Sharing the agenda: pondering the politics and practices of occupational therapy research

Abstract

Aims: Occupational therapists espouse a client-centred philosophy of practice, yet little attention has been given to pondering the politics or client-centred practices of occupational therapy research. The aim of this paper is thus to foster reflection on occupational therapy's commitment to client-centredness in the practice of occupational therapy research. Major findings: Occupational therapy research is not consistently undertaken in a collaborative manner. Power resides in control of the research agenda and participants' priorities can be supplanted by those of researchers. However, examples from the literature and from the authors' research suggest that study participants may wish to influence the research agenda such that their needs and priorities are addressed. Practice conclusion: Client-centred principles appear to require occupational therapists to undertake collaborative research and to ensure that research agendas are informed by clients' priorities. Commitment to client-centred principles demands concerted efforts to identify and address potential barriers to meaningful client participation in the occupation of research. However, it is argued that if researchers and disabled people collaborate, and pool their knowledge and expertise, they may achieve research that is more philosophically compatible with espoused professional values; and that collaborative research may also inform more relevant and useful client-centred clinical practices.     

Perceptions of evidence-based practice: A survey of Australian occupational therapists

Evidence-based practice (EBP) requires clinicians to access, appraise and integrate research literature with clinical experience and clients' perspectives. Currently, little is known about occupational therapists' attitudes to EBP, their perception of implementation barriers or their educational needs. A questionnaire reflecting these issues was sent to a proportionate random sample of 1491 members of the national professional occupational therapy association, OT AUSTRALIA. The questionnaire was completed by 649 (44%) participants. Occupational therapists were positive about EBP with most (96%) agreeing that EBP is important to occupational therapy. Although 56% used research to make clinical decisions, more relied on clinical experience (96%), information from continuing education (82%) and colleagues (80%). Lack of time, evidence and skills were identified as the main barriers to the implementation of EBP. Over half (52%) expressed strong interest in EBP skills training, and most (80%) indicated an interest in the availability of brief summaries of evidence. Targeted educational initiatives, resources and systems are needed to support EBP in occupational therapy.     

Effects of profession and facility type on research utilization by rehabilitation professionals

Information about the use of research by rehabilitation professionals to make clinical decisions in everyday practice is limited. This study compared perceived research use and knowledge sources across professions, practice situations, and work environments. Participants were 165 randomly selected Canadian occupational therapists, physical therapists, and speech-language pathologists. Self-report ratings during an interview, an interviewer rating, and questionnaire scores (Edmonton Research Orientation Survey, General Use of Research, Knowledge Acquisition Survey) were compared. Speech-language pathologists had the most education and the highest research use ratings. Research use was highest during program planning. Programs to encourage research use must consider the research available to guide practice and therapists' education level. Facility size and location (rural, urban) do not affect perceived research use.     

The self-reported use of research in clinical practice: A survey of occupational therapists in Sweden

Background: Today, healthcare providers and occupational therapists are increasingly required to rely on evidence-based practices. In both outpatient and inpatient settings, the use of research-based practices can be identified using the Research Utilization Measure questionnaire. Aim: This study explores how occupational therapists in Sweden perceive research utilization. Method: The Research Utilization Measure was sent to 807 randomly selected occupational therapists in Sweden, and the response rate was 59% (n = 472). Results: The majority of respondents (56%, n = 256) reported use of research-based knowledge in their practice “very or rather often”, although 49% (n = 225) of the therapists noted that they “very seldom or never” discussed research findings with their managers. Differences in answers for most items were related to degree of education and length of experience. Occupational therapists with higher education levels more often reported use of research in their clinical practice and therapists with greater experience less often reported use of research in their clinical practice. Conclusion: Education seems to influence the degree to which occupational therapists rely on research to inform their practices. A future challenge for managers and occupational therapists is to create strategic discussions on how to implement treatment that is based on current research.     

