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

Upton, Dominic; Stephens, Danielle; Williams, Blair; Scurlock-Evans, Laura

doi:10.4276/030802214x13887685335544

Cited by 121 publications

(126 citation statements)

References 46 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…This very much concurs with the wider accepted view of the current situation 1,6,59 and therapists' views on the barriers to evidence-based practice. [60][61][62][63][64][65][66][67][68] These findings are not unique to the therapy professions investigated in this study, and have been reported across a wide range of health-care professions. [64][65][66] Furthermore, and as other studies report, [61][62][63] the applicability of existing, higher-quality evidence (derived from studies not conducted in routine practice or clinical settings) was questioned.…”

Section: Views About the Need For Researchmentioning

confidence: 69%

“…[60][61][62][63] Perceived challenges of designing and conducting evaluative research Study participants readily identified challenges with evaluating therapy interventions and a minority believed that these were insurmountable. Most regarded them as issues that may themselves need to be researched.…”

Section: Views About the Need For Researchmentioning

confidence: 99%

“…university hospital vs. services unconnected with academic/research endeavours) being found to influence an individual's viewpoint. [61][62][63] Research infrastructure within the therapy professions…”

Section: Views About the Need For Researchmentioning

confidence: 99%

See 2 more Smart Citations

Therapy interventions for children with neurodisabilities: a qualitative scoping study

Beresford

Clarke

Maddison

2018

Health Technol Assess

View full text Add to dashboard Cite

Background Therapy interventions emerged four times in the top 10 research priorities in a James Lind Alliance research prioritisation exercise for children with neurodisabilities (Morris C, Simkiss D, Busk M, Morris M, Allard A, Denness J, et al. Setting research priorities to improve the health of children and young people with neurodisability: a British Academy of Childhood Disability-James Lind Alliance Research Priority Setting Partnership. BMJ Open 2015;5:e006233). The National Institute for Health Research (NIHR) commissioned this study as part of an information-gathering exercise in response to this. Objectives The objectives were to (1) describe the current practice, approaches and schools of thought in relation to physiotherapy, occupational therapy and speech and language therapy for children with neurodisability; (2) explore clinical decision-making; (3) investigate views on outcomes and their measurement, particularly participation as an outcome, that is, the child’s ability to have the opportunity to be involved in life situations and activities (e.g. communication, mobility, interpersonal interactions, self-care, learning and applying knowledge); (4) seek views on the aspects of therapy interventions that have an impact on outcomes; and (5) elicit stakeholder views on research needs and priorities. Design, setting and participants More than 70 professionals (therapists, service leads, paediatricians and education staff) and 25 parents participated in a qualitative interview (either individually or as part of a focus group). Results Professional thinking and models of service delivery are in a state of flux and development. There is a move towards goals-focused, family-centred approaches. Work tends to be highly individualised, with few protocols. Parents are certain of the value of therapies, although they may experience difficulties with provision and may seek (additional) private provision. Therapy interventions are conceived as three components: the therapist, the procedures/equipment, etc., and the wider therapeutic environment. They are believed to be highly complex and poorly understood. Although participation is widely endorsed as a core intervention objective of therapy interventions, its suitability, or appropriateness, as an outcome measure was questioned. Other child and/or parent outcomes were identified as more or equally important. Notions of intermediate outcomes – in terms of body structure/function, and the achievement of activities – were regarded as important and not counter to participation-focused approaches. Among therapists, research on intervention effectiveness was (cautiously) welcomed. A number of methodological challenges were identified. A portfolio of study designs – quantitative and qualitative, experimental and observational – was called for, and which included economic evaluation and clear pathways to impact. Limitations The study was not successful in recruiting children and young people. Further work is required to elucidate the views of this key stakeholder group. Conclusions Therapy interventions are poorly understood. There was strong support, tempered a little by concerns among some about the feasibility of demonstrating impact, for investment in research. Future work The identification of research priorities was a core study objective, and a wide-ranging research agenda was identified. It included ‘foundational’ research into neurodisability, the active components of therapy interventions and the concept of participation. Three areas of evaluation were identified: overall approaches to therapy, service organisation and delivery issues, and the evaluation of specific techniques. Parents regarded evaluations of approaches to therapy (e.g. goals-focused; supporting family-self management) as priorities, along with evaluations of models of service provision. Professionals’ views were broadly similar, with an additional emphasis on methodological research. In terms of specific techniques, there was no shared agreement regarding priorities, with views informed by personal interests and experiences. Funding The NIHR Health Technology Assessment programme.

show abstract

Section: Views About the Need For Researchmentioning

confidence: 69%

Section: Views About the Need For Researchmentioning

confidence: 99%

See 1 more Smart Citation

Therapy interventions for children with neurodisabilities: a qualitative scoping study

Beresford

Clarke

Maddison

2018

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…The most cited barriers are: lack of time, lack of access to research literature, organisational barriers, lack of skills such as searching for literature and critically appraising scientific articles (see also Law & MacDermid, 2014c). Upton, Stephens, Williams and Scurlock-Evans (2014) concluded in their review that the therapists' positive attitudes towards EBP 'do not translate into practice ' (p. 24). Therefore, it is no longer a question if EBP is essential and valued, but rather how to sustainably implement it into clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Supporting evidence-based practice: Changes in service provision and practitioners’ attitudes following EBP Service Centre consultation – a qualitative study / Evidenzbasierte Praxis unterstützen: Veränderungen der Arbeitsweise und der Einstellungen von Ergotherapeuten/-innen durch die Nutzung eines EBP Service Centers - eine qualitative Studie

