Developing multisectoral strategies to promote evidence-based practice in rehabilitation: findings from an end-of-grant knowledge translation symposium.

PURPOSE: Following a longitudinal study to understand how evidence-based practice evolves during the initial years of occupational therapy (OT) and physiotherapy (PT) practice, we held an end-of-grant symposium with representatives from education, practice, research, and policy. The objectives were to: (1) elicit feedback on the implications of the study results; and (2) co-develop a list of actionable recommendations for each sector. METHODS: Qualitative participatory approach. The symposium was held over two half days and consisted of a presentation of study findings, a discussion on the implications of the research for each sector and future recommendations. Discussions were audio recorded, transcribed verbatim and analyzed using qualitative thematic analysis. RESULTS: The themes related to implications of the longitudinal study included: (1) A need to rethink what evidence-based practice (EBP) really is; (2) How to practice EBP; and (3) The continuing challenge of measuring EBP. The co-development of actionable recommendations resulted in nine strategies. CONCLUSIONS: This study highlighted how we may collectively promote EBP competencies in future OTs and PTs. We generated sector-specific avenues that may be pursued to promote EBP and argued for the importance of pooling efforts from the four sectors so that we may achieve the intended ethos of EBP.IMPLICATIONS FOR REHABILITATIONThere is a need to revisit the definition of evidence-based practice (EBP) and the traditional 3-circle model in rehabilitation to include a broader conceptualization of what constitutes evidence.We recommend using EBP measures as tools for self-reflection and professional development that can support practitioners to be reflective and accountable evidence-based practitioners.Optimal promotion of EBP competencies in occupational therapists and physiotherapists should rest upon collaborative efforts from the education, practice, research, and policy sectors.

Measurement Properties of the Mayo-Portland Adaptability Inventory (MPAI-4) and Related Measures: A Systematic Review.

OBJECTIVE: To assess the Mayo-Portland Adaptability Inventory-version 4 (MPAI-4) and related measures' measurement properties and the quality of evidence supporting these results; and identify the interpretability and feasibility of the MPAI-4 and related measures. DATA SOURCES: We conducted a systematic review according to COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. We searched 9 electronic databases and registries, and hand searched reference lists of included articles. STUDY SELECTION: Two independent reviewers screened and selected all articles. From 605 retrieved articles, 48 were included. DATA EXTRACTION: Two independent reviewers appraised the evidence quality and rated the extracted classical test theory and Rasch results from each study. DATA SYNTHESIS: We used meta-analysis and COSMIN's approach to synthesize measurement properties evidence (insufficient, sufficient), and the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to synthesize evidence quality (very low, low, moderate, high) by diagnosis (traumatic brain injury [TBI], stroke), and setting (inpatient, outpatient). The MPAI-4 and its subscales are sufficiently comprehensible (GRADE: very low), but there is currently no other content validity evidence (relevance, comprehensiveness). The MPAI-4 and its participation index (M2PI) have sufficient interrater reliability for stroke and TBI outpatients (GRADE: moderate), whereas interrater reliability between TBI inpatients and clinicians is currently insufficient (GRADE: moderate). There is no evidence for measurement error. For stroke and TBI outpatients, the MPAI-4 and M2PI have sufficient construct validity (GRADE: high) and responsiveness (GRADE: moderate-high). For TBI inpatients, the MPAI-4 and M2PI have mixed indeterminant/sufficient construct validity and responsiveness evidence (GRADE: moderate-high). There is 1 study with mixed insufficient/sufficient evidence for each MPAI-4 adaptation (21- and 22-item MPAI, 9-item M2PI) (GRADE: low-high). CONCLUSION: Users can be most confident in using the MPAI-4 and M2PI in TBI and stroke outpatient settings. Future research is needed on reliability, measurement error, predictive validity, and content validity of the MPAI-4 and its related measures across populations and settings.