Sharing the agenda: pondering the politics and practices of occupational therapy research

AIMS: Occupational therapists espouse a client-centred philosophy of practice, yet little attention has been given to pondering the politics or client-centred practices of occupational therapy research. The aim of this paper is thus to foster reflection on occupational therapy's commitment to client-centredness in the practice of occupational therapy research. MAJOR FINDINGS: Occupational therapy research is not consistently undertaken in a collaborative manner. Power resides in control of the research agenda and participants' priorities can be supplanted by those of researchers. However, examples from the literature and from the authors' research suggest that study participants may wish to influence the research agenda such that their needs and priorities are addressed. PRACTICE CONCLUSION: Client-centred principles appear to require occupational therapists to undertake collaborative research and to ensure that research agendas are informed by clients' priorities. Commitment to client-centred principles demands concerted efforts to identify and address potential barriers to meaningful client participation in the occupation of research. However, it is argued that if researchers and disabled people collaborate, and pool their knowledge and expertise, they may achieve research that is more philosophically compatible with espoused professional values; and that collaborative research may also inform more relevant and useful client-centred clinical practices.     

Occupational therapists report a low level of knowledge,skill and involvement in evidence‐based practice

This study was conducted to collect information about Australian occupational therapists’ involvement in evidence‐based practice. The study aimed to document: (i) respondents’ level of knowledge and skills; (ii) their level of participation in continuing education; and (iii) perceived barriers to evidence‐based practice. A purposive sample of 85 occupational therapists was invited to complete a questionnaire prior to attending an introductory workshop on evidence‐based practice. Sixty‐seven questionnaires were returned and analysed (78.8% response rate). Half of the respondents rated their level of knowledge and skills required for evidence‐based practice as low (conducting database searches = 50.7%; critically appraising literature = 53.0%). The majority of respondents (79.1%) reported a low level of knowledge about electronic databases. Few respondents had attended education sessions on evidence‐based practice (15.0%). The six most commonly reported barriers to adopting evidence‐based practice were lack of time, a large caseload, limited searching skills, limited appraisal skills, difficulty accessing journals and a perceived lack of evidence to support occupational therapy intervention. The majority of occupational therapists in this sample were entering the first phase of continuing professional development in relation to evidence‐based practice.     

Clinical outcomes research from the occupational therapist's perspective

With increasing costs and scarcity of resources, occupational therapists need to embrace outcomes research to demonstrate the effectiveness of its clinical interventions. To explore clinicians' perspectives on clinical outcomes research a qualitative study was undertaken involving three in-depth group interviews with 15 occupational therapists from the South Western Sydney Area Health Service. Five broad themes permeated participants' perception: (a) defining the process, (b) factors that impact on participation in clinical outcomes research, (c) organizational influences, (d) the value of clinical outcomes research, and (e) potential partnerships with academics. Three conceptual categories are identified: knowledge and understanding about clinical outcomes research, clinicians' experience conducting or participating in clinical outcomes research and the relevance of clinical outcomes research to occupational therapy clinical practice. Similarity to findings in the international literature on occupational therapists' engagement in clinical research suggests that the findings from this small sample of Australian therapists are robust. The implications of the findings for continuing professional education programmes and clinical supervision are presented.     

What do Swedish occupational therapists feel about research? A survey of perceptions, attitudes, intentions, and engagement

The aim of this study was to identify Swedish occupational therapists' perceptions and attitudes to research-related activities as well as the therapists' present engagement in future plans for research. A follow up design was used, and the study was undertaken between 1997 and 2003. A total of 425 and 442 Swedish occupational therapists responded to a postal questionnaire (response rate 74.4% and 70.4%). Questions regarding research-related activities were measured on a Likert-type scale, whereas questions referring to attitudes towards research used a semantic differential scale. There were small differences between the two surveys. The result showed that occupational therapists considered research-related activities to be an important part of their development of the professional role and status. Reading research literature to update knowledge was the most important research activity and the second most important activity was applying research findings to improve occupational therapy practice. High workload and lack of time were the most commonly mentioned barriers to participation in research- related activities. Occupational therapists read a large variety of journals, preferably in Swedish. The barriers to participation in research-related activities did not change from 1997 to 2003. The fact that occupational therapists reported reading research as rating highly gives hope for the future development of the occupational therapy profession and practice.     

