A Test of the ARCC© Model Improves Implementation of Evidence‐Based Practice, Healthcare Culture, and Patient Outcomes

Melnyk, Bernadette Mazurek; Fineout-Overholt, Ellen; Giggleman, Martha; Choy, Katie

doi:10.1111/wvn.12188

Cited by 149 publications

(188 citation statements)

References 18 publications

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“…Levels of evidence were applied using a Hierarchy of Evidence diagram adapted from Melnyk and Fineout-Overholt 34 accessed on the Medical University of South Carolina’s Library website. 35 The methodological quality and bias was assessed using the Cochrane Collaboration’s tool for assessing risk of bias.…”

Section: Methodsmentioning

confidence: 99%

A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios

Wonsetler

Bowden

2017

Topics in Stroke Rehabilitation

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Background In walking rehabilitation trials, self-selected walking speed has emerged as the dominant outcome measure to assess walking ability. However, this measure cannot differentiate between recovery of impaired movement and compensation strategies. Spatiotemporal variables and asymmetry ratios are frequently used to quantify gait deviations and are hypothesized markers of recovery. Objectives The purpose of this review is to investigate spatiotemporal variables and asymmetry ratios as mechanistic recovery measures in physical therapy intervention studies post-stroke. Methods A systematic literature search was performed to identify physical therapy intervention studies with a statistically significant change in self-selected walking speed post intervention and concurrently collected spatiotemporal variables. Methodological quality was assessed using the Cochrane Collaboration’s tool. Walking speed, spatiotemporal, and intervention data were extracted. Results 46 studies met the inclusion criteria, 41 of which reported raw spatiotemporal measures and 19 reported asymmetry ratio calculations. Study interventions included: aerobic training (n=2), functional electrical stimulation (n=5), hippotherapy (n=2), motor dual task training (n=2), multidimensional rehabilitation (n=4), robotics (n=4), sensory stimulation training (n=8), strength/resistance training (n=4), task specific locomotor rehabilitation (n=9), and visually guided training (n=6). Conclusions Spatiotemporal variables help describe gait deviations, but scale to speed, so consequently, may not be an independent factor in describing functional recovery and gains. Therefore, these variables are limited in explaining mechanistic changes involved in improving gait speed. Use of asymmetry measures provides additional information regarding the coordinative requirements for gait and can potentially indicate recovery. Additional laboratory-based mechanistic measures may be required to truly understand how walking speed improves.

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Section: Methodsmentioning

confidence: 99%

A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios

Wonsetler

Bowden

2017

Topics in Stroke Rehabilitation

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“…Levels of evidence were applied using a Hierarchy of Evidence diagram adapted from Melnyk and Fineout-Overholt 18 accessed on the Medical University of South Carolina's Library website. 19 The methodological quality and bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias.…”

Section: Methodsmentioning

confidence: 99%

A systematic review of mechanisms of gait speed change post-stroke. Part 2: exercise capacity, muscle activation, kinetics, and kinematics

Wonsetler

Bowden

2017

Topics in Stroke Rehabilitation

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Background Regaining locomotor ability is a primary goal in stroke rehabilitation and is most commonly measured using changes in self-selected walking speed. However, walking speed cannot identify the mechanisms by which an individual recovers. Laboratory-based mechanistic measures such as exercise capacity, muscle activation, force production, and movement analysis variables may better explain neurologic recovery. Objectives The objectives of this systematic review are to examine changes in mechanistic gait outcomes and describe motor recovery as quantified by changes in laboratory-based mechanistic variables in rehabilitation trials. Methods Following a systematic literature search (in PubMed, Ovid, and CINAHL), we included rehabilitation trials with a statistically significant change in self-selected walking speed post-intervention that concurrently collected mechanistic variables. Methodological quality was assessed using the Cochrane Collaboration's tool. Walking speed changes, mechanistic variables, and intervention data were extracted. Results 25 studies met the inclusion criteria and examined: cardiorespiratory function (n=5), muscle activation (n=5), force production (n=11), and movement analysis (n=10). Interventions included: aerobic training, functional electrical stimulation, multidimensional rehabilitation, robotics, sensory stimulation training, strength/resistance training, task-specific locomotor rehabilitation, and visually-guided training. Conclusions Following this review, no set of outcome measures to mechanistically explain changes observed in walking speed was identified. Nor is there a theoretical basis to drive the complicated selection of outcome measures, as many of these outcomes are not independent of walking speed. Since rehabilitation literature has yet to support a causal, mechanistic link for functional gains post stroke, a systematic, multi-modal approach to stroke rehabilitation will be necessary in doing so.

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“…Advancing Research and Clinical Practice Through Close Collaboration (ARCC) model [11,12] was used to guide the implementation of the project. All patients that were admitted to the facility with history of smoking were asked to sign a smoking consent (which was part of the facility's policies and procedures) education and recruitment materials were all reviewed and approved by Institutional Review Board Office of Research and Integrity Assurance at Arizona State University and the Boards of Directors of the participating organization.…”

Section: Methodsmentioning

confidence: 99%

“…By monitoring outcomes these mentors could assess for any needed refinement of the practice change, implement these changes and continue to monitor, work directly with the front-line staff to educate about evidence base practices and maintain enthusiasm for the change practice. These mentors will be able to assess changes in the organizational culture and provide specific interventions to address these changes following the ARCC model [11,12]. Making the guidelines of the project as a standard of work and in -cooperating them into the policies and procedures of the organization is another way to ensure sustainability over time.…”

Section: Future Implicationsmentioning

confidence: 99%

An Evidence Based Smoking Cessation Project in Patients Admitted to an In-patient Alcohol and Drug Treatment Rehabilitation Program

Willock¹

2017

J Healthc Commun

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Smoking has emerged as a significant public health issue and evidence showed that in people who use or used drugs and alcohol smoking rates are at an all-time high. Smoking has been identified as a contributing factor in a myriad of chronic illness including Asthma, COPD and Cancer. For people to break a smoking habit, of many years, requires a dynamic comprehensive approach like those currently utilized in drug and alcohol treatment programs. The literature suggests that intensive smoking cessation interventions involving behavioral support through counseling and pharmacotherapy are needed to effectively treat this population. An evidence-based project was conducted to assess the quit rates among patients receiving Nicotine Replacement Therapy (NRT) and intensive counseling compared to patients receiving standard care: NRT and brief information on smoking cessation. A significant decrease in tobacco use and a willingness of staff to incorporate the intervention into clinical practice was observed. This change in practice has resulted in more sustain quit rates over time. The findings of this project revealed significantly better results in the intervention group's quit rates over-time. This intervention can be used in all healthcare settings.

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A Test of the ARCC© Model Improves Implementation of Evidence‐Based Practice, Healthcare Culture, and Patient Outcomes

Abstract: Background: Although several models of evidence-based practice (EBP) exist, there is a paucity of studies that have been conducted to evaluate their implementation in healthcare settings.

Cited by 149 publications

References 18 publications

A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios

A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios

A systematic review of mechanisms of gait speed change post-stroