An exploration of evidence-based practice work files for occupational therapy students during clinical placements: a descriptive cross-sectional study.

BACKGROUND: Bachelor students of occupational therapy are expected to work in accordance with evidence-based practice (EBP). The EBP work file, a learning tool in a Word document format, covering all steps in the EBP process, is an approach to teaching and learning EBP. The aim of this study was to examine the attitudes and behaviours of occupational therapy students' in relation to applying evidence-based practice during their second-year clinical placement. We compared cohorts who received training in EBP work files with those who did not receive such training. METHODS: A descriptive, cross-sectional comparative study was conducted. Five cohorts of second-year occupational therapy students took part in the study. The students answered two questionnaires, the EBP Beliefs Scale and the EBP Implementation Scale, after completing their second-year clinical placement. The analysis was based on descriptive statistics and calculation of the frequencies, percentages, mean and standard deviations of all participating students' scores across both questionnaires. ANOVA with Bonferroni correction was conducted to analyse the differences between the mean totals of the questionnaires. RESULTS: In this study, 126 occupational therapy students participated (response rate = 57.3%). The students reacted positively to EBP, although few were practicing EBP. The students believed that EBP resulted in the best clinical care for patients, but they lacked confidence in their own ability to apply EBP. The students in Cohort 5, who received extra instruction and assignments via the EBP work file, rated their EBP behaviour statistically lower than the students in Cohort 1, who did not receive extra training on the EBP work file. CONCLUSIONS: Additional EBP work file assignments were insufficient in terms of supporting students in the implementation of EBP during clinical placements. It is, therefore, important to facilitate the learning strategies of EBP skills and demonstrate how students can practise this competency during clinical placements. Including clinical instructors in EBP teaching and learning seems essential.

Inter-rater reliability of the early functional abilities scale.

OBJECTIVE: To investigate the inter-rater reliability of the Early Functional Abilities (EFA) scale. DESIGN: An observational study of inter-rater reliability in an open cohort. PATIENTS: Twenty-four patients with traumatic brain injury in need of medical or surgical intervention in the early rehabilitation section of the intensive care unit. METHODS: The EFA was assessed by 4 different professions in the rehabilitation team. Inter-rater reliability was assessed using linear weighted kappa statistics. RESULTS: The overall weighted kappa values of the different EFA items varied from 0.27 to 0.60. The items in the sensorimotor functional area had the highest pairwise agreement,with a mean kappa range of 0.68­0.76. The vegetativest ability, position tolerance and wakefulness items had the lowest mean kappa values (0.49, 0.33 and 0.49, respectively). Agreement was good to excellent between the occupational therapist and physiotherapist across the majority of the items, whereas the physician and nurse agreed less with one another. CONCLUSION: The inter-rater reliability of the EFA scale was good for most items among all the raters. The scale maybe used by all members of the interdisciplinary team after training in administration and scoring. A reduction in the number of items in the vegetative functional domain is recommended.

Self-rated competency in activities predicts functioning and participation one year after traumatic brain injury.

OBJECTIVE: To investigate whether the Patient Competency Rating Scale at three months predicts global functioning and participation one year after traumatic brain injury. DESIGN: Prospective cohort study with follow-up at 3 and 12 months post injury. The Patient Competency Rating Scale was analysed in a logistic regression model with the outcomes Community Integration Questionnaire, Glasgow Outcome Scale Extended and return to work/study. SETTING: The neurosurgical department of a trauma referral centre in a metropolitan hospital. SUBJECTS: A cohort of 70 patients with acute traumatic brain injury, ranging from mild to severe injury. MAIN MEASURES: The Patient Competency Rating Scale, assessing competency in activities, was applied as a predictor. Outcomes describing community participation at 12 months were the Community Integration Questionnaire and return to work/study. Global functioning was evaluated by the Glasgow Outcome Scale Extended. RESULTS: Factor analysis of the Patient Competency Rating Scale items yielded three domains: activities demanding cognition, interpersonal/emotional skills, and activities of daily living (ADL) competency. The first two of these domains significantly predicted return to work/study and community integration, whilst global functioning at one year was predicted by interpersonal/emotional competency. CONCLUSIONS: The Patient Competency Rating Scale at three months predicted functioning and participation one year after traumatic brain injury. This indicates that rehabilitation interventions should focus on cognitive and interpersonal competency in order to enhance participation after traumatic brain injury.