Challenges and future directions in the measurement of evidence-based practice: Qualitative analysis of umbrella review findings.

RATIONALE, AIMS AND OBJECTIVES: An important aspect of scholarly discussions about evidence-based practice (EBP) is how EBP is measured. Given the conceptual and empirical developments in the study of EBP over the last 3 decades, there is a need to better understand how to best measure EBP in educational and clinical contexts. The aim of this study was to identify and describe the main challenges, recommendations for practice, and areas of future research in the measurement of EBP across the health professions as reported by systematic reviews (SRs). METHODS: We conducted a secondary analysis of qualitative data obtained in the context of a previously published umbrella review that aimed to compare SRs on EBP measures. Two reviewers independently extracted excerpts from the results and discussion/conclusion sections of the 10 included SRs that aligned with the three research aims. An iterative six-phase reflexive thematic analysis according to Braun and Clarke was conducted. RESULTS: Our thematic analysis produced five themes describing the main challenges associated with measuring EBP, four themes outlining main recommendations for practice, and four themes representing areas of future research. Challenges include limited psychometric testing and validity evidence for existing EBP measures; limitations with the self-report format; lack of construct clarity of EBP measures; inability to capture the complexity of the EBP process and outcomes; and the context-specific nature of EBP measures. Reported recommendations for practice include acknowledging the multidimensionality of EBP; adapting EBP measures to the context and re-examining the validity argument; and considering the feasibility and acceptability of measures. Areas of future research included the development of comprehensive, multidimensional EBP measures and the need for expert consensus on the operationalization of EBP. CONCLUSIONS: This study suggests that existing measures may be insufficient in capturing the multidimensional, contextual and dynamic nature of EBP. There is a need for a clear operationalization of EBP and an improved understanding and application of validity theory.

Quality, methods, and recommendations of systematic reviews on measures of evidence-based practice: an umbrella review.

OBJECTIVES: The objective of the review was to estimate the quality of systematic reviews on evidence-based practice measures across health care professions and identify differences between systematic reviews regarding approaches used to assess the adequacy of evidence-based practice measures and recommended measures. INTRODUCTION: Systematic reviews on the psychometric properties of evidence-based practice measures guide researchers, clinical managers, and educators in selecting an appropriate measure for use. The lack of psychometric standards specific to evidence-based practice measures, in addition to recent findings suggesting the low methodological quality of psychometric systematic reviews, calls into question the quality and methods of systematic reviews examining evidence-based practice measures. INCLUSION CRITERIA: We included systematic reviews that identified measures that assessed evidence-based practice as a whole or of constituent parts (eg, knowledge, attitudes, skills, behaviors), and described the psychometric evidence for any health care professional group irrespective of assessment context (education or clinical practice). METHODS: We searched five databases (MEDLINE, Embase, CINAHL, PsycINFO, and ERIC) on January 18, 2021. Two independent reviewers conducted screening, data extraction, and quality appraisal following the JBI approach. A narrative synthesis was performed. RESULTS: Ten systematic reviews, published between 2006 and 2020, were included and focused on the following groups: all health care professionals (n = 3), nurses (n = 2), occupational therapists (n = 2), physical therapists (n = 1), medical students (n = 1), and family medicine residents (n = 1). The overall quality of the systematic reviews was low: none of the reviews assessed the quality of primary studies or adhered to methodological guidelines, and only one registered a protocol. Reporting of psychometric evidence and measurement characteristics differed. While all the systematic reviews discussed internal consistency, feasibility was only addressed by three. Many approaches were used to assess the adequacy of measures, and five systematic reviews referenced tools. Criteria for the adequacy of individual properties and measures varied, but mainly followed standards for patient-reported outcome measures or the Standards of Educational and Psychological Testing. There were 204 unique measures identified across 10 reviews. One review explicitly recommended measures for occupational therapists, three reviews identified adequate measures for all health care professionals, and one review identified measures for medical students. The 27 measures deemed adequate by these five systematic reviews are described. CONCLUSIONS: Our results suggest a need to improve the overall methodological quality and reporting of systematic reviews on evidence-based practice measures to increase the trustworthiness of recommendations and allow comprehensive interpretation by end users. Risk of bias is common to all the included systematic reviews, as the quality of primary studies was not assessed. The diversity of tools and approaches used to evaluate the adequacy of evidence-based practice measures reflects tensions regarding the conceptualization of validity, suggesting a need to reflect on the most appropriate application of validity theory to evidence-based practice measures. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020160874.

