Katrina Bannigan

Barriers to implementing the evidence base in four NHS therapies

Summary Background and purpose This study aimed to examine the attitudes to research and the barriers to implementing evidence-based practice in four professions allied to medicine: dietitians, occupational therapists, physiotherapists, and speech and language therapists. Method Postal questionnaire survey of a 20% sample (n = 715) of four professions allied to medicine in the Northern and Yorkshire region of the NHS. Results The survey achieved a response rate of 80% (N = 572). The majority of therapists (97%) agreed that research findings are important for the development of professional practice. Only 5% had no interest in reading research findings. The majority reported problems with the literature including understanding statistics (78%), the literature not being compiled in one place (78%) and implications for practice not being made clear (66%). Problems with the evidence included conflicting results (75%), methodological problems (66%), a lack of replication (54%) and poor generalisability (53%). The main institutional barriers included insufficient time (66%), inadequate facilities (57%), being isolated from colleagues (37%) and doctors not co-operating with change (36%). Two subscales — perceived importance of research, and perceived barriers — revealed significant differences between professions. Conclusions Therapists value research findings, but the majority have problems accessing and understanding the literature, which is perceived as flawed and incomplete. This suggests a need to improve training at both undergraduate and postgraduate level, improve the quality of publications in professional journals, and commission therapy-relevant trials, systematic reviews and meta-analyses. A substantial number of respondents reported institutional barriers, including poor resources and resistance to change by medical staff.

Reliability and validity in a nutshell

AIMS To explore and explain the different concepts of reliability and validity as they are related to measurement instruments in social science and health care. BACKGROUND There are different concepts contained in the terms reliability and validity and these are often explained poorly and there is often confusion between them. DESIGN To develop some clarity about reliability and validity a conceptual framework was built based on the existing literature. RESULTS The concepts of reliability, validity and utility are explored and explained. CONCLUSIONS Reliability contains the concepts of internal consistency and stability and equivalence. Validity contains the concepts of content, face, criterion, concurrent, predictive, construct, convergent (and divergent), factorial and discriminant. In addition, for clinical practice and research, it is essential to establish the utility of a measurement instrument. RELEVANCE TO CLINICAL PRACTICE To use measurement instruments appropriately in clinical practice, the extent to which they are reliable, valid and usable must be established.

A Model of Professional Thinking: Integrating Reflective Practice and Evidence Based Practice:

Background Internationally, occupational therapists operate in increasing complex health and social care settings. To function in this environment, high-level thinking skills are required. Reflective practice and evidence-based practice are two key skills that shape the way occupational therapists think. Purpose To integrate reflective practice and evidence-based practice so that their complementary qualities form part of a model of professional thinking. Key issues Reflective practice and evidence-based practice skills both contribute to clinical reasoning. The “model of professional thinking” can enable occupational therapists to integrate these two skills into their professional thinking. Implications Rather than teaching reflective practice and evidence-based practice as discrete subjects, “professional thinking” should be taught as an overarching topic within curricula. This may mean changes to the organisation and delivery of curricula, including practice placements. This model of professional thinking will need to be evaluated.

Clinical Effectiveness: Systematic Reviews and Evidence-Based Practice in Occupational Therapy

Evidence-based health care can be defined as an approach to health care that involves finding and using up-to-date research into the effectiveness of health care interventions to inform decision making (Entwistle et al, 1996). For many occupational therapists, the practicalities of keeping up to date with the best research evidence is difficult; however, through the National Health Service Centre for Reviews and Dissemination (NHS CRD), the NHS Research and Development (R&D) Programme is aiming to improve the availability of high quality research evidence to all health care professionals. The NHS CRD carries out and commissions systematic reviews. Systematic reviews are a means of pulling together large quantities of research information and are considered to be one of the most reliable sources of information about effectiveness (Chalmers and Altman, 1995). The NHS CRD also disseminates the findings of systematic reviews, one method of which is through the Database of Abstracts of Reviews of Effectiveness (DARE). The relevance of systematic reviews to the clinical practice of occupational therapists is explored in this paper using two examples: a poor quality and a high quality systematic review identified from the abstracting process for DARE. Both reviews are directly relevant to occupational therapy, being about sensory integration and falls in the elderly respectively. The implications of these reviews for evidence-based practice in occupational therapy are discussed.

Priorities in Mental Health Research: The Results of a Live Research Project

Occupational therapists are increasingly being asked to identify priorities for research. This article is based on a questionnaire survey which was used to identify a priority list for research into occupational therapy in mental health. The delegates at the Association of Occupational Therapists in Mental Healths 3rd Annual Conference were surveyed. The demographic data collected included grade and specialism (as defined by the AOTMH). The delegates were asked to prioritise the area of intervention that they most needed to know was effective, to justify this choice and then to write an associated research question. The data were collected during the ‘Research in Action‘ session at the conference and analysed using SPSS and thematic analysis. The results were presented to the conference the following day. The top three priorities identified were activity/occupation, groupwork and occupational performance skills. The background literature, method and results are discussed and recommendations are made for further action.

