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.

Experiences of burnout and coping strategies utilized by occupational therapists.

BACKGROUND: Work-related stress and burnout have been found to lead to job dissatisfaction, low-organizational commitment, absenteeism, and high turnover. PURPOSE: The purpose of this study was to examine the burnout experiences of occupational therapists practicing in Ontario and to describe the practice implications and coping strategies employed. METHODS: Data for this mixed methods study were collected using the Maslach Burnout Inventory-General Survey, Areas of Worklife Survey, focus groups, and interviews in the hermeneutics tradition. FINDINGS: High levels of emotional exhaustion were reported by 34.8% of participants, high levels of cynicism by 43.5%, and low professional efficacy by 24.6%. Practice issues included excessive demands on time, conflict, and lack of autonomy and respect. Coping strategies included spending time with family and maintaining professional/personal balance, control of work responsibilities, maintaining a sense of humor, and self-awareness/self-monitoring. IMPLICATIONS: This study contributes to understanding the practice challenges for occupational therapists, factors that contribute to therapist burnout, and strategies employed to maintain competent practice.

Interprofessional jargon: how is it exclusionary? Cultural determinants of language use in health care practice.

Language can impact significantly on the ways in which health care professionals relate and provide clinical services, as well as the way in which patients conceptualize their role in the healthcare encounter. The aim of this project was to explore the barriers and challenges to developing a collaborative approach in health care. A hermeneutic research approach was used with a convenience sample of international key informants representing 6 disciplines. A total of 10 individual, semi-structured interviews were conducted. Findings emphasized the need to be more inclusive by avoiding the use of exclusionary jargon so that all members of the health care team, including patients and families, can adopt a collaborative practice orientation.

Development and pilot testing of the collaborative practice assessment tool.

Collaborative practice is receiving increased attention as a model of healthcare delivery that positively influences the effectiveness and efficiency of patient care while improving the work environment of healthcare providers. The collaborative practice assessment tool (CPAT) was developed from the literature to enable interprofessional teams to assess their collaborative practice. The CPAT survey included 56 items across nine domains including: mission and goals; relationships; leadership; role responsibilities and autonomy; communication; decision-making and conflict management; community linkages and coordination; perceived effectiveness and patient involvement; in addition to three open-ended questions. The tool was developed for use in a variety of settings involving a diversity of healthcare providers with the aim of helping teams to identify professional development needs and corresponding educational interventions. The results of two pilot tests indicated that the CPAT is a valid and reliable tool for assessing levels of collaborative practice within teams. This article describes the development of the tool, the pilot testing and validation process, as well as limitations of the tool.

Conceptualizing community development: occupational therapy practice at the intersection of health services and community.

BACKGROUND: Despite occupational therapy's theoretical commitment to community development (CD) approaches, current practice models focus on individual interventions rather than community issues. PURPOSE: This research examined three cases of Canadian occupational therapists working in CD to conceptualize CD from an occupational therapy perspective. METHOD: Data collection occurred over 12-14 days at each site and included observations, document reviews, and interviews with 14 colleagues and program participants. Constructivist grounded theory informed data analysis. FINDINGS: A conceptual framework was developed that describes the contextual background to CD initiatives and the strategies used: nurturing community partnerships, building community capacity, influencing health services, and linking sectors. Underlying these strategies was the strategic use of self which allowed the sharing of power and legitimacy to create opportunities for meaningful occupational engagement. IMPLICATIONS: The conceptual framework helps articulate CD's underlying processes and can be used to understand and guide practice.

Core competencies: the next generation. Comparison of a common framework for multiple professions.

This report demonstrates the application of a competency model to the regulated and unregulated professions of medical radiation technology, social work, pharmacy, and psychology. The competency model is based on the CanMEDS framework and was originally applied to the professions of medicine, occupational therapy, physical therapy, and nursing in an earlier work. The framework identifies the core competencies common to learners in health care, which are professional (and health advocate), expert, scholar, manager, communicator, and collaborator. In this report, these core competencies are applied to four additional disciplines in an effort to make the cultural shift from discipline-based silos to a common language for ascertaining the skills, knowledge, and attitudes needed to function in interprofessional teams.

Entry-level interprofessional education: perceptions of physical and occupational therapists currently practicing in Ontario.