Advancing social inclusion of people with disabilities through awareness and training activities: A collaborative process between community partners and researchers.

OBJECTIVE: The main objectives were to 1) search and map current disability awareness and training activities in Quebec, Canada, 2) collectively reflect on these practices, and 3) develop a five-year strategic plan. METHODS: We used an integrated knowledge translation approach whereby researchers and community partners were involved in all stages. This project consisted of two sequential phases: 1) an environmental scan (web review and interview) of current practices, and 2) a reflection process with an external expert-facilitator in social transformation. Outcome results and process data are reported. RESULTS: We identified 129 activities (71 training, 58 awareness) from 39 organizations (from 123 organizations initially invited). A wide range of characteristics were collected for each activity which allowed for the identification of gaps. The working group met seven times in one year to discuss results from phase 1 and co-create a five-year strategic plan. Main priorities are 1) the development of a methodology for measuring collective impact and 2) content synchronization of activities. CONCLUSION: Involvement of partners and researchers enabled a concerted and efficient approach to the development of a five-year strategic plan. PRACTICE IMPLICATIONS: A transition committee led by partners will ensure implementation and sustainability of the plan across the province.

A mixed-methods approach to understanding partnership experiences and outcomes of projects from an integrated knowledge translation funding model in rehabilitation.

BACKGROUND: Integrated knowledge translation (IKT) can optimize the uptake of research evidence into clinical practice by incorporating knowledge users as equal partners in the entire research process. Although several studies have investigated stakeholder involvement in research, the literature on partnerships between researchers and clinicians in rehabilitation and their impact on clinical practice is scarce. This study described the individual research projects, the outcomes of these projects on clinical practice and the partnership experiences of an initiative that funds IKT projects co-led by a rehabilitation clinician and a researcher. METHODS: This was a sequential explanatory mixed methods study where quantitative data (document reviews and surveys) informed the qualitative phase (focus groups with researchers and interviews with clinicians). Descriptive analysis was completed for the quantitative data and thematic analysis was used for the qualitative data. RESULTS: 53 projects were classified within multiple steps of the KTA framework. Descriptive information on the projects and outcomes were obtained through the survey for 37 of the 53 funded projects (70%). Half of the respondents (n = 18) were very satisfied or satisfied with their project's impact. Only two (6%) projects reported having measured sustainability of their projects and four (11%) measured long-term impact. A focus group with six researchers and individual interviews with nine clinicians highlighted the benefits (e.g. acquired collaborative skills, stronger networks between clinicians and academia) and challenges (e.g. measuring KT outcomes, lack of planning for sustainability, barriers related to clinician involvement in research) of participating in this initiative. Considerations when partnering on IKT projects included: the importance of having a supportive organization culture and physical proximity between collaborators, sharing motives for participating, leveraging everyone's expertise, grounding projects in KT models, discussing feasibility of projects on a restricted timeline, and incorporating the necessary knowledge users. Clinicians discussed the main outputs (scientific contribution, training and development, increased awareness of best practice, step in a larger effort) as project outcomes, but highlighted the complexity of measuring outcomes on clinical practice. CONCLUSION: The study provides a portrait of an IKT funding model, sheds light on past IKT projects' strengths and weaknesses and provides strategies for promoting positive partnership experiences between researchers and rehabilitation clinicians.