Challenges and Strategic Solutions for a Research Emergent Profession

The development of pre-registration occupational therapy student perceptions of research and evidence-based practice: A Q-methodology study

BACKGROUND

Pedagogically sound curricula are needed for occupational therapy (OT) students to adopt evidence-based practice (EBP) principles and internalise EBP within their professional identities. Exploring students' perceptions of this knowledge area can contribute to effective curriculum design.

AIMS/OBJECTIVES

To explore the evolution of pre-registration OT student perceptions of research and EBP over the course of their engagement with undergraduate teaching and learning.

MATERIALS AND METHODS

The Q-sort approach synthesises different viewpoints regarding a sample of statements, using by-person factor analysis (respondents = variables; statements = sample). Final year pre-registration OT students completed the same Q-sort at three timepoints (pre-dissertation [n = 18]; post-dissertation submission [n = 12]; post-student research conference [n = 6]). Q-sort responses were intercorrelated and factor-analysed; extraction of factors with an eigenvalue of ¬>0.9 and varimax rotation identified majority viewpoints.

RESULTS

Significant factors were revealed at each timepoint: 1a: 'Evidence-inseparable from OT practice', 1b: 'Research for research's sake-inseparable from the occupational therapy identity', 2: 'Who am I to question the gurus?', 3: 'I can do it with confidence…but so what?'

CONCLUSIONS

Opportunities for completing 'authentic' student research projects, with 'ownership' of results, may enhance research and EBP confidence and professional identity.

SIGNIFICANCE

Findings expand current knowledge regarding effective use of pre-registration educational opportunities to support future research and EBP.

A qualitative investigation of influences on occupational therapists’ research involvement in Ireland

Background:

To fulfil the desire for evidence-based practice, there is impetus for occupational therapy (OT) to make research a priority and to encourage research engagement.

Purpose:

This study’s aim was to explore occupational therapists’ reasons for and for not getting involved in research and to determine potential barriers and enablers to engaging in research.

Methods:

Three focus groups were conducted with five participants each. Data were thematically analysed.

Findings:

Occupational therapists’ reasons for expressing interest in getting involved in research were having an interest in the condition and/or the symptoms being studied; promoting client support and service development; and ‘upskilling’. Three themes emerged from the thematic analysis: (1) motivation to get involved in research can be influenced; (2) ‘firefighting’: barriers and organisational culture; and (3) The nature of research needs consideration from an occupational therapist perspective.

Implications:

Findings suggest that though occupational therapists are able to get involved in research, it remains that there are difficulties in doing so (e.g., organisational culture); and such difficulties may outweigh both reasons and enablers to such involvement. Reasons for expressing interest, enablers, barriers and the relationships among them warrant further investigation and consideration with respect to involving occupational therapists in research.

P, Ibrahim Ramzi O. Visualizing highly cited scientific output of Indian physiotherapists: A bibliometric study

Background: Physiotherapy research supports the advancement of evidence-based practice and the development of a highly skilled workforce. This study aims to visualize the highly cited scientific output of Indian physiotherapists from 1999 to 2018. Methods: A descriptive study design was adopted to visualize the highly cited scientific output of Indian physiotherapists using the Web of Science (WoS) database from 1999 to 2018. A search was carried out using the following keywords "((TS=(physiotherapy) OR TS=("physical rehabilitation") OR TS=("physical therapy")) AND AD=(India))Indexes=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI, CCR-EXPANDED, IC Timespan=1999-2018". Data collected were analyzed using Incites from WoS and VOSviewer software. Results:  A total of 488 articles were published between 1999 and 2018, with a peak of 103 in 2016 with 2419 citations. A decline in publication count was observed after 2016. The journal International Journal of Physiotherapy published the highest number of articles (n=35). Manipal University (n=36) was found to be the most active institution for physiotherapy research in India, as determined by publishing the most articles. Indian physiotherapists published the highest number of research articles in collaboration with US authors (n=24). Conclusion: There is an increasing trend in the scientific output of Indian physiotherapists over the past two decades; however, a decline is observed after 2016. It is recommended that research collaborations across the globe are increased and scientific output should be improved, leading to a higher number of citations. Future research should explore factors influencing the scientific production of Indian physiotherapists and devise appropriate strategies to attain further improvement.