To gain insight into the specific interprofessional education (IPE) needs of occupational and physical therapists, an online questionnaire was developed and distributed to currently practicing therapists in the province of Ontario, Canada. The questionnaire included both open- and closed-ended questions to survey the opinions, perceptions, and experiences of therapists working both in public and private practice who possess varying levels of clinical training and years of experience. Data collection resulted in 765 responses (397 OTs, 368 PTs), which allowed for a 95% confidence level based on 2007 population totals supplied by the professional colleges. Data analysis involved descriptive data analysis in conjunction with percentage comparisons of the responses as well as the coding of responses to open-ended questions. The therapists' opinions regarding the type, amount, and need for IPE were compared based on discipline and area of practice. Overall, the data show that 97% of OTs and PTs in both public and private settings hold IPE to be important for effective clinical practice. When asked about their own IPE experiences, only 50% of OTs and 43% of PTs felt that they received an appropriate level of IPE training during their entry-level clinical training. When given the choice to select the location/time when IPE should be completed, 65% choose clinical placements, with 26% classroom. Implications of the findings as well as study limitations are discussed.

A new inter-professional course preparing learners for life in rural communities.

The 'Professionals in Rural Practice' course was developed with the aim of preparing students enrolled in professional programs in Canada to become better equipped for the possible eventuality of professional work in a rural setting. To match the reality of living and working in a rural community, which by nature is interprofessional, the course designers were an interprofessional teaching team. In order to promote group cohesiveness the course included the participation of an interprofessional group of students and instructors from the disciplines of medicine, nursing, occupational therapy, physical therapy, teacher education, and theology. The format of the course included three-hour classes over an eight-week period and a two-day field experience in a rural community. The course utilized various experiential and interactive teaching and learning methods, along with a variety of assessment methods. Data were collected from student participants over two iterations of the course using a mixed methods approach. Results demonstrate that students value the interprofessional and experiential approach to learning and viewed this course as indispensable for gaining knowledge of other professions and preparation for rural practice. The data reveal important organizational and pedagogical considerations specific to interprofessional education, community based action research, and the unique interprofessional nature of training for life and work in a rural community. This study also indicates the potential value of further longitudinal study of participants in this course. Key words: Canada, community based action research, education, interdisciplinary, interprofessional.

Exploring Canadian occupational therapists' understanding of and experiences in community development.

BACKGROUND: Occupational therapists are increasingly recognizing the importance of working with communities as a way to enhance health and well-being. Such work can occur through community development, a community-driven process in which communities are supported in identifying and addressing their health priorities. PURPOSE: This paper presents the qualitative findings of a study that explored the experiences of occupational therapists in Canada working in community development including how they understand community development and how they designed their role in this field. METHODS: Occupational therapists working in community development shared their experiences and understanding of community development during 12 interviews. RESULTS: The results of this study describe the iterative, reflexive process occupational therapists have undergone in coming to establish their role in this field. IMPLICATIONS: Recommendations are made regarding the preparation of future occupational therapists and for supporting those currently working in this field.

Developing empathy as a foundation of client-centred practice: evaluation of a university curriculum initiative.

BACKGROUND: The foundation of client-centred practice is the therapist's capacity to view the world through the client's eyes and to develop an understanding of the lived experience of disability. PURPOSE: This paper describes the evaluation of an educational initiative promoting student empathy to the lived experience of disability. METHODS: Pairs of first-year occupational therapy students visited adults with disabilities who shared their knowledge and experience of living with a disability. Students reflected on their visits in journals, which were later analyzed using pattern matching. FINDINGS: Students appeared to appreciate the co-existence of health and disorder and demonstrated a holistic understanding of living with a disability. Little attention was focused on cultural and institutional environments. Students struggled to define the nature of their relationship with their tutors. Practice Implications. The evaluation confirmed our belief that this educational initiative could facilitate student empathy, consistent with critical features of client-centred practice.

Core competencies for health care professionals: what medicine, nursing, occupational therapy, and physiotherapy share.