Schönthaler

Schwab

Zettel-Tomenendal

et al. 2017

International Journal of Health Professions

View full text Add to dashboard Cite

Evidence-based practice (EBP) aims at optimal fulfilment of clients´ needs, but also plays an essential role in establishing an effective and efficient health care system. It is no longer a question whether EBP is essential and valued, but rather how to sustainably implement it into clinical practice. A new implementation strategy of an EBP workshop in combination with a CAT (critically appraised topic) service was established and investigated. The aim of this study was to explore post EBP Service Centre consultation effects regarding occupational therapists´ changes in service provision, professional viewpoints and attitudes and job satisfaction. The second aim was receiving feedback on the EBP Service Centre for its further development. For the evaluation of the EBP Service Centre the qualitative approach of content analysis by Gläser and Laudel was chosen. Two focus group discussions with 13 participants were conducted. The combination of an EBP workshop and a CAT service, as provided by the EBP Service Centre, seems to be an effective tool to facilitate EBP implementation. The service was used intensively. Participants reported changes in service provision, e.g. increased client-centredness and occupation-based practice and changed professional attitudes like increased reflection and critical questioning. A division of resources and strengths between research staff and practitioners seems to be reasonable. Hence research staff takes over literature search and appraisal and produces CATs, whereas practitioners focus on asking clinical questions and integrating the knowledge from the CAT into their clinical decisions.Evidence-based practice(EBP) -implementation strategy -service provision changes -client-centred practice -theory-practice-transfer Keywords Abstract

show abstract

“…Technical uncertainty results from having inadequate information to predict effectiveness of the interventions and inform prognosis. For example, often occupational therapy practice has limited research to support interventions (Kuipers & McKenna, 2009;Rassafiani et al, 2008) or therapists may be unaware of the research which is available (Kielhofner, 2005;Upton et al, 2014), both of which could contributing to clinician's technical uncertainty. Personal uncertainty is related to the client-practitioner relationship and understanding the client's goals whereas conceptual uncertainty is linked to applying guidelines, theories and past experiences to current clients (Hall, 2002).…”

Section: Managing Uncertainty In Decision-makingmentioning

confidence: 99%

Understanding and supporting occupational therapists clinical decision-making for the management of upper limb post stoke sensory impairment

Doyle¹

View full text Add to dashboard Cite

BackgroundStroke survivors form the largest client group seen by occupational therapists and a large proportion of these stroke survivors experience upper limb post-stroke sensory impairments (ULPSSI) which impact upper limb function and participation. This thesis addresses the clinical decision-making (CDM) of occupational therapists when managing ULPSSI. No appraised and synthesised summary of the research evidence related to the effectiveness of interventions for ULPSSI is available to support therapists' CDM.Information on occupational therapists' practice choices and decisions about managing ULPSSI and the survivors' perspective on ULPSSI is scant. This information could support occupational therapists CDM when addressing ULPSSI and potentially improve stroke survivors' outcomes. Thesis AimsThis thesis aims to:1. Synthesise the effectiveness of interventions for ULPSSI; 2. Explore how occupational therapists make and manage decisions regarding ULPSSI management; 3. Describe practice choices occupational therapists commonly make when managing ULPSSI and the sources of information they use to make these decisions; 4. Compare current assessment choices and intervention practices with recommendations from the research evidence and clinical practice guidelines; 5. Describe the stroke survivors' perspective with regard to ULPSSI; and 6. Design and pilot an evidence-based, theory-driven educational intervention to support occupational therapists' CDM when addressing ULPSSI. Thesis MethodsFive distinct studies addressed the above aims. A Cochrane systematic review evaluated the evidence for the effectiveness of ULPSSI interventions.iii  Twelve occupational therapists participated in a qualitative descriptive study exploring therapists' practice choices and CDM related to ULPSSI. Based on the qualitative study, a survey of 187 occupational therapists described therapists' current practice choices regarding ULPSSI management and factors impacting CDM. A qualitative descriptive study using semi-structured interviews with 15 stroke survivors explored their experience of ULPSSI and the associated rehabilitation encounter. Finally, based on the need for training expressed by the survey participants, a one group pre-and post-test design, feasibility study evaluated the effect of a one day, theory-based educational intervention on 19 occupational therapists' knowledge, perceived behavioural control, attitudes and intended behaviour regarding ULPSSI management, research utilisation, and shared decision-making. Workshop content incorporated information from the prior research studies forming this thesis. ResultsA Cochrane systematic review located 13 randomised controlled trials (RCTs) addressing ULPSSI interventions, with benefit shown from individual RCTs evaluating mirror therapy, a graded thermal stimulation, and intermittent pneumatic compression. Other single RCTs reporting statistically significant results for repetitive peripheral magnetic stimulation, early intensive task-orientated training and graded...

show abstract

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

Cited by 121 publications

References 46 publications

Therapy interventions for children with neurodisabilities: a qualitative scoping study

Therapy interventions for children with neurodisabilities: a qualitative scoping study

Understanding and supporting occupational therapists clinical decision-making for the management of upper limb post stoke sensory impairment

Contact Info

Product

Resources

About