Fostering Full Implementation of Evidence-Based Practice

Occupational Therapy Doctoral Capstone Research Agenda: A Scoping Review

IMPORTANCE

As identified in the American Occupational Therapy Association's (AOTA's; 2023) statement about the purpose and value of the occupational therapy doctoral capstone, there is a lack of evidence about the purpose and value of the doctoral capstone. As an essential element of occupational therapy doctoral degree curricula, the capstone is unique to each program, supports the program's scholarship agenda, and serves the needs of students and the communities served by the profession.

OBJECTIVE

To develop a doctoral capstone research agenda in an attempt to prioritize and guide research that can supplement the current paucity of evidence related to capstone efficacy or effectiveness.

METHOD

The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were used to conduct a scoping review. Peer-reviewed articles published between 1999 and June 2023 were searched using the CINAHL, PsycINFO, PubMed, and Embase databases.

RESULTS

The doctoral capstone research agenda was developed and organized into five categories to drive research activities inclusive of the didactic and experiential learning associated with the planning, implementation, and evaluation of the capstone process: (1) teaching and learning; (2) learner characteristics and competencies; (3) shaping professional identity; (4) faculty/mentor development and resources; and (5) promotion of diversity, equity, and inclusion.

CONCLUSIONS AND RELEVANCE

A doctoral capstone research agenda was developed in accordance with AOTA's (2018) Occupational Therapy Education Research Agenda. It identifies an array of areas in which research is needed to inform the distinct value and purpose of the doctoral capstone to students, sites, programs, and the profession. Plain-Language Summary: The occupational therapy doctoral capstone is unique to each program, supports the program's scholarship agenda, and supports the needs of students and the communities served by the profession. The American Occupational Therapy Association's official document on the "Occupational Therapy Doctoral Capstone: Purpose and Value" states that there is a lack of evidence about how to identify the distinct purpose and value of the doctoral capstone. This scoping review explored the development of a doctoral capstone research agenda. A research agenda is provided to guide and prioritize research to articulate best practices and the distinct purpose and value of the doctoral capstone in occupational therapy education and for the profession.

The use of practice evidence by Australian occupational therapists: Perspectives and actions

INTRODUCTION

Evidence-based practice supports clinical decision-making by using multiple sources of evidence arising from research and practice. Research evidence develops through empirical study while practice evidence arises through clinical experience, client preferences, and the practice context. Although occupational therapists have embraced the paradigm of evidence-based practice, some studies have identified limits in the availability and use of research, which can lead to reliance on other forms of evidence. This study aimed to understand how Australian occupational therapists use practice evidence, manage potential bias, and enhance trustworthiness. Potential use of a critical appraisal tool for practice evidence was also explored.

METHODS

A 42-item questionnaire was developed to address the study aims. It consisted of a 7-point Likert scale, ordinal and free text questions. Likert scales were collapsed into binary scales and analysed using SPSS. Ordinal data were graphed and free text responses were analysed using manifest content analysis.

RESULTS

Most respondents (82%) indicated that practice evidence was an important informant of practice and is used alongside research evidence. Almost all respondents (98%) expressed confusion when reconciling discrepancies between research and practice evidence. There was general acknowledgement that practice evidence is prone to bias (82%), yet 92% were confident in trusting their own practice evidence. Most respondents (74.5%) undertook some measures to appraise practice evidence, and almost all respondents (90%) agreed they would refer to a critical appraisal tool that helped them evaluate practice evidence.

CONCLUSION

Occupational therapists in this study routinely use practice evidence arising from their own experience, client perspectives, and their practice context to inform clinical decision-making. While they agreed that practice evidence was prone to bias and misinterpretation, they generally trusted their own practice evidence. Participants indicated they needed guidance to critically appraise their practice evidence and supported the development of a critical appraisal tool for this purpose.

Implementation of Evidence-Based Practice and Burnout Among Occupational Therapists: The Role of Self-Efficacy

IMPORTANCE

Implementing evidence-based practice (EBP) is essential for ensuring optimal quality care and obtaining positive outcome in treatment. Occupational therapists generally hold positive attitudes toward EBP; however, EBP is not always fully implemented.