INNOVATE Research: Impact of a workshop to develop researcher capacity to engage youth in research

BackgroundEngaging youth in research provides substantial benefits to research about youth‐related needs, concerns and interventions. However, researchers require training and capacity development to work in this manner.MethodsA capacity‐building intervention, INNOVATE Research, was co‐designed with youth and adult researchers and delivered to researchers in three major academic research institutions across Canada. Fifty‐seven attendees participated in this research project evaluating youth engagement practices, attitudes, perceived barriers, and perceived capacity development needs before attending the intervention and six months later.ResultsThe intervention attracted researchers across various career levels, roles and disciplines. Participants were highly satisfied with the workshop activities. Follow‐up assessments revealed significant increases in self‐efficacy six months after the workshop (P = .035). Among possible barriers to youth engagement, four barriers significantly declined at follow‐up. The barriers that decreased were largely related to practical knowledge about how to engage youth in research. Significantly more participants had integrated youth engagement into their teaching activities six months after the workshop compared to those who were doing so before the workshop (P = .007). A large proportion (71.9%) of participants expressed the need for a strengthened network of youth‐engaged researchers; other future capacity‐building approaches were also endorsed.ConclusionsThe INNOVATE Research project provided improvements in youth engagement attitudes and practices among researchers, while lifting barriers. Future capacity‐building work should continue to enhance the capacity of researchers to engage youth in research. Researchers notably pointed to the need to establish a network of youth‐engaged researchers to provide ongoing, sustainable gains in youth engagement.     

Language, identity and representation: occupation and occupational therapy in acute settings

Aim:   This article presents findings from a participatory action research study into the experience and use of occupation, theory and evidence in the everyday practice of a group of occupational therapists working in a large metropolitan hospital delivering a range of acute services, in Melbourne, Australia.
Methods and findings:   Narrative data gathered from 11 individual interviews and 10 group discussions were analysed through numerous iterative cycles to explore research issues and evaluate research actions. This article discusses why the participating occupational therapists chose to change the language they used to describe their practice from a focus on 'function' to a focus on 'occupation'. This change improved the therapists' levels of confidence, strengthened their professional identities and provided for a sense of renewed empowerment within the organisation.
Conclusions:   The findings suggest that occupational therapists in acute settings can utilise language more effectively to augment their ability to promote the vital and unique contribution that occupational therapy has to make. Such small, yet powerful changes can empower occupational therapists to address long-standing dilemmas of representation and enable transformative practices.     

Management of patients with cognitive impairment after stroke: A survey of Australian occupational therapists

Background/aim: Cognitive impairment is a common and often debilitating consequence of stroke. The current practice patterns of Australian occupational therapists who work in this area are not clearly known. The aim of this study was to investigate the theoretical approaches, assessments, interventions and research evidence used by Australian occupational therapists who work with patients who have cognitive impairment poststroke.
Methods: A self-administered, purpose-designed online survey was used.
Results: Survey responses were received from 102 occupational therapists. The client-centred approach was the most commonly used theoretical approach, with 81.3% and 72% using it often or all of the time with inpatients and outpatients, respectively. Assessments that were most frequently used were the Mini Mental State Examination (63.7% of participants), the Lowenstein Occupational Therapy Cognitive Assessment (45.1%), the Functional Independence Measure (57.8%, and the Assessment of Living Skills and Resources (10.0%). Interventions involving functional activities were used more frequently than compensatory techniques, such as diaries, alarms, or other electronic devices, and paper and pencil remedial exercises. Few (16%) participants used computer programs specifically designed for cognitive rehabilitation. Although 60.8% of the participants reported using research literature when making decisions about interventions, a higher percentage reported relying on their past experience (88.3%) and colleagues' opinions (77.4%).
Conclusion: This study provides an insight into the current practices of Australian occupational therapists who work with people who have cognitive impairment after stroke. Client-centredness is emphasised in current practice; however, the use of research evidence to inform practice appears to be limited.     