P, Ibrahim Ramzi O. Visualizing highly cited scientific output of Indian physiotherapists: A bibliometric study

Background: Physiotherapy research supports the advancement of evidence-based practice and development of a highly skilled workforce. This study aims to visualize highly cited scientific output of Indian physiotherapists from 1999 to 2018. Methods: A descriptive study design was adopted to visualize highly cited scientific output of Indian physiotherapists using the Web of Science (WoS) database from 1999 to 2018. A search was carried out using the following term "((TS=(physiotherapy) OR TS=("physical rehabilitation") OR TS=("physical therapy")) AND AD=(India))Indexes=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI, CCR-EXPANDED, IC Timespan=1999-2018". Data collected were analyzed using Incites from WoS and VOSviewer software. Results:  A total of 489 articles were published between 1999 and 2018, with a peak of 103 in 2016 with 2420 citations. A decline in publication count was observed after 2016. The journal International Journal of Physiotherapy published the highest number of articles (n=35). Manipal University (n=26) was found to be the most active institution for physiotherapy research in India, as determined by producing the most articles. Indian physiotherapists published the highest number of research articles in collaboration with US authors (n=24). Conclusion: There is an increasing trend in the scientific output of Indian physiotherapists over the past two decades; however, a decline is observed after 2016. It is recommended that research collaborations across the globe are increased and scientific output should be improved, leading to a higher number of citations. Future research should explore factors influencing scientific production of Indian physiotherapists and devise appropriate strategies to attain further improvement.

Research culture and capacity in community health services: results of a structured survey of staff

Developing research capacity is recognised as an important endeavour. However, little is known about the current research culture, capacity and supports for staff working in community-based health settings. A structured survey of Division of Community Health staff was conducted using the research capacity tool. The survey was disseminated by email and in paper format. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically. In total, 109 usable responses were received, giving a response rate of 26%. Respondents were predominately nurses (n=71, 65.7%), with ~50% reporting post-graduate vocational qualifications. The highest levels of skills or organisational success were in using evidence to plan, promote and guide clinical practice. Most participants were unsure of organisational and team level skills and success at generating research. Few reported recent experience in research-generating activities. Barriers to undertaking research included lack of skills, time and access to external support and funding. Lack of skills and success in accessing external funding and resources to protect research time or to 'buy-in' technical expertise appeared to exacerbate these barriers. Community health staff have limited capacity to generate research with current levels of skill, funding and time. Strategies to increase research capacity should be informed by knowledge of clinicians' research experience and interests, and target development of skills to generate research. Resources and funding are needed at the organisational and team levels to overcome the significant barriers to research generation reported.

Evidence-Based Occupational Therapy: It's Time to Take a Global Approach

This opinion piece advocates that the time is right to adopt a worldwide strategic approach to evidence-based occupational therapy (EBOT). This means globalising the evidence and localising decision making in a context-sensitive way. The main barriers to and needs for collaborative action over the next 10 years are identified. The analysis is based on our experience and on reflections upon an international meeting on EBOT held in Washington DC in 2004. We hope to challenge readers to think about what they can do to make EBOT a reality for everyone everywhere.

Evidence for Occupational Therapy Interventions: Effectiveness Research Indexed in the OTseeker Database

The aim of this study was to determine the overall quantity and quality of randomised controlled trials and the quantity of systematic reviews relevant to occupational therapy practice.

