Creation of an evidence-based practice reference model in falls prevention: findings from occupational therapy

Promoting the use of a self-management strategy among novice chiropractors treating individuals with spine pain: A mixed methods pilot clustered-clinical trial

Background

The uptake of Self-Management Support (SMS) among clinicians is suboptimal. To date, few studies have tested knowledge translation (KT) interventions to increase the application of SMS in chiropractic teaching clinics.

Study objective

Evaluate the feasibility of implementing a KT intervention to promote the use of a SMS strategy among chiropractic interns, their supervisors, and individuals with spine pain compared to controls.

Methods

Mixed methods pilot clustered-clinical trial. Clusters of 16 Patient Management Teams were allocated to a complex KT intervention (online and workshop training). Primary feasibility outcomes for clinicians, interns and patients were rates of recruitment, retention, and adherence to protocol. A nominal group technique and interviews were used to seek end-users’ views on the implementation process, and generate possible solutions.

Results

In total, 16 (84%) clinicians, 65 (26%) interns and 42 patients agreed to participate. All clinicians in the intervention group completed all KT intervention components, 23 interns (85%) completed the online training and 14 interns (51.8%) attended the workshop training. All clinicians in the intervention and seven (78%) in the control group completed all outcome measures at baseline and 6-month follow-up, while 15 (55.6%) and 23 (60.5%) interns in the intervention and control groups completed the questionnaires at baseline and 6-month follow-up, respectively. Among patients, 10 (52.6%) and 12 (52.2%) in the intervention and control groups respectively completed the questionnaires at the end of the study. Based on interview findings, solutions to improve the feasibility of conducting a full trial include: making SMS a part of the internship, changing the time of introducing the study to the interns, and having more training on SMS.

Conclusion

Recruitment and retention of chiropractic interns and patients for a larger implementation trial in a single outpatient teaching clinic may be challenging.

Students' Perceptions of Instructional Rubrics in Neurological Physical Therapy and Their Effects on Students' Engagement and Course Satisfaction

One of the main challenges faced by physical therapy (PT) students is to learn the practical skills involved in neurological physical therapy (PT). To help them to acquire these skills, a set of rubrics were designed for formative purposes. This paper presents the process followed in the creation of these rubrics and their application in the classroom, noting that students perceived them as valid, reliable, and highly useful for learning. The perception of the validity and usefulness of the rubrics has different closely related dimensions, showing homogeneous values across the students´ sociodemographic and educational variables, with the exception of dedication to studying, which showed a significant relationship with schoolwork engagement and course satisfaction. The adequacy of the hypothesized structural model of the relationships among the variables was confirmed. Direct effects of the perception of the rubrics' validity and engagement on course satisfaction were found, as well as direct effects of the assessment of the usefulness of the rubrics on schoolwork engagement and indirect effects on course satisfaction through this latter variable. The results are discussed taking into account the conclusions of previous research and different instructional implications.

Attributes of evidence-based occupational therapists in stroke rehabilitation

BACKGROUND.

A better understanding of the features characterizing expert evidence-based occupational therapists in stroke rehabilitation is needed to inform the design of educational and knowledge translation interventions aimed at addressing research-practice gaps.

PURPOSE.

The study aimed to identify the attributes of evidence-based occupational therapy stroke rehabilitation experts from the perspective of their peers.

METHOD.

Forty-six occupational therapy clinicians and managers completed an online questionnaire asking them to nominate "outstanding" and "expert evidence-based" occupational therapists in stroke rehabilitation and to explain their choices. A thematic analysis of respondents' statements was conducted.

FINDINGS.

Both outstanding and expert evidence-based occupational therapists were perceived to be motivated self-learners; to have extensive knowledge, skills, and experience; to act as scholarly practitioners; to achieve superior client outcomes; and to work in specialized settings.

IMPLICATIONS.

The development of future strategies supporting occupational therapy students and clinicians to become lifelong learners should take into account key attributes of expertise, such as motivation for continuous learning and professional development.

Promoting the use of self-management in novice chiropractors treating individuals with spine pain: the design of a theory-based knowledge translation intervention

Background

Clinical practice guidelines generally recommend clinicians use self-management support (SMS) when managing patients with spine pain. However, even within the educational setting, the implementation of SMS remains suboptimal. The objectives of this study were to 1) estimate the organizational readiness for change toward using SMS at the Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario from the perspective of directors and deans, 2) estimate the attitudes and self-reported behaviours towards using evidence-based practice (EBP), and beliefs about pain management among supervisory clinicians and chiropractic interns, 3) identify potential barriers and enablers to using SMS, and 4) design a theory-based tailored Knowledge Translation (KT) intervention to increase the use of SMS.

Methods

Mixed method design. We administered three self-administered questionnaires to assess clinicians’ and interns’ attitudes and behaviours toward EBP, beliefs about pain management, and practice style. In addition, we conducted 3 focus groups with clinicians and interns based on the Theoretical Domain Framework (TDF) to explore their beliefs about using SMS for patients with spine pain. Data were analysed using deductive thematic analysis by 2 independent assessors. A panel of 7 experts mapped behaviour change techniques to key barriers identified informing the design of a KT intervention.

