Practitioner and organizational barriers to evidence-based practice of physical therapists for people with stroke

BACKGROUND AND PURPOSE: The purpose of this study was to identify practitioner barriers (education, attitudes and beliefs, interest and perceived role, and self-efficacy) and organizational barriers (perceived support and resources) to physical therapists' implementation of evidence-based practice (EBP) for people with stroke. SUBJECTS: The participants were 270 physical therapists providing services to people with stroke in Ontario, Canada. METHODS: A cross-sectional mail survey was conducted. RESULTS: Only half of respondents had learned the foundations of EBP in their academic preparation or received training in searching or appraising research literature. Although 78% agreed that research findings are useful, 55% agreed that a divide exists between research and practice. Almost all respondents were interested in learning EBP skills; however, 50% indicated that physical therapists should not be responsible for conducting literature reviews. Average self-efficacy ratings were between 50% and 80% for searching and appraising the literature and below 50% for critically appraising psychometric properties and understanding statistical analyses. Despite Internet access at work for 80% of respondents, only 8% were given protected work time to search and appraise the literature. DISCUSSION AND CONCLUSION: Lack of education, negative perceptions about research and physical therapists' role in EBP, and low self-efficacy to perform EBP activities represent barriers to implementing EBP for people with stroke that can be addressed through continuing education. Organizational provision of access to Web-based resources is likely insufficient to enhance research use by clinicians.     

Intervention planning facets---four facets of occupational therapy intervention planning: economics, ethics, professional judgment, and evidence-based practice.

OBJECTIVE: This study determined occupational therapists' perceptions of the following facets of intervention planning: economics, ethics, independent professional judgment, and evidence-based practice. METHOD: A cross-sectional survey of 142 occupational therapists who provide short-term rehabilitation in five northeastern states was undertaken. RESULTS: Most occupational therapists (n = 137, 96.5%) fell into one of four clusters, with the largest cluster (n = 86, 60.6%) having positive perceptions about ethics and independent professional judgment but negative perceptions about economic issues. Smaller clusters of occupational therapists were more positive about economic issues or less positive about ethics and independent professional judgment. Negative perceptions about the ability to implement evidence-based practice spanned all clusters. CONCLUSION: American Occupational Therapy Association's efforts to educate occupational therapists about ethics appear to be effective. Most occupational therapists exercise independent professional judgment but perceive economic limitations when developing intervention plans. Practicing occupational therapists need additional research to support evidence-based practice and help in accessing and using research.     

Continuing professional education and the Internet: views of Alberta occupational therapists

BACKGROUND: Occupational therapists have identified barriers to accessing continuing professional education (CPE) in the traditional face-to-face formats. One alternative to traditional, centrally located, face-to-face CPE is course delivery through the Internet. PURPOSE: This study examined Alberta occupational therapists' perceptions of Internet-based CPE. METHOD: A questionnaire was mailed to 800 randomly sampled Alberta occupational therapists (response rate = 35.5%; n = 281). RESULTS: Respondents pursued CPE to increase skills, knowledge and maintain clinical competency. They reported that a face-to-face CPE course was more useful than distance courses. Although almost 90% of respondents had access to computers with an Internet connection at home or at work, and nearly 65% thought that their computer knowledge was sufficient, only 2.9% had previously taken Internet-based CPE. PRACTICE IMPLICATIONS: In order for the Internet to be accepted as a common, useful and alternative delivery tool for CPE in occupational therapy, the perceived barriers such as the lack of personal time, cost, and limited interaction with other learners and instructors will need to be addressed.     

Theory use in practice: a national survey of therapists who use the Model of Human Occupation.

OBJECTIVE: This study describes how occupational therapists who reported using the Model of Human Occupation (MOHO) actually use the concepts and tools of this model in everyday practice as well as identifies supports and barriers to its use. METHOD: A systematic random sample of 1,000 occupational therapists was surveyed as to what theories they used in their practice. Those using MOHO (430) were sent a detailed questionnaire; 259 therapists (60.2%) responded to the survey questionnaire. RESULTS: More than 80% of respondents indicated that they used MOHO in their practice at least some of the time. Therapists reported that MOHO supports holistic, occupation-focused, client-centered, and evidence-based practice. They reported finding MOHO concepts useful for treatment planning and intervention. Most saw the major barrier to using MOHO as their own lack of knowledge. CONCLUSION: Making resources more readily available and accessible to therapists might enhance the extent to which they use conceptual models such as MOHO.     