OBJECTIVE

To explore the mediating role of self-efficacy on the relationship between implementing EBP and burnout among occupational therapists.

DESIGN

A cross sectional study.

SETTING

Data were collected through social media and WhatsApp groups using an online survey accessible through Qualtrics, a secured web-based data collection system; responses were anonymous.

PARTICIPANTS

The final sample consisted of 261 female Israeli occupational therapists (ages 24-65 yr, with 1-40 yr of clinical experience).

OUTCOMES AND MEASURES

The following questionnaires assessed EBP implementation, burnout, and self-efficacy, respectively: the EBP Implementation Scale, the Maslach Burnout Inventory, and the Occupational Therapy Self-Efficacy Questionnaire. Demographic data were also collected.

RESULTS

EBP implementation was low (0-43 points out of a maximum 72 points), moderate levels of burnout and high levels of self-efficacy were reported. Significant associations with medium effect sizes were found between EBP implementation and burnout: the higher the levels of EBP implementation, the lower the levels of burnout frequency and intensity. Moreover, self-efficacy mediated these relationships. EBP implementation was related to elevated self-efficacy, which, in turn, was associated with lower burnout.

CONCLUSIONS AND RELEVANCE

EBP implementation may serve as an important tool to limit burnout among occupational therapists by fostering their trust in their ability to handle clinical challenges. Further research is needed. Plain-Language Summary: This study explored implementing evidence-based practice (EBP) and its relationships to burnout and work-related self-efficacy among occupational therapists. The study found that self-efficacy mediated the relationships between implementing EBP and burnout. Implementing EBP was associated with higher self-efficacy, which, in turn, was associated with lower burnout among occupational therapists.

Expert Recommendations for a Clinical Guide Supporting the Use of Electrical Stimulation in Occupational Therapy Treatment of Spinal Cord Injury

IMPORTANCE

Clinical application of electrical stimulation (ES) to address functional deficits for those with spinal cord injury (SCI) is not consistent among occupational therapy practitioners, likely because of limited occupational therapy-specific clinical guidelines (OT-CG). Clinicians report the need for evidence-based guidance that supports their practice.

OBJECTIVE

To identify occupational therapy practitioners' needs to support ES application in treatment sessions, utility of existing clinical practice guidelines for occupational therapy practitioners, challenges and opportunities to translate research findings into clinical practice, and desirable characteristics for an occupational therapy-specific ES clinical guide.

DESIGN

A panel of 7 senior occupational therapy clinicians with ES expertise was convened for two stages. In Stage 1, two focus group discussions were recorded, transcribed, analyzed, and thematically summarized. In Stage 2, panel members completed a member-check survey, and panelists reviewed a proposed outline for an OT-CG ES guide, rating the desirability of each section.

SETTING

Online expert panel.

PARTICIPANTS

A purposive sample of occupational therapy clinicians eligible to administer ES, actively using ES with SCI, and employed at preeminent SCI centers.

RESULTS

An outline for an OT-CG to support consistent clinical use of ES among occupational therapy practitioners was developed. Three themes emerged: difficulty using clinical practice guidelines for electrical stimulation, lack of clinical examples to guide specific electrical stimulation treatment activities, and modifications to existing guidelines.

CONCLUSIONS AND RELEVANCE

An outline for a proposed guideline was created; ideally, such a manual would improve treatment fidelity and predictable patient outcomes for those with SCI. What This Article Adds: A novel outline for an OT-CG was developed to provide treatment fidelity, structure to treatment approaches, and a basis for future scholarly study.

Exploring Knowledge Translation Concepts in U.S. Occupational Therapy Research: A Content Analysis

IMPORTANCE

As a new Accreditation Council for Occupational Therapy Education® standard, knowledge translation (KT) is an important concept to occupational therapy. A better understanding of KT in occupational therapy research could inform its relevance to occupational therapy education, research, and practice.