Results

Participants showed high level of EBP knowledge, positive attitude of EBP, and moderate frequency of EBP use. A number of barrier factors were identified from clinicians (N = 6) and interns (N = 16) corresponding to 7 TDF domains: Knowledge; Skills; Environmental context and resources; Emotion; Beliefs about Capabilities; Memory, attention & decision making; and Social Influence. To address these barriers, the expert panel proposed a multifaceted KT intervention composed of a webinar and online educational module on a SMS guided by the Brief Action Planning, clinical vignettes, training workshop, and opinion leader support.

Conclusion

SMS strategies can help maximizing the health care services for patients with spine pain. This may in turn optimize patients’ health. The proposed theory-based KT intervention may facilitate the implementation of SMS among clinicians and interns.

Electronic supplementary material

The online version of this article (10.1186/s12891-018-2241-1) contains supplementary material, which is available to authorized users.

Assessment of knowledge and skills in information literacy instruction for rehabilitation sciences students: a scoping review

Objective

This scoping review investigates how knowledge and skills are assessed in the information literacy (IL) instruction for students in physical therapy, occupational therapy, or speech-language pathology, regardless of whether the instruction was given by a librarian. The objectives were to discover what assessment measures were used, determine whether these assessment methods were tested for reliability and validity, and provide librarians with guidance on assessment methods to use in their instruction in evidence-based practice contexts.

Methods

A scoping review methodology was used. A systematic search strategy was run in Ovid MEDLINE and adapted for CINAHL; EMBASE; Education Resources Information Center (ERIC) (EBSCO); Library and Information Science Abstracts (LISA); Library, Information Science & Technology Abstracts (LISTA); and Proquest Theses and Dissertations from 1990 to January 16, 2017. Forty articles were included for data extraction.

Results

Three major themes emerged: types of measures used, type and context of librarian involvement, and skills and outcomes described. Thirty-four measures of attitude and thirty-seven measures of performance were identified. Course products were the most commonly used type of performance measure. Librarians were involved in almost half the studies, most frequently as instructor, but also as author or assessor. Information literacy skills such as question formulation and database searching were described in studies that did not involve a librarian.

Conclusion

Librarians involved in instructional assessment can use rubrics such as the Valid Assessment of Learning in Undergraduate Education (VALUE) when grading assignments to improve the measurement of knowledge and skills in course-integrated IL instruction. The Adapted Fresno Test could be modified to better suit the real-life application of IL knowledge and skills.

Advancing the value and quality of occupational therapy in health service delivery

The authors set forth a foundation on which to build further dialogue and evidence to highlight occupational therapy’s distinctive contribution, significance, and viability as health care policies shift to focus on quality and value.

Evidence-based practice supports among Canadian occupational therapists

Background.

Supports for evidence-based practice (EBP) and research utilization are needed for moving evidence into practice.

Purpose.

The purpose of this study was to identify the presence of individual and organizational EBP supports (based on a previous scoping review) and the attitudes toward the supports in a convenience sample of Canadian occupational therapists.

Method.

A cross-sectional survey was used to collect data from members of the Canadian Association of Occupational Therapists.

Findings.

Data from 368 clinicians (21%) indicated that although factors that have been shown to support EBP, such as student supervision and participation in research and mentoring, were not common practice, attitudes toward these EBP supports were positive.

Implications.

EBP supports, although viewed favourably by clinicians, have yet to be integrated fully into clinical practice. These findings provide researchers with an opportunity to design studies to support clinicians who view EBP in a positive light in integrating evidence into their practice.

Research utilization and evidence-based practice in occupational therapy: a scoping study

Many articles have been written on the barriers to and facilitators of the use of evidence in practice in nursing and medicine, but to date no extensive review has been published of the literature on evidence-based practice (EBP) supports in occupational therapy. This article presents the results of a scoping review that examined factors that support the integration of research into practice. A review of 69 articles revealed four themes: (1) attitudes toward, perceptions of, confidence in, and use of research and EBP; (2) factors that support the use of research in practice; (3) effects of interventions targeting changes in knowledge, attitudes, skills, behaviors, and evidence-based practices; and (4) identification of the processes involved in the acquisition of EBP skills and their application in clinical practice. A process that integrates client-centered practice, structured reflection, case application, and peer consultations within a scholarship of practice model facilitates occupational therapists' evaluation and integration of research evidence.

Evidence-based practice behaviours: a comparison amongst occupational therapy students and clinicians

BACKGROUND

Occupational therapy graduates are expected to demonstrate entry-level competencies in evidence-based practice. To support students during the course of professional education in developing the knowledge, skills, and attitudes for integrating scientific findings into clinical practice, educators must identify the process by which these competencies are developed.

PURPOSE

To identify the differences in evidence-based practice decisions amongst occupational therapy students and experienced clinicians.

METHODS

Using a vignette depicting an older client with a history of falls, participants' evidence-based practice decisions were compared to a reference model.

RESULTS

In the initial steps of the process, knowledge of evidence-based practice concepts appeared to be dependent upon formal instruction, whereas expert-like behaviours in the integration of evidence for decision-making seemed to be a function of clinical experience.

IMPLICATIONS

Academic and clinical educators can use identified gaps in knowledge and synthesis of concepts to update the evidence-based practice content in occupational therapy curricula and fieldwork.