This paper describes the amalgamation of the core competencies identified for medicine, nursing, physical therapy, and occupational therapy and the "harmonization" of these competencies into a framework for interprofessional education. The study was undertaken at a Canadian university with a Faculty of Health Sciences comprised of three schools (namely, medicine, nursing, and rehabilitation therapy). Leaders in interprofessional education began to identify the common standards for the core competencies expected of learners in all three schools at commensurate levels to facilitate the integration of educational curricula aimed at interprofessional education across the Faculty. The model that was created serves as a basis for curriculum design and assessment of individuals and groups of learners from different domains across and within the four professions. It particularly highlights the relevance of cross-disciplinary competency teaching and 360-degree evaluation in teams. Most importantly, it provides a launch pad for clarifying performance standards and expectations in interdisciplinary learning.

Quality of life and exercise rehabilitation in end stage renal disease.

Using a qualitative approach, this study explored the perceptions of individuals with end stage renal disease (ESRD) regarding their physical, emotional, and social well-being after having participated in an eight-week hospital-based intra-dialytic exercise program. Individual semi-structured interviews (approximately 60 min. duration) were conducted with hemodialysis (HD) patients (n= 7) during their regular dialysis sessions, two weeks immediately following the completion of the exercise program. Interviews were audio-taped, transcribed verbatim, and content analysis was used to identify emerging themes. Data management was assisted by NVivo software. Using the interpretive paradigm, three primary themes emerged: improved performance in activities of daily living (ADL), positive change in HD experience, and enhanced sense of control. Participants reported an overall positive experience with the intra-dialytic exercise program and felt that their quality of life was enhanced to such an extent that they would choose to continue exercising while on HD.

Clinical education in private practice: an interdisciplinary project.

Education of rehabilitation professionals traditionally has occurred in acute care hospitals, rehabilitation centres, and other publicly funded institutions, but increasing numbers of rehabilitation professionals are now working in the community in private agencies and clinics. These privately owned clinics and community agencies represent underutilized resources for the clinical training of students. Historically, private practitioners have been less likely to participate in clinical education because of concerns over patient satisfaction and quality of care, workload, costs, and liability. Through a program funded by the Ministry of Health of Ontario, we conducted a series of interviews and focus groups with private practitioners, which identified that several incentives could potentially increase the numbers of clinical placements in private practices, including participation in the development of student learning objectives related to private practice, professional recognition, and improved relationships with the university departments. Placement in private practices can afford students skills in administration, business management, marketing and promotion, resource development, research, consulting, networking, and medical-legal assessments and processes. This paper presents a discussion of clinical education issues from the perspective of private practitioners, based on the findings of a clinical education project undertaken at Queen's University, Kingston, Ontario, and previous literature.

Adolescent group empowerment: Group-centred occupations to empower adolescents with disabilities in the urban slums of North India.

This study aimed to understand how adolescents with disabilities can assume greater control over their rehabilitation and participation within a community-based rehabilitation programme in the urban slums of North India. A critical ethnographical approach using multiple qualitative and participatory data collection methods was adopted. Fieldwork was conducted from January to May 2005 and October 2006 to March 2007 with 21 adolescents with and 11 adolescents without disabilities (aged 12 to 18 years), and 10 community-based rehabilitation staff members. A conceptual framework called the 'Adolescent Group Empowerment Pyramid' was developed. Four themes informed the framework: group participation, group demonstration, group recognition and the socio-cultural environment's interaction with disability. Group empowerment, achieved through group-centred occupations, encourages adolescents to work together to address their rehabilitation challenges and agendas. Three external support factors and 10 areas for nurturing the group empowerment process also emerged. A limitation of this study is the lack of data on how the familial and local political and economic environment impact adolescents' ability to make decisions about their rehabilitation. Further research might explore group occupations and occupational recognition, and what this means for social change and the personal and collective growth of adolescents in underserviced communities.

Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice.

AIM: To synthesis the literature relevant to guideline dissemination and implementation strategies for healthcare teams and team-based practice. METHODS: Systematic approach utilising Joanna Briggs Institute methods. Two reviewers screened all articles and where there was disagreement, a third reviewer determined inclusion. RESULTS: Initial search revealed 12,083 of which 88 met the inclusion criteria. Ten dissemination and implementation strategies identified with distribution of educational materials the most common. Studies were assessed for patient or practitioner outcomes and changes in practice, knowledge and economic outcomes. A descriptive analysis revealed multiple approaches using teams of healthcare providers were reported to have statistically significant results in knowledge, practice and/or outcomes for 72.7% of the studies. CONCLUSION: Team-based care using practice guidelines locally adapted can affect positively patient and provider outcomes.