Measuring Activity and Participation Outcomes for Children and Youth with Acquired Brain Injury: An Occupational Therapy Perspective

Introduction: Intervention outcomes for children and youth with acquired brain injuries should be measured in terms of participation in activities. The aim of this study was to explore the occupational therapy outcome measures used with this group. Method: One cycle of an action research study, which focused specifically on occupational therapists, is reported. Ten occupational therapists working with children and youth with acquired brain injuries collated the outcome measures they used and mapped their frequently used measures onto the International Classification of Functioning, Disability and Health — Children and Youth, using established linking rules. Findings: Forty-two outcome measures and assessments were identified. Of these, 19 were used frequently and 15 were used as outcome measures. All activity and participation domains were represented, with learning and applying knowledge, mobility, communication and self-care (except looking after ones health) particularly well covered. Conclusion: Occupational therapists are using measures that reflect the domains of activity and participation, unlike those previously identified which were linked predominantly to body functions. The importance of occupational therapists working in rehabilitation teams is reiterated in that some of the domains that are not covered by occupational therapists impact on participation, for example, pain.

Reviewing work-based learning opportunities in the community for physiotherapy students: an action research study

Physiotherapy became a graduate profession in the 1990s marking a shift from ‘training’ to ‘education’. This means students are required to develop as reflective, innovative and autonomous practitioners. Traditional work-based learning has remained a key component in the curricula of physiotherapy programmes in higher education. This is delivered by qualified physiotherapists who take on the role of ‘practice educator’ with responsibility for teaching, supervision and assessment. The teaching and learning strategies of the university and work-based components of physiotherapy curricula are aligned. Concomitantly the delivery of physiotherapy services have become increasingly diverse and the wider health and social care context has changed. In response to these challenges the Chartered Society of Physiotherapy (2006) published guidance on the development of work-based learning in community and non-traditional settings. This study explored how community-based placements could be developed to ensure work-based learning continues to meet students’ needs. An action research methodology was used because any change to established practice is more successful if it involves the people who are responsible for its implementation. Thematic analysis identified three important considerations in the development of community placements: Skill acquisition within community settings; expectations of the available learning and teaching opportunities; effects of health service improvements. This research has highlighted the importance of consultation between all those responsible for physiotherapy work-based learning. A review framework has subsequently been developed to both facilitate this consultation and evaluate placement opportunities available in a specific community setting.

A global approach to evidence based occupational therapy: what progress has been made since 2006?

WFOT Bulletin Volume 64 November 2011 In 2006 Ilott et al declared that evidence based practice was part of the occupational therapy profession’s psyche. They also challenged the profession to work collaboratively over the next ten years in order to make evidence based occupational therapy (EBOT) a global reality for occupational therapists. Their principle was ‘one world, one profession and many evidences’ (Ilott et al 2006a, p. 40). They advised that international cooperation was needed to support EBOT and recommended three levels of activity, i.e.:

A Simple Trick to Market Ourselves

It is a rare occupational therapist that has not felt misunderstood or undervalued at some point in his or her career. This is despite the fact that, as occupational therapists, we have valuable expertise, which makes us an asset to any multidisciplinary team. The role of the occupational therapist is almost a clichéd topic, especially in the mental health field. This has led many to discuss how we market ourselves. In these discussions, frustration is often expressed at other professions not understanding us, rather than our recognising that we need to make ourselves understood. After all, would we know what psychotherapists did if they did not tell us? Recently, the band 5 occupational therapists on rotation at South London and Maudsley NHS Foundation Trust were reflecting on their learning needs. They expressed concern about finding and using their voice and how their colleagues were not always clear about what occupational therapy has to offer. They turned these concerns into a challenge: how could they find a voice in each specialty of their rotation? The solution offered was to use the literature focused on occupation to identify the five key articles that drove their practice. They were then to commit these to memory so that, when based in their new teams, they would have a core literature to draw upon when discussing their practice. Those therapists involved in the teaching session said that they found the exercise very useful and, in particular, they could see how they could use the literature and language of occupation positively in order to reinforce their identity within the team. Although this exercise was devised for band 5 occupational therapists, it could be useful to all occupational therapists because we have an ethical obligation to keep up to date (College of Occupational Therapists 2005). If practised regularly, even every 4 or 6 months, most of us would increase our use of research-based knowledge. Two aspects of the exercise are particularly useful: ■ It is habit forming: It encourages us to incorporate using the literature into our work routine. Keeping up to date without good routines is very difficult and, without these routines, it is very easy for us to lose touch with the literature in our specialty. ■ It enables us to be better ambassadors: If we are well informed, it is much easier to speak (and be heard) with regard to what occupational therapy has to offer service users. Ultimately, we can make a difference by behaving differently. The use of occupation-focused literature is a way of naming the difference between us and the rest of the team. By using this literature, we can be champions of that difference. This simple trick can be very powerful in marketing occupational therapy.

Getting to Grips with Evidence-Based Practice: The Ten Commandments:

There is an expectation that all occupational therapists will be evidence-based practitioners. This paper reports on an education intervention that has helped therapists working in clinical practice to respond to the challenges posed by evidence-based practice. The intervention was developed for a group of clinicians who had already undertaken an evidence-based practice course. The aim was to enable them to apply evidence-based practice skills to their practice settings. The intervention, which used the problem of evidence-tinged practice as a focus, is described and the ten commandments generated by the clinicians involved are presented for others as a potentially useful tool.