OBJECTIVE

To answer the question "To what extent does published U.S.-based occupational therapy research that is explicitly underpinned by a KT theory, model, or framework reflect processes and concepts outlined in the knowledge-to-action (KTA) framework?"

DESIGN

A systematic search was conducted to purposively sample U.S.-based occupational therapy research. A content analysis of 11 articles explored concepts of the KTA framework.

OUTCOMES AND MEASURES

KTA was used as a conceptual foundation.

RESULTS

Multiple sources of data mapped onto concepts in the knowledge creation cycle and each of the first five concepts of the knowledge action cycle. We found that three concepts from the knowledge action cycle-monitor knowledge use, evaluate outcomes, and sustain knowledge use-were not well represented in the sample.

CONCLUSIONS AND RELEVANCE

Future research on the monitoring, evaluation, and sustained use of occupational therapy interventions is needed. The adoption of new interventions is important, and the knowledge of how they are sustained in practice will facilitate the clinical integration of future interventions. What This Article Adds: Occupational therapy research that uses KT lacks an emphasis on monitoring and sustaining evidence-informed interventions. Future research on the integration of such interventions into clinical practice is needed so that best practices in occupational therapy can be promoted.

Learning Health Systems Can Promote and Sustain High-Value Occupational Therapy

In the current policy context, the occupational therapy profession must act to promote and sustain high-value care. Stakeholders have delineated efforts, such as defining and measuring high-quality care processes or promoting the adoption of evidence into practice, that can enhance the value of occupational therapy services. There is a growing recognition, however, that low-value care is the product of deficiencies within health care systems and is therefore most amenable to system-level solutions. To date, the specific nature of system-level changes capable of identifying and rectifying low-value occupational therapy has yet to be elucidated. In this "The Issue Is. . ." column, we introduce occupational therapy to the Learning Health System concept and its essential functions. Moreover, we discuss action steps for occupational therapy stakeholders to lay the foundation for Learning Health Systems in their own professional contexts. What This Article Adds: This article is the first to outline concrete action steps needed to transform occupational therapy practice contexts into Learning Health Systems. Such a transformation would represent a system-level change capable of fostering the delivery of high-value occupational therapy services to clients in a variety of practice settings.

Sources of evidence for professional decision-making in novice occupational therapy practitioners: clinicians’ perspectives

Introduction

Evidence-based practice skills and habits begin during undergraduate education and continue through professional life. It is important novices learn the skills in their education programme that are required in practice. This study explores strategies experienced occupational therapy supervisors use to encourage novices to be evidence based, and how these might be enhanced.

Method

Qualitative descriptive methodology was used to explore the views and experiences of 15 experienced supervisors from a range of practice areas and geographical locations, interviewed in four focus groups.

Results

Evidence-based practice is an element of professional reasoning not isolated from client-centred practice or from reflective practice. Five sources of evidence to inform competence in professional decision-making were identified: (a) research evidence from literature; (b) local environment, resources and culture; (c) client’s expertise and perspective; (d) expertise of others; and (e) practitioners’ own knowledge and experience.

Conclusion

Intentional use of all five sources of evidence to inform professional decision-making contributes to habits of evidence-based thinking and practice. Experienced therapists and educators can support evidence-based practice in novices by prompting questioning and developing systems supportive of scanning for evidence in each area. Collaboration in this endeavour will enhance integration of academic and practice education.

Narrowing the Gap: An Implementation Science Research Agenda for the Occupational Therapy Profession

Despite advancements in occupational therapy research, the widespread research-to-practice gap continues to delay how quickly evidence-based practices are implemented in real-world clinical settings. Implementing research in practice is a complex process that mandates attention from all occupational therapy stakeholders; however, researchers are uniquely positioned to help minimize the 17-yr lag between scientific discovery and the implementation of research findings into practice. Our article serves as a response to Marr's (2017) Centennial Topics article, which proposed that purposeful efforts are needed to advocate for implementation research in occupational therapy. We provide an implementation science research agenda informed by concepts from the implementation science literature and suggest how researchers can structure methodologies to examine implementation-related outcomes and strategies. We provide explanations of gold-standard implementation outcomes and offer several recommendations for how researchers can report and disseminate implementation research findings to occupational therapy stakeholders.