Self-reported knowledge, attitudes and behaviour towards evidence-based practice of occupational therapy students in Ireland

It is widely accepted that the occupational therapy profession needs to incorporate research findings into clinical practice so as to improve client outcomes. The purpose of this study was to investigate the knowledge and attitudes toward evidence-based practice (EBP) of occupational therapy students in the Republic of Ireland. A validated questionnaire was used to survey the population of final-year students from the four universities in Ireland in 2008. There was a response rate of 77% (n?=?86) to the Knowledge, Attitude and Behaviour Questionnaire. All students reported that they had a clear understanding of EBP and were willing to practice EBP in the future. The majority (85%, n?=?73) reported accessing evidence weekly or more often. Lack of time and fieldwork educators not practising EBP were important barriers for 31% (n?=?27) and 27% (n?=?23), respectively. Over half (55%, n?=?47) reported difficulty in finding evidence. The internet (28%, n?=?24) and textbooks (27%, n?=?23) were the most popular sources of evidence. Limitations include the self-report, cross-sectional design. Future research could include longitudinal studies to understand the transfer of learning into clinical practice.     

Knowledge and use of evidence-based practice by allied health and health science professionals in the United Kingdom

Clinical effectiveness (CE) and evidence-based practice (EBP) are the cornerstone of modern-day health care. Although many studies have explored attitudes and perceived knowledge of individual professions, few have compared these factors between professional groups, especially in the allied health professions (AHP) and health science services (HSS). We report a study comparing the knowledge and practice of 14 different professional groups from the AHP and HSS in terms of EBP and CE. The aim was to highlight any differences between the 14 professional groups along with the needs of the groups. A postal questionnaire survey was completed by a random sample of 1,000 members of AHP and HSS across the United Kingdom. There were significant differences between professional groups with, in general, professionals from the HSS groups rating their knowledge and application of CE and EBP as lower than members of the AHP. Differences were also noted between individual professional groups. For example, podiatrists, radiographers, and orthoptists reported having less knowledge of CE and EBP than physiotherapists, occupational therapists, dietitians, speech and language therapists, and psychologists. Barriers to implementing EBP were similar for all groups, with lack of both time and money cited as the main issues. A number of differences between professions were recorded that highlight the difference in educational and policy approach required for greater uptake of EBP.     

An Exploratory Factor Analysis of the Knowledge of Evidence-Based Services Questionnaire

Recent developments for disseminating and implementing evidence-based practices (EBPs) have emphasized the importance of increasing therapists’ knowledge of such techniques. However, systematic efforts to measure knowledge in therapists serving youth have mostly relied on poorly researched study-specific measures. This study investigated the structure of EBP knowledge in a large sample of youth community therapists (N?=?240) via a therapist report instrument emphasizing therapeutic commonalities across various types of treatment approaches. Findings supported a three-factor structure of knowledge with scores on factors varying by therapists’ primary practice setting and education level. The relationships between therapist knowledge of and attitudes towards EBPs are also discussed.     

The Use of Evidence-Based Practice by Occupational Therapists

The purpose of this study was to explore occupational therapists' attitudes, knowledge, and use of evidence-based practice. Results indicated that therapists have positive attitudes toward evidence-based practice; however, use of research evidence in practice remains limited primarily due to lack of time. Suggestions for clinical and academic partnerships are offered.     

Evidence-Based Practice Among Swedish Medical Social Workers

We have explored Swedish medical social workers’ attitudes, beliefs, knowledge, and behavior concerning evidence-based practice (EBP) and investigated the properties of a questionnaire to measure EBP. One hundred seventy-four Swedish medical social workers within university hospital care and primary care participated in a cross-sectional survey. Our results showed positive attitudes toward EBP and the use of evidence to support clinical decision making. EBP was seen as necessary and something that needed to be implemented more often. The main barriers to implementing EBP were lack of time (78%), the perception that EBP does not take into account the limitations of the clinical practice setting (78%), and lack of knowledge about relevant research (46%).