Practice Guideline Dissemination and Implementation Strategies for Healthcare Teams and Team-Based Practice: a systematic review.

OBJECTIVES: The objective of this systematic review is to describe and identify the effectiveness of different practice guideline implementation strategies on team-based practice and/or patient outcomes. METHODS: A systematic review was conducted, using a comprehensive, reproducible search strategy that revealed 88 studies that met the inclusion criteria. RESULTS: A descriptive analysis revealed multiple approaches using teams of health care providers with 72.7% of the studies reporting statistically significant results in knowledge, practice and/or outcomes. Of 10 dissemination strategies the most effective were reminders, and audit and feedback. The most popular strategy was education meetings. A secondary analysis revealed different populations with chronic or complex disorders where a team approach was effective in practice guideline dissemination and implementation. CONCLUSIONS: Many of the studies provided caveats to explain how or why the strategies did or did not demonstrate improvements. Overall, authors described complex health care requiring increasingly complex approaches to ensure evidence based guidelines were utilised in practice, including using multiple dissemination and implementation strategies. The review has provided evidence that a multi-pronged approach to dissemination and implementation of practice guidelines will assist in gaining significant improvements in change in knowledge, practice and patient outcomes.

Use of clinical placements as a means of recruiting health care students to underserviced areas in Southeastern Ontario: part 1 - student perspectives.

OBJECTIVE: This two-part study examines the present gap between financial and educational incentives required and the recruitment strategies used to draw health science students to underserviced areas in Southeastern Ontario. Part 1 explores the impact of offering travel stipends, rent-free accommodation and interprofessional educational opportunities to health science students on their willingness to participate in clinical placements in underserviced areas. DESIGN: Mixed-method two-part study using a self-administered questionnaire. SETTING: Canadian university campus. PARTICIPANTS: Four hundred and sixty-eight senior level medical, nursing, occupational therapy, physical therapy and X-ray technology students from a Canadian university and affiliated professional school. MAIN OUTCOME MEASURES: The influence of currently established incentives on student willingness to complete a clinical placement in designated underserviced communities in Southeastern Ontario. RESULTS: Based on a 75% response rate, the results demonstrate that, in general, students agree that they are more willing to complete a clinical placement in an underserviced community if provided travel stipends (75%), rent-free housing (92%) and interprofessional educational opportunities (65%). Students also identified 15 additional factors influencing willingness. CONCLUSIONS: Students are more willing to complete clinical placements in underserviced communities if provided incentives. The findings of this study support an interprofessional clinical education and recruitment enhancement program in Southeastern Ontario.

Use of clinical placements as a means of recruiting health care professionals to underserviced areas in Southeastern Ontario: part 2 - community perspectives.

OBJECTIVE: Part 2 of this two-part study identifies current recruitment strategies and existing incentives used by underserviced communities to recruit health science students during the clinical placement stage. Discussion surrounding current gaps in recruitment strategies and potential funding sources are explored. DESIGN: Mixed-method two-part study using a self-administered questionnaire. SETTINGS: Six community hospitals and one private practice. PARTICIPANTS: Community resource contact from seven underserviced communities in Southeastern Ontario. MAIN OUTCOME MEASURES: Level of community agreement that current recruitment strategies include travel stipends, rent-free accommodation and interprofessional education opportunities. RESULTS: A 100% response rate established that one sample community provides travel stipends, three provide rent-free accommodation, and four offer interprofessional education opportunities. These incentives were frequently offered exclusively to medical students. CONCLUSIONS: When considering the results from part 1 of the study, there is a substantial gap between financial incentives students deem important in the creation of an appealing clinical placement opportunity and the provisions offered to them by the sample communities. The findings of this study support the need for a recruitment enhancement program in Southeastern Ontario.

Preparing professionals from a wide range of disciplines for life and work in rural and small communities.

A new inter-professional subject has been offered at a Canadian university, which examines issues related to professionals' integrating into rural practice; understanding the history and geography of rural communities and important issues affecting life in rural settings.