Characteristics of research with older people (over 65 years) in occupational therapy journals, 2013-2017

Background: A growing population of older people will require different types of occupational therapy services in the future. For occupational therapists to provide effective services and to optimize care, their practice must rely on high-quality evidence. Research is one important pillar of evidence-based practice. Therefore, it is important to examine the research published in occupational therapy journals, which guides practitioners in their work with clients.Aim: The overall aim of this study was to review research characteristics in articles with older persons as participants, aged over 65 years, with or without illness, diseases or disabilities, reported in occupational therapy journals during the period 2013-2017.Materials and methods: Data was collected from peer-reviewed occupational therapy journals and categorized in relation to research characteristics using descriptive statistics.Results: The findings show that most articles presented basic research, using quantitative design where the sources of data were instruments.Conclusion: The findings suggest that both qualitative and quantitative articles use appropriate sample sizes. However, descriptions of the studied populations are frequently unclear, which may affect the transferability and generalization of the results.Significance: In order to support practice, efforts are needed to develop research aims and questions that develop knowledge to embrace more than just basic research.

Implementing Evidence-Based Interventions With Community-Dwelling Older Adults: A Scoping Review

OBJECTIVE

With the rapid growth of the community-dwelling older adult population, evidence-based occupational therapy interventions targeting older clients need to be effectively implemented. However, little is understood about the factors influencing effective intervention implementation into practice.

METHOD

We performed a scoping review to explore what strategies and factors relate to the uptake of older adult interventions into practice. Concepts from implementation science literature guided our review.

RESULTS

Our review yielded 13 articles that met our search criteria. Study designs examined barriers, facilitators, and strategies related to the implementation of evidence-based older adult interventions into practice. Effective implementation strategies included training sessions, workshops, consultations, and outreach meetings.

CONCLUSION

Our findings suggest that practitioners, administrators, and researchers should adopt strategies such as workshops, consultations, fidelity vignettes, peer mentoring, and standardized training to effectively implement research into practice with older adults.

Assessing Sensory Processing Dysfunction in Adults and Adolescents with Autism Spectrum Disorder: A Scoping Review

Sensory reactivity is a diagnostic criterion for Autism Spectrum Disorder (ASD), and has been associated with poorer functional outcomes, behavioral difficulties, and autism severity across the lifespan. Yet, there is little consensus on best practice approaches to assessing sensory processing dysfunction in adolescents and adults with ASD. Despite growing evidence that sensory symptoms persist into adolescence and adulthood, there is a lack of norms for older age groups, and pediatric assessments may not target appropriate functional outcomes or environments. This review identified approaches used to measure sensory processing in the scientific literature, and to describe and compare these approaches to current best practice guidelines that can be incorporated into evidence-based practice. Method and Analysis: A search of scientific databases and grey literature (professional association and ASD society websites), from January 1987-May 2017, uncovered 4769 articles and 12 clinical guidelines. Study and sample characteristics were extracted, charted, and categorized according to assessment approach.

RESULTS

There were 66 articles included after article screening. Five categories of assessment approaches were identified: Self- and Proxy-Report Questionnaires, Psychophysical Assessment, Direct Behavioral Observation, Qualitative Interview Techniques, and Neuroimaging/EEG. Sensory research to date has focused on individuals with high-functioning ASD, most commonly through the use of self-report questionnaires. The Adolescent and Adult Sensory Profile (AASP) is the most widely used assessment measure (n = 22), however, a number of other assessment approaches may demonstrate strengths specific to the ASD population. Multi-method approaches to assessment (e.g., combining psychophysical or observation with questionnaires) may have clinical applicability to interdisciplinary clinical teams serving adolescents and adults with ASD. Contribution: A comprehensive knowledge of approaches is critical in the clinical assessment of a population characterized by symptomatic heterogeneity and wide-ranging cognitive profiles. This review should inform future development of international interdisciplinary clinical guidelines on sensory processing assessment in ASD across the lifespan.