The content of OTseeker ( www.otseeker.com ) was surveyed in June 2006. There were 3401 randomised controlled trials and 939 systematic reviews in OTseeker (total = 4340), published mostly in non-occupational therapy journals. The diagnostic areas of stroke (n = 458) and back or neck conditions/injuries (n = 391), and the intervention categories of exercise (n = 1262) and consumer education (n = 1098), were the most frequently listed. Although the quantity of evidence available about the effectiveness of occupational therapy interventions is rapidly increasing, some areas require greater research effort. Occupational therapists also need to search more broadly than occupational therapy journals for research to support clinical decision making.

Comparison of research experience and support needs of rural versus regional allied health professionals

OBJECTIVE

We compared the research experience or support needs of allied health professionals in rural versus regional cities to identify if they were the same or different.

DESIGN

Descriptive study using a cross sectional survey.

SETTING

This study was carried within Queensland Health's northern six health services.

PARTICIPANTS

Queensland health staff classified as Health Practitioners.

INTERVENTIONS

This survey was conducted as part of a research capacity building initiative within Queensland Health to increase AHPs' participation in research in regional cities and rural areas of Queensland.

MAIN OUTCOME MEASURES

Questions in the survey identified demographics, research experience, need for research support, research knowledge and beliefs about research. Data were compared using Chi-square and t-tests.

RESULTS

The total response rate was 54.5% with 18% of the HPs located in rural communities of less than 5000 people and the rest from the three major cities in northern Queensland. Rural HPs have less research experience in most research activities than regional city HPs and need more research support. Rural HPs have more qualitative research experience than regional city HPs and research is perceived positively by both. Barriers to conducting research were similar across both groups and included insufficient time, lack of staff and no statistical support.

CONCLUSION

Rural HPs are younger and have less research experience than their counterparts working in regional cities. Therefore, building rural HP research capacity initiatives may require more access to facilitators such as the Research Fellows.

Building research capacity in south-west Sydney through a Primary and Community Health Research Unit

The Primary and Community Health Research Unit was established in 2010 in south-west Sydney to build research capacity in primary and community health services and help generate evidence to underpin clinical activities. In 2011, six project teams participated in a 12-month researcher mentoring program, undertaking projects in quality improvement and service evaluation. Project teams were linked with academic mentors and participated in four research skill development workshops covering research design, research ethics, statistical analysis and academic writing. All project teams presented their work at two or more research conferences, and all are preparing manuscripts for publication in peer-reviewed journals. The Primary and Community Health Research Unit’s approach to research capacity building in primary and community health services appears to be effective in supporting novice researchers to undertake research in their clinical settings. Sustainability is dependent on securing ongoing funding. Further analysis is needed to identify strengths and weaknesses of this approach.

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.

Motivators, enablers, and barriers to building allied health research capacity

Purpose

A sound, scientific base of high quality research is needed to inform service planning and decision making and enable improved policy and practice. However, some areas of health practice, particularly many of the allied health areas, are generally considered to have a low evidence base. In order to successfully build research capacity in allied health, a clearer understanding is required of what assists and encourages research as well as the barriers and challenges.

Participants and methods

This study used written surveys to collect data relating to motivators, enablers, and barriers to research capacity building. Respondents were asked to answer questions relating to them as individuals and other questions relating to their team. Allied health professionals were recruited from multidisciplinary primary health care teams in Queensland Health. Eighty-five participants from ten healthcare teams completed a written version of the research capacity and culture survey.

Results

The results of this study indicate that individual allied health professionals are more likely to report being motivated to do research by intrinsic factors such as a strong interest in research. Barriers they identified to research are more likely to be extrinsic factors such as workload and lack of time. Allied health professionals identified some additional factors that impact on their research capacity than those reported in the literature, such as a desire to keep at the “cutting edge” and a lack of exposure to research. Some of the factors influencing individuals to do research were different to those influencing teams. These results are discussed with reference to organizational behavior and theories of motivation.

Conclusion

Supporting already motivated allied health professional individuals and teams to conduct research by increased skills training, infrastructure, and quarantined time is likely to produce better outcomes for research capacity building investment.