Professional accountability in restructured contexts of occupational therapy practice

Professional standards for accountability establish essential competencies for clinical practices and provide strategies for professional advancement. This study examines the perspectives of a sample of occupational therapists on their capacity to engage in continuing education, to provide evidence-based practices and to have confidence in the effectiveness of available quality assurance mechanisms within restructured contexts of occupational therapy practice. The analysis of in-depth interviews with participants from program management, managed competition and private practice suggested three urgent needs: the development of strategies to assist therapists' translation of research evidence into clinical practices, research to determine the effectiveness of models of professional leadership within the workplace that promote professional accountability and alliances to advance policies that eliminate workplace barriers to professional accountability.     

Factors affecting occupational therapy job site selection in underserviced areas.

Rural and isolated areas such as those found in northern Ontario are often underserved with respect to occupational therapy. These areas present special problems for those involved in recruitment and planning recruitment programs. While it is generally recognized that practice in these areas can be both stimulating and rewarding, little is known about what factors might influence occupational therapists to choose these areas for job sites. It was the purpose of this study to investigate factors affecting job site selection and retention among occupational therapists in northern Ontario. Seven potential factors were explored: family proximity, place of origin, lifestyle, fieldwork placements, job opportunities and recruitment tours. These became the basis for the development of a questionnaire which was sent to all facilities employing occupational therapists in northern Ontario. The responses of twenty eight therapists (70%) indicated that the factors affecting job site selection were, in descending order: lifestyle, job opportunity, partner's employment and family proximity. The results also indicated that the factors influencing recruitment and retention differ. Based on the findings, recruitment efforts should focus on emphasizing the attractive features of the north and perhaps on people with family in the north. Retention incentives should include money for equipment, space, continuing education, travel, better salaries, links to educational resources and fieldwork placements.     

Utilization of research findings by graduate nurses and midwives

BACKGROUND: There is mounting pressure on nurses and midwives in the United Kingdom to use research findings to inform their practice. However, many still find research difficult to understand and are poorly prepared by education to make use of it. Hence, there is a pressing need to evaluate the research education included in nursing and midwifery curricula. AIM: This paper reports a study assessing the impact of research education on the attitudes towards research and use of research findings in practice by graduate nurses and midwives. METHOD: A cross-sectional survey using a self-completed postal questionnaire was conducted with a sample of 340 nurse and midwife graduates in the South East of England. FINDINGS: A response rate of 51% was obtained. A large number of respondents stated that their critical appraisal (96%) and search skills (87%) had improved following graduation and they reported using research findings in practice (16.8% all the time, 50.5% frequently and 32.6% sometimes). Furthermore, the majority expressed positive attitudes towards research and these were related to the research education received. However, a significant number reported finding statistics difficult to understand, lack of time to read research and limited access to research findings at their place of work. Also, a number of respondents would still like more help with searching the literature, implementing research findings in practice and developing their critical appraisal skills further. CONCLUSION: It is crucial that some of the major barriers to research utilization are addressed at both individual and organizational levels if evidence-based care is to become a reality. Also, health service managers should consider a number of strategies suggested by respondents to increase the use of research findings in clinical settings.     

Article 6: Rehabilitation practitioners’ perspectives on research utilization for evidence-based practice

Objective: To explore rehabilitation practitioners’ perspectives on barriers and solutions related to research utilization for evidence-based practice. Design: Focus group study. Setting: Conference room. Participants: 13 rehabilitation practitioners (occupational therapists, physical therapists, speech-language pathologists). Intervention: Participants discussed the barriers that prevented them from effectively using research information for evidence-based practice, and ways that they thought would help improve the usability of research information. Main Outcome Measures: Transcribed and coded verbal responses. Results: Top barriers included research topic not relevant to practice, sample not relevant to practice, lack of explanation for practical application, researchers’ lack of real-life knowledge about clinical situation, and presentation of research in article format not user-friendly. Practitioners also suggested ways to help alleviate those barriers. Conclusion: Rehabilitation researchers may need to rethink the way they conduct and report research in order to make information more usable, and thus increase utilization, for evidence-based practice. Although definite conclusion cannot be drawn from the present study due to its preliminary nature, the findings strongly indicated the need for future research about the issue of research utilization, which has not been adequately studied in the rehabilitation community.     

