Testing a Multifaceted Knowledge Translation Intervention for Acute Care Occupational Therapists

PURPOSE: Evidence-based practice (EBP) is vital in acute care to provide scientific rigor, ensure consideration of unique and patient-specific information, and fulfill requirements of third-party payers. Current use of EBP is limited because of multiple barriers, including time, resources, space, and therapist competency. This study’s purpose was to examine the feasibility and preliminary efficacy of a novel, multicomponent knowledge translation (KT) intervention with acute care occupational therapists. We hypothesized that an intervention focused on training in standardized assessments appropriate to occupational therapy acute care treatment would improve occupational therapists’ knowledge, confidence, attitudes, and beliefs regarding the use of EBP and change their practice by increasing their use of the assessments. We specifically hypothesized that the intervention would have stronger short-term effects (immediately after the intervention) on EBP that would taper when the intervention was discontinued. We also hypothesized that use of the standardized assessments would increase over the study period (18 wk).

METHOD: The study design was pretest–posttest with repeated measures at baseline (Week 0), postintervention (Week 6), and follow-up (Week 18). Participants were occupational therapists in the acute care setting at a large teaching institution who were recruited via flyers or email. They participated in a 5-wk intervention. Didactic weekly sessions led by the principal investigator (PI) focused on training in standardized assessments including the Chelsea Critical Care Scale, the Brain Injury Visual Assessment Battery, and the Rookwood Driving Battery. Participants were asked to conduct these assessments with patients at their own discretion and were provided with assessment resources, custom educational handouts, and electronic documentation templates.

Outcome measures administered to participants were the Evidence-Based Practice Beliefs Scale, the Evidence-Based Practice Confidence Scale, and the Evidence-Based Practice Implementation Scale. Participants were assessed at baseline, immediately after intervention, and at follow-up. Participants recorded their use of assessments in practice immediately after intervention and at follow-up. t tests were used to examine short-term and long-term effects on EBP measure scores, and descriptive statistics were used to quantify use of assessments in practice.

RESULTS: Participants were 12 registered occupational therapists, and 80% participated in four of the five sessions. Significant short-term improvements were found on the Evidence-Based Practice Beliefs scale, t(11) = 3.05, p = .01; Evidence-Based Practice Confidence scale, t(11) = 2.53, p = .03; and Evidence-Based Practice Implementation Scale, t(11) = 3.02, p = .01. The significant effects tapered between Week 6 and Week 18, although all scores remained higher than at baseline. The participants administered assessments to patients a total of 15 times; 45% of participants used an assessment at least once during the study period.

CONCLUSION: A KT intervention with occupational therapists resulted in short-term improvement in EBP attitudes, knowledge, and implementation. Positive effects were not maintained after the intervention was discontinued, so future interventions would likely need booster sessions. However, participants did increase their use of standardized assessments as a result of the intervention. This KT intervention is important to practice because it identifies a potential strategy to facilitate use of EBP in acute care settings. EBP KT interventions can alter daily practice by providing practical assessment training that results in positive attitudes, confidence, and proficiency in EBP among occupational therapists.

References

Marr, D. (2017). Fostering full implementation of evidence-based practice. American Journal of Occupational Therapy, 71, 7101100050. https://doi.org/10.5014/ajot.2017.019661

Menon, A., Korner-Bitensky, N., Kastner, M., McKibben, K., & Straus, S. (2009). Strategies for rehabilitation professionals to move evidence-based knowledge into practice: A systematic review. Journal of Rehabilitation Medicine, 41, 1024–1032. https://doi.org/10.2340/16501977-0451

Metzler, M. J., & Metz, G. A. (2010). Translating knowledge into practice: An occupational therapy perspective. Australian Journal of Occupational Therapy, 57, 373–379. https://doi.org/10.1111/j.1440-1630.2010.00873.x

Sudsawad, P. (2007). Knowledge translation: Introduction to models, strategies, and measures. Austin, TX: Southwest Educational Development Laboratory, National Center for the Dissemination of Disability Research.