Vocational intervention based on the Model of Human Occupation: a review of evidence

Work is a growing concern in disability and rehabilitation fields. Specific evidence related to occupational therapy in the area of vocational rehabilitation is somewhat limited. With increased demands for occupation-focused, evidence-based, and theory-informed practice, this review aims to use clinically relevant questions to organize and synthesize evidence regarding work-related interventions specifically related to an occupation-focused theory, the Model of Human Occupation. A total of 45 published works related to both the MOHO and vocational issues were identified and included in the review. The review demonstrates that there is a range of evidence that supports the use of the MOHO and its tools as a basis for work-based clinical interventions. Evidence supports the conclusion that MOHO-based work assessments have good psychometric properties and are useful in evaluating vocational potential and needs. MOHO-based work programs have been shown to have a positive impact in improving vocational outcomes to a range of clients.

Achieving best practice: a review of evidence linked to occupation-focused practice models

ABSTRACT The aim of this paper is to identify and synthesize evidence concerning the most widely used contemporary occupation-focused models including Ecology of human performance; Model of human occupation; Occupational adaptation; and Person-environment-occupational performance. The paper characterizes the amount and type of evidence. Evidence found includes illustrations of how the models can be applied to understand and address a particular problem or population, basic studies that test or expand theoretical concepts, psychometric studies, studies that document therapy outcomes, and studies that examine clinical reasoning and/or practice based on the models. The four models differed widely in the amount and type of evidence available.

Connecting with clinicians: opportunities to strengthen rehabilitation research

PURPOSE

This article examines the distinctive opportunities and challenges involved in connecting with clinicians to strengthen rehabilitation research.

METHOD

The relevant literature on various factors that link researchers and clinicians is summarized and discussed.

RESULTS

Links between researchers and clinicians are demonstrated by evidence-based practice, common conceptual background and the development of research capacity. Sustainable partnerships can evolve throughout the research process by using various enduring strategies such as experts' committee as well as novel approaches like communities of practice.

CONCLUSION

This paper reflects the conviction that reducing the gap between research and clinical practice will be facilitated by implementing partnerships originating from both researchers and clinicians.

Getting started in evidence-based practice for childhood speech-language disorders

PURPOSE

Evidence-based practice (EBP) entails a critical mindset and rigorous methods that foster the judicious integration of scientific evidence into clinical decision making. The purpose of this tutorial is to present strategies, resources, and examples to help speech-language pathologists get started in EBP for childhood speech and language disorders.

METHOD

The tutorial begins with an overview of key principles of EBP, including potential benefits and challenges, and other initial considerations. Five recommended steps for implementing EBP are then presented: posing a question, locating the evidence, appraising the evidence, making and implementing clinical decisions, and evaluating those decisions. Included is a compilation of synthesized evidence resources, such as systematic reviews/meta-analyses and EBP guidelines. Finally, illustrative examples are provided to assist practitioners with integrating research evidence into clinical decision making in childhood speech-language disorders.

CONCLUSIONS

Speech-language pathologists who work with children are encouraged to adopt EBP for clinical decision making.

Utilization of evidence-based practice by registered occupational therapists

Although the use of evidence-based practice (EBP) is presently on the rise, there have been limited studies examining its use by occupational therapists within the US. The purpose of this study was to examine the use of EBP among registered occupational therapists in the occupational therapy intervention planning process. This descriptive study surveyed 500 members of the American Occupational Therapy Association (AOTA), of which 131 participants responded (26%). The results of the study supported the hypothesis that, within the sample studied, a minority of registered occupational therapists in the US utilize EBP in the intervention planning process. Other results included: (1) As level of academic education increased, the view of the importance of research to occupational therapy decreased. (2) As the years of practice increased, the use of research evidence in making clinical decisions decreased. As the occupational therapy profession moves towards utilization of EBP as a professional standard, it is imperative that the profession examines specific strategies to promote the adoption of such practice by its members, including the promotion of competency in evidence utilization, and the valuing of the established clinical reasoning skills of the practitioner while integrating research evidence into intervention planning to support professional practice.