Occupational therapists' perceptions of evidence-based practice.

Occupational therapists are increasingly urged to carry out evidenced-based practice; however, little is known regarding their present practice and perceptions of evidence-based practice. To explore this phenomenon, a qualitative study was completed using a grounded theory approach. Semi-structured interviews were carried out with eight occupational therapists who worked in diverse practice settings. Participants were asked to reflect on their own views of evidence-based practice and their use of evidence in therapy. Data were analyzed inductively using constant comparison analysis. Participants' perceptions of evidence-based practice were described in three broad categories. To these occupational therapists, evidence-based practice is: (a) a process of looking for understanding; (b) associated with research, and; (c) a potential threat to the occupational therapist. These findings produce a basis from which recommendations are made to increase the use of evidence-based practice by occupational therapists.     

Barriers to and facilitators of research utilization among Finnish registered nurses

1. The aim of nursing research is to produce a sound foundation for evidence-based nursing; the job of nurses is to make the best possible use of that foundation and apply the knowledge produced to the practice of nursing. 2. The purpose of this study was to identify and describe barriers to and facilitators of research utilization from the point of view of Finnish Registered Nurses. 3. The BARRIERS Scale was administered to 316 nurses in two major hospitals; 253 nurses returned the questionnaire, giving a response rate of 80%. The structured data were processed with SPSS 9.0, and the unstructured data were interpreted using the method of content analysis. 4. The main barriers to research utilization identified by the respondents were: the fact that most research is published in a foreign language; that physicians will not co-operate with implementation; and that statistical analyses are difficult to understand. The facilitators mentioned most often were nurses' positive attitudes and abilities. Other important facilitators included the support and activity of a ward sister as well as encouragement, a favourable attitude and collaboration on the part of all staff members. 5. The findings are discussed in relation to the Finnish healthcare context and nurse education, and evidence-based nursing practice.     

Private practice: benefits,barriers and strategies of providing fieldwork placements

BACKGROUND: Occupational therapists are entering private practice in ever increasing numbers. In order to gain the skills to practice in this area, students should have the opportunity to experience private practice fieldwork placements. However, the number offered in private practice settings continues to be limited. The purpose of this exploratory qualitative study was to identify the benefits, the barriers, and the strategies associated with providing fieldwork opportunities in private practice. METHODS: Data were obtained through semi-structured interviews with six occupational therapists in private practice. RESULTS: Results indicated that participating in fieldwork education affords benefits to the profession of occupational therapy, to the clinician, and to the facility. Potential barriers included student characteristics, cost, time, travel and legalities. Involvement from the university and the private setting were considered necessary for providing and implementing strategies. CLINICAL IMPLICATIONS: The findings have implications for increasing private practice placements for future students in occupational therapy and other health care professions offering clinical placements as a component of their formal education.     

Enhancing research utilization capacity through multifaceted professional development.

Some occupational therapists report that they do not feel adequately prepared to perform the arduous tasks involved in integrating research into their practice. To explore how research utilization can be conducted by practicing clinicians, self-reported research utilization behaviors of a sample of 11 occupational therapists practicing in adult stroke rehabilitation were analyzed. The constant comparison of the interview data revealed that participants' clinical experiences, engagement in continuing education, involvement in research activities, and their mentoring of students contributed to their capacity to translate research evidence into practice. The results of the study suggest a model for enhancing research utilization capacity through professional development. Implications for practitioners, provider organizations, educators, and regulators of occupational therapy are discussed.     

Research activities and perceptions of barriers to research utilization among critical care nurses in Korea.

