Enhancing Occupational Therapists' Intervention Capabilities With Adolescents With Neurodevelopmental Disorders

Background. Adolescents with neurodevelopmental disorders (NDDs) have an increased risk of participation limitations. Occupational therapy faces knowledge-to-practice gaps among this population. Purpose. To examine the effectiveness of a continuing-education program for occupational therapists working with adolescents with NDDs. Methods. The study used a mixed-method design, including pre-post comparisons of competence and sense of self-efficacy of occupational therapists to work with adolescents with NDDs. Interviews regarding the program's perceived contribution to practice were conducted. Results. Post-program results showed significantly (p < .001) higher professional competence and self-efficacy for interventions and evaluation skills with NDD's adolescents and transition programs as well as higher knowledge about adolescence and NDDs characteristics. Contrary, there was no change in competence and self-efficacy regarding client-centred interventions with adolescents. Program participants increased their professional confidence and incorporated evidence-based methods into routine practice. Conclusions and Implications. The continuing-education program that was examined expanded the occupational therapy practitioner's knowledge and professional skills, resulting in a change in their capacity to practice with adolescents narrowing the knowledge-to-practice gap. Future studies involving the client perspective, regarding their participation may validate and support continuing-education program for occupational therapists.

Attitudes and perceived barriers to evidence-based practice among occupational therapists in Jordan

Evidence-based practice (EBP) refers to the clinical decision-making process incorporating the best available evidence from research, therapists' clinical experience, and patient values. The current study aimed to examine the experience of Jordanian occupational therapy practitioners (OTs) in using EBP and to identify the perceived barriers to implementing EBP among OTs in Jordan. The study utilized a cross-sectional descriptive study design. A questionnaire was emailed to OTs who have been working in Jordan for the last six months of their practice in a clinical setting. The majority of the participants had a positive attitude toward EBP. However, they reported several barriers to implementing EBP, including a lack of tools and equipment in clinical settings as a major barrier (65.8%). National collaborative actions are needed to develop strategies to improve the utilization of EBP in occupational therapy (OT) practice and to overcome the barriers therapists experience with implementing EBP.

Quality, methods, and recommendations of systematic reviews on measures of evidence-based practice: an umbrella review

OBJECTIVES

The objective of the review was to estimate the quality of systematic reviews on evidence-based practice measures across health care professions and identify differences between systematic reviews regarding approaches used to assess the adequacy of evidence-based practice measures and recommended measures.

INTRODUCTION

Systematic reviews on the psychometric properties of evidence-based practice measures guide researchers, clinical managers, and educators in selecting an appropriate measure for use. The lack of psychometric standards specific to evidence-based practice measures, in addition to recent findings suggesting the low methodological quality of psychometric systematic reviews, calls into question the quality and methods of systematic reviews examining evidence-based practice measures.

INCLUSION CRITERIA

We included systematic reviews that identified measures that assessed evidence-based practice as a whole or of constituent parts (eg, knowledge, attitudes, skills, behaviors), and described the psychometric evidence for any health care professional group irrespective of assessment context (education or clinical practice).

METHODS

We searched five databases (MEDLINE, Embase, CINAHL, PsycINFO, and ERIC) on January 18, 2021. Two independent reviewers conducted screening, data extraction, and quality appraisal following the JBI approach. A narrative synthesis was performed.

RESULTS

Ten systematic reviews, published between 2006 and 2020, were included and focused on the following groups: all health care professionals (n = 3), nurses (n = 2), occupational therapists (n = 2), physical therapists (n = 1), medical students (n = 1), and family medical residents (n = 1). The overall quality of the systematic reviews was low: none of the reviews assessed the quality of primary studies or adhered to methodological guidelines, and only one registered a protocol. Reporting of psychometric evidence and measurement characteristics differed. While all the systematic reviews discussed internal consistency, feasibility was only addressed by three. Many approaches were used to assess the adequacy of measures, and five systematic reviews referenced tools. Criteria for the adequacy of individual properties and measures varied, but mainly followed standards for patient-reported outcome measures or The Standards of Educational and Psychological Testing. Two hundred and four unique measures were identified across 10 reviews. One review explicitly recommended measures for occupational therapists, and four reviews identified adequate measures for all health care professionals (n = 3) and medical students (n = 1). The 27 measures deemed adequate by these five systematic reviews are described.

