steps, the most important barrier for students who felt competent was the lack of practice; for students who did not feel competent, the major barriers were both the lack of theoretical knowledge and the lack of practice. A total of 61% of students reported not seeing EBP being practised by their clinical practice placements supervisors; 55% reported never having used their EBP knowledge during their clinical practice placements.

CONCLUSIONS & IMPLICATIONS

The students interviewed had a positive perception of EBP. Nevertheless, these results demonstrate a need to improve the EBP curricula and to include EBP in clinical education, under the guidance of clinical practice placements supervisors.

WHAT THIS PAPER ADDS

What is already known on the subject Despite the fact that EBP is widespread, previous studies have shown that it is not sufficiently used in the practice of speech and language therapists (SLT) and that young professionals tend to seek advice from experienced professionals rather than use EBP. Some students, despite their programme, do not feel competent enough to implement EBP. What this study adds to the existing knowledge French SLT students had a positive opinion of EBP despite barriers to implementation in their future professional practice, especially regarding the critical analysis of evidence. Moreover, the study reveals a need to practise EBP during clinical practice placements, and to create specific pedagogical framework for EBP. What are the potential or actual clinical implications of this work? The potential implication of this study is the use of the questionnaire to investigate the students' perception of EBP from a theoretical and a practical point of view, in collaboration with clinical practice placement supervisors, with the aim of promoting the task value and the self-efficacy as the two best factors to enhance students' motivation in favour of EBP.

Therapy interventions for children with neurodisabilities: a qualitative scoping study

BACKGROUND

Therapy interventions emerged four times in the top 10 research priorities in a James Lind Alliance research prioritisation exercise for children with neurodisabilities (Morris C, Simkiss D, Busk M, Morris M, Allard A, Denness J, et al. Setting research priorities to improve the health of children and young people with neurodisability: a British Academy of Childhood Disability-James Lind Alliance Research Priority Setting Partnership. BMJ Open 2015;5:e006233). The National Institute for Health Research (NIHR) commissioned this study as part of an information-gathering exercise in response to this.

OBJECTIVES

The objectives were to (1) describe the current practice, approaches and schools of thought in relation to physiotherapy, occupational therapy and speech and language therapy for children with neurodisability; (2) explore clinical decision-making; (3) investigate views on outcomes and their measurement, particularly participation as an outcome, that is, the child's ability to have the opportunity to be involved in life situations and activities (e.g. communication, mobility, interpersonal interactions, self-care, learning and applying knowledge); (4) seek views on the aspects of therapy interventions that have an impact on outcomes; and (5) elicit stakeholder views on research needs and priorities.

DESIGN, SETTING AND PARTICIPANTS

More than 70 professionals (therapists, service leads, paediatricians and education staff) and 25 parents participated in a qualitative interview (either individually or as part of a focus group).

RESULTS

Professional thinking and models of service delivery are in a state of flux and development. There is a move towards goals-focused, family-centred approaches. Work tends to be highly individualised, with few protocols. Parents are certain of the value of therapies, although they may experience difficulties with provision and may seek (additional) private provision. Therapy interventions are conceived as three components: the therapist, the procedures/equipment, etc., and the wider therapeutic environment. They are believed to be highly complex and poorly understood. Although participation is widely endorsed as a core intervention objective of therapy interventions, its suitability, or appropriateness, as an outcome measure was questioned. Other child and/or parent outcomes were identified as more or equally important. Notions of intermediate outcomes - in terms of body structure/function, and the achievement of activities - were regarded as important and not counter to participation-focused approaches. Among therapists, research on intervention effectiveness was (cautiously) welcomed. A number of methodological challenges were identified. A portfolio of study designs - quantitative and qualitative, experimental and observational - was called for, and which included economic evaluation and clear pathways to impact.

LIMITATIONS

The study was not successful in recruiting children and young people. Further work is required to elucidate the views of this key stakeholder group.

CONCLUSIONS

Therapy interventions are poorly understood. There was strong support, tempered a little by concerns among some about the feasibility of demonstrating impact, for investment in research.

FUTURE WORK

The identification of research priorities was a core study objective, and a wide-ranging research agenda was identified. It included 'foundational' research into neurodisability, the active components of therapy interventions and the concept of participation. Three areas of evaluation were identified: overall approaches to therapy, service organisation and delivery issues, and the evaluation of specific techniques. Parents regarded evaluations of approaches to therapy (e.g. goals-focused; supporting family-self management) as priorities, along with evaluations of models of service provision. Professionals' views were broadly similar, with an additional emphasis on methodological research. In terms of specific techniques, there was no shared agreement regarding priorities, with views informed by personal interests and experiences.

FUNDING

The NIHR Health Technology Assessment programme.

Evidence-based intervention for preschool children with primary speech and language impairments: Child Talk – an exploratory mixed-methods study

Background

The Child Talk study aimed to develop an evidence-based framework to support the decision-making of speech and language therapists (SLTs) as they design and plan interventions appropriate to the needs of individual children with primary speech and language impairments and their families. The need for early identification and effective intervention for these children continues to be a government policy priority because of the link between children’s early speech and language skills and their broader well-being and outcomes in later life. The first phase of Child Talk sought to map and describe current SLT practice for these children; identify and summarise the existing research evidence relating to practice; and investigate the perspectives of parents, early years practitioners, preschool children and ‘underserved’ communities on speech and language therapy. The second phase of Child Talk focused on the development of a toolkit – assessment tools, outcome measures and a data set – to support future service and economic evaluations of the framework.

Methods

Child Talk adopted a mixed-methods design. Quantitative methods included surveys and investigated the prevalence and patterns of intervention usage; qualitative data collection methods included focus groups, interviews and reflection to investigate participants’ perspectives and understandings of interventions. Data analysis methods included descriptive and inferential statistics, thematic and content analysis and framework analysis. Participants were recruited nationally through six NHS sites, professional bodies, parent groups and advertising. Participants included SLTs (n = 677), parents (n = 84), preschool children (n = 24), early years practitioners (n = 31) and ‘underserved’ communities (n = 52).

Key findings

Speech and language therapy interventions were characterised in terms of nine themes, viewed as comprehensive and inclusive by practitioners. Relevant assessments, interventions and outcome domains were identified for the nine themes. Areas of tacit knowledge and underspecified processes contributed to variability in the detail of the framework. Systematic reviews identified 58 relevant and robust studies (from 55,271 papers retrieved from the initial literature search). The number of studies relevant to each theme varied from 1 to 33. Observational data on preschool children’s perspectives on speech and language therapy interventions revealed the dynamic nature of their interaction with different activities and people within therapy sessions. Parents’ experiences of speech and language therapy were generally positive although some reported that the rationale for therapy was not always clear. Parental perspectives in underserved communities suggested that, although parents were confident about how to support children’s language development, they were less informed about the nature of language impairments and the function of speech and language therapy. The availability of information regarding resources directed towards speech and language therapy services was poor. In particular, services lacked both a culture of collecting outcome data routinely and measures of professional input and costs associated with their activities.

Conclusion

A descriptive framework of SLT practice has been developed to support the discussions between therapists and families when making decisions regarding the selection of interventions and outcome measures. Further research is needed to address gaps in the intervention framework and evaluate its effectiveness and cost-effectiveness in improving outcomes for preschool children with primary speech and language impairments.

Study registration

This study is registered as PROSPERO CRD42013006369.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.