BACKGROUND: Research utilization is vital to promote evidence-based practice in the critical care area, where nursing practice continues to grow in complexity and nurses have greater responsibility and accountability for patient care. However, information about research activities and barriers to research utilization of critical care nurses is limited. AIMS: This study aimed to describe research activities, to identify barriers to research utilization for practice and to examine factors related to research barriers among critical care nurses. METHODS: Data from 63 critical care nurses were analyzed from a national study examining research utilization of clinical nurses working in university affiliated and educational hospitals in Korea. FINDINGS: Research activities were relatively low. A lack of guidance for clinical implication and insufficient time to implement new ideas in the clinical area were identified as the highest-ranking barriers to use of research in this group. Perceptions of barriers to research utilization were significantly higher in those staff nurses with lesser clinical experience. The critical care nurses in this study shared a strong sense of valuing the contribution of research, but also shared perceptions on barriers for administrative aspects. Organizational support is crucial for critical care nurses to achieve evidence-based practice.     

Practitioners' reading patterns, attitudes, and use of research reported in occupational therapy journals.

Occupational therapists are encouraged to use research-based evidence to guide practice. In this study, we investigated whether members of the American Occupational Therapy Association read their flagship journal, the American Journal of Occupational Therapy (AJOT, or other scholarly journals. Therapists' attitudes about research, their reading patterns, and their use of research in clinical practice were also explored. A proportional, random sample of 626 therapists from five states was mailed a questionnaire; 52% were returned. Of the 328 respondents, 85% reported reading AJOT: For those who did not read AJOT, barriers cited included time constraints, difficulty interpreting results, lack of clinical information, and too much scientific information. Attitudes about research generally were positive, although ratings regarding the usefulness of research to inform clinical practices were less favorable. Attitudes about and use of research ratings were not strongly related to practice settings, educational degree level, years of experience, or state of residence. Results suggest education and clinical practice changes may be necessary to support therapists' use of empirical evidence in practice contexts.     

Canadian physical therapists' interest in web-based and computer-assisted continuing education

BACKGROUND AND PURPOSE: Distance education via computer-assisted learning (CAL), including Web-based and CD-ROM learning, confers a number of advantages compared with traditional learning methods. The purposes of this study were (1) to determine the interest of Canadian physical therapists in participating in continuing education using CAL methods and (2) to determine whether interest in CAL was related to type of employment, area of practice, education, computer skill and access, and other demographic variables. SUBJECTS AND METHODS: A random sample of Canadian physical therapists and all members of cardiopulmonary interest groups were surveyed. RESULTS: Of 1,426 survey questionnaires mailed, 69 were returned (58 were unopened and 11 were duplicates). From the remaining 1,357 potential survey responses, 757 responses were received, for an overall response rate of 56%. Seventy-eight percent of the respondents indicated their interest in participating in CAL. Factors associated with interest in CAL included 2 or more hours of Internet access per week, Internet access at both home and work, computer skill, education level, practice area, and belonging to a cardiopulmonary interest group. DISCUSSION AND CONCLUSION: The findings indicate a large positive interest in CAL. Increasing CAL continuing education opportunities could increase options for physical therapists to meet professional expectations for continuing competency.     

Enhancing research use through online action research

BACKGROUND: Many health professionals, including occupational therapists, have difficulty utilizing research findings in daily practice. PURPOSE: To determine if an online action research project could enhance research use among occupational therapists working in similar practice areas. METHODS: Four groups of 12-14 occupational therapists met online for approximately one year. They discussed barriers and facilitators to research utilization, defined practice questions, and attempted to search for, synthesize and apply relevant research findings. Online communications and post-group interviews were thematically analyzed. RESULTS: Only half of the participants who began the project were still online with the research project at completion. These participants believed that their involvement in the group led to increased personal awareness, motivation and confidence regarding the use of research evidence in practice and knowledge to be used in practice. Time to review, critique and synthesize research evidence continued to be a major barrier to enhanced research utilization. PRACTICE IMPLICATIONS: Online meetings designed to enhance research use among occupational therapists appear to hold some promise, but refinements are needed to ensure their ultimate success.