CONCLUSIONS

Our results suggest a need to improve the overall methodological quality and reporting of systematic reviews on evidence-based practice measures to increase the trustworthiness of recommendations and allow comprehensive interpretation by end-users. Risk of bias is common to all the included systematic reviews as the quality of primary studies was not assessed. The diversity of tools and approaches used to evaluate the adequacy of evidence-based practice measures reflects tensions regarding the conceptualization of validity, suggesting a need to reflect on the most appropriate application of validity theory to evidence-based practice measures.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020160874.

Self-Reflection as a Support to Evidence-Based Practice: A Grounded Theory Exploration

The purpose of this study was to explore how reflective practice is experienced by occupational therapists. Thirty participants were purposefully sampled to explore reflective practice experiences using a critical reflection inquiry model as a theoretical framework. Grounded theory using a constant comparative analysis method was used to analyze interview data. Three categories emerged: triggers to reflection, depth of reflection, and actions taken. The frequency of statements compared across survey groups showed that participants with high reflection behaviors made more critical reflections, used steps of the EBP cycle, and took actions to correct practice. Results inform practice in three ways: (1) practitioner experiences were analyzed through the complete reflective practice construct, (2) findings indicated that greater depth of reflective thinking promotes EBP use and actions taken to correct practice, and (3) narrative content analysis was found to be a credible method of assessing reflection within practice narratives, suggesting it as useful for education and promoting continuing competency.

Occupational Therapists' Implementation of Evidence-Based Practice: A Cross Sectional Survey

Evidence-based practice (EBP) implementation has been associated with quality health care outcomes, yet only a small proportion of occupational therapists implement EBP. We conducted a cross-sectional survey measuring EBP implementation, skill and knowledge, self-reflection behavior, and practice demographics to clarify implementation of EBP and factors acting as supports. A random sample of occupational therapists practicing in the U.S. was invited to participate; 578 surveys were included in the final analysis. Participants implemented EBP less than 1 time over the previous 8 weeks; EBP use was highest in those with a doctorate (p = .002) and high self-reflection behavior (p = .001); EBP use was marginally higher in those with organizational support (p = .008; p = .009), time for EBP (p = .009), and access to full text articles (p = .006). Further investigation of how reflective practice and levels of doctoral education support EBP use are recommended.

Assessing occupational performance in special housing in Sweden

BACKGROUND

Assessing occupational performance is commonly done by occupational therapists [OTs] working in special housing in municipal elder care. Assessments should be relevant and evidence-based. Even so, we know little about how assessment of occupational performance is conducted in special housing.

AIM

The aim of this study was to identify OTs' use and perceptions of different methods to assess occupational performance for elderly clients living in special housing.

METHOD

An email questionnaire was sent to OTs working in special housing in Sweden. Data was analyzed using descriptive and parametric statistics.

RESULTS

The findings, based on data from 660 respondents, showed that OTs regularly assessed occupational performance but did not use standardized assessment instruments or structured methods to any great extent. In general, OTs reported that they were not pleased with their ability to assess their clients; however, OTs with higher education and with responsibility for fewer clients were more pleased with their assessments and stated that they had more knowledge about assessment methods.

CONCLUSIONS

To support OTs in using structured assessments of occupational performance in everyday practice, organization as well as structures in the work environment and educational development need to be taken into consideration.

Students' attitudes and perceptions of teaching and assessment of evidence-based practice in an occupational therapy professional Master's curriculum: a mixed methods study

BACKGROUND

Most health professions, including occupational therapy, have made the application of evidence-based practice a desired competency and professional responsibility. Despite the increasing emphasis on evidence-based practice for improving patient outcomes, there are numerous research-practice gaps in the health professions. In addition to efforts aimed at promoting evidence-based practice with clinicians, there is a strong impetus for university programs to design curricula that will support the development of the knowledge, attitudes, skills and behaviours associated with evidence-based practice. Though occupational therapy curricula in North America are becoming increasingly focused on evidence-based practice, research on students' attitudes towards evidence-based practice, their perceptions regarding the integration and impact of this content within the curricula, and the impact of the curriculum on their readiness for evidence-based practice is scarce. The present study examined occupational therapy students' perceptions towards the teaching and assessment of evidence-based practice within a professional master's curriculum and their self-efficacy for evidence-based practice.

METHODS

The study used a mixed methods explanatory sequential design. The quantitative phase included a cross-sectional questionnaire exploring attitudes towards evidence-based practice, perceptions of the teaching and assessment of evidence-based practice and evidence-based practice self-efficacy for four cohorts of students enrolled in the program and a cohort of new graduates. The questionnaire was followed by a focus group of senior students aimed at further exploring the quantitative findings.

RESULTS

All student cohorts held favourable attitudes towards evidence-based practice; there was no difference across cohorts. There were significant differences with regards to perceptions of the teaching and assessment of evidence-based practice within the curriculum; junior cohorts and students with previous education had less favourable perceptions. Students' self-efficacy for evidence-based practice was significantly higher across cohorts. Four main themes emerged from the focus group data: (a) Having mixed feelings about the value of evidence-based practice (b) Barriers to the application of evidence-based practice; (c) Opposing worlds and (d) Vital and imperfect role of the curriculum.

CONCLUSION

This study provides important data to support the design and revision of evidence-based practice curricula within professional rehabilitation programs.

Research culture in allied health: a systematic review

Research evidence is required to guide optimal allied health practice and inform policymakers in primary health care. Factors that influence a positive research culture are not fully understood, and nor is the impact of a positive research culture on allied health professionals. The aim of this systematic review was to identify factors that affect allied health research culture and capacity. An extensive search of 11 databases was conducted in June 2015. Studies were included if they were published in English, had full-text availability and reported research findings relating to allied health professions. Study quality was evaluated using the McMaster Critical Review Forms. Fifteen studies were eligible for inclusion. A meta-analysis was not performed because of heterogeneity between studies. Allied health professionals perceive that their individual research skills are lower in comparison to their teams and organisation. Motivators for conducting research for allied health professionals include developing skills, increasing job satisfaction and career advancement. Barriers include a lack of time, limited research skills and other work roles taking priority. Multilayered strategies, such as collaborations with external partners and developing research leadership positions, aimed at addressing barriers and enablers, are important to enhance allied health research culture and capacity.

Turning evidence into practice: Barriers to research use among occupational therapists

Introduction

Research has demonstrated that occupational therapists generally have a positive attitude regarding the use of evidence in their daily practice and decision-making. In addition, occupational therapists are expected to implement evidence-based practice, which is often understood as equivalent to research. However, evidence-based practice might be difficult to reconcile with occupational therapy from a client-centred focus. This study examines what occupational therapists perceive as barriers to research use and discusses the challenge of clinical implementation.

Method

This study uses a descriptive cross-sectional design. The Barriers to Research Utilization Scale questionnaire was mailed to 807 randomly selected Swedish occupational therapists. The response rate was 59%.

Findings

The occupational therapists identified three main barriers to the use of research: insufficient facilities (82%); lack of time to read research (77%); difficulty understanding statistical analyses (75%). Degree of education was shown to affect results; occupational therapists with higher education levels indicated a higher use of research.

Conclusion

Implementing research in clinical practice is a challenge. Occupational therapists are interested but they lack the optimal prerequisites and time.

Malaysian occupational therapists’ practices with children and adolescents with autism spectrum disorder

Introduction

Occupational therapy is one of the health care professions that provides assessments and interventions for children and adolescents with autism spectrum disorder. However, to date, there is no information available regarding occupational therapy practices in Malaysia for this population. The purpose of this study is to describe the occupational therapy services for children and adolescents with autism spectrum disorder in Malaysia, including the perceived training needs of practitioners.

Method

We surveyed the registered members of the Malaysian Occupational Therapy Association using a mailed questionnaire.

Results

A response rate of 15.5% was obtained. The majority of the responses were from those working in hospital settings who had less than 5 years’ experience working as occupational therapists with children and adolescents with autism spectrum disorder. The theories, assessments, interventions, and training that related to respondents’ practices mainly revolved around sensory-based approaches. Encouragingly, more than 70% of the respondents claimed that they performed assessments of daily living activities in their service. Client-centred practice was a further feature of occupational therapist respondents involved in this study.

Conclusion

Future study is needed, especially to engage more respondents and thereby produce more generalizable results and an in-depth exploration of the continuing education needs of occupational therapists in Malaysia.

What Do We Know about Knowledge Brokers in Paediatric Rehabilitation? A Systematic Search and Narrative Summary

PURPOSE

To conduct a systematic review of the literature related to the use of knowledge brokers within paediatric rehabilitation, and specifically to determine (1) how knowledge brokers are defined and used in paediatric rehabilitation and (2) whether knowledge brokers in paediatric rehabilitation have demonstrably improved the performance of health care providers or organizations.

METHODS

The MEDLINE, CINAHL, EMBASE, and AMED databases were systematically searched to identify studies relating to knowledge brokers or knowledge brokering within paediatric rehabilitation, with no restriction on the study design or primary aim. Following review of titles and abstracts, those studies identified as potentially relevant were assessed based on the inclusion criteria that they: (1) examined some aspect of knowledge brokers/brokering in paediatric rehabilitation; (2) included sufficient descriptive detail on how knowledge brokers/brokering were used; and(3) were peer-reviewed and published in English.

RESULTS

Of 1513 articles retrieved, 4 met the inclusion criteria, 3 of which referenced the same knowledge broker initiative. Two papers used mixed methods, one qualitative methodology, and one case presentation. Because of the different methods used in the included studies, the findings are presented in a narrative summary.

CONCLUSIONS

This study provides an overview of the limited understanding of knowledge brokers within paediatric rehabilitation. Knowledge broker initiatives introduced within paediatric rehabilitation have been anchored in different theoretical frameworks, and no conclusions can be drawn as to the optimum combination of knowledge brokering activities and methods, nor about optimal duration, for sustained results.

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.

Occupational Therapists' Attitudes, Knowledge, and Implementation of Evidence-Based Practice: A Systematic Review of Published Research

Introduction:

Evidence-based practice is the procedure whereby clinicians incorporate best research evidence, clinical expertise, and patient values to provide best patient care. Recently, there has been a significant push towards occupational therapists' adoption of evidence-based practice. This systematic review aimed to determine occupational therapists' attitudes, knowledge, and utilization of evidence-based practice.

Method:

A search of literature published between 2000–12 was conducted in relation to occupational therapists' practice. Academic Search Complete, Cumulative Index of Nursing and Allied Health Literature Plus, PsycARTICLES, Ingenta, Medline, Science Direct, and Journal Storage were systematically searched using MeSH and free-text keywords. Google Scholar and reference lists were also searched.

Findings:

Thirty-two papers were selected for review: 23 were quantitative, 8 were qualitative, and 1 used a mixed methods design. Studies demonstrated that occupational therapists hold positive attitudes towards evidence-based practice. However, these attitudes do not translate into practice, with research indicating a lack of evidence-based practice utilization. Occupational therapists perceive a number of barriers to evidence-based practice, including lack of time, lack of availability and accessibility of research, and having limited research skills.

Conclusion:

It is essential that educational and training initiatives provide therapists with the tools and support they need to engage fully with research evidence and its application within clinical care.

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.

Positioning occupational therapy as a discipline on the research continuum: results of a cross-sectional survey of research experience

BACKGROUND/AIM

Evidence-based practice and research are beginning and endpoints on a research continuum. Progression along the continuum builds research capacity. Occupational Therapy has a low evidence base, thus, clinicians are not implementing evidence-based practice or publishing research. Barriers to implementing evidence-based practice and engaging in research include a lack of confidence. This research gauged Occupational Therapists' research experience, support needs and barriers, and compared levels of research anxiety between allied health disciplines.

METHODS

A cross-sectional survey was sent to Health Practitioners in northern Queensland in May-June 2011. Responses about experience, support needs and barriers, between Occupational Therapists, were analysed using Chi-square 'goodness of fit' tests. Multivariate analysis compared responses between disciplines about research anxiety. This paper reports results for the subset of Occupational Therapists.

RESULTS

The whole population, consisting of 152 Occupational Therapists, was sent a questionnaire, from which 86 responded. More Occupational Therapists than not had experience of evidence-based practice and less support was required, but they had little experience of producing research and required more support. The amount of support required for activities along the research continuum was inversely related to the level of experience in these tasks. Barriers included lack of staff and time. Occupational Therapists were more anxious about research (53 of 79, 67%) than all other Health Practitioner disciplines combined (170 of 438, 39%, P < 0.0001).

CONCLUSION

A cohesive strategy should focus on consolidating Occupational Therapists' evidence-based practice skills and building confidence. Clinicians wishing to engage in research need access to academic support. Academics and clinicians should work closely to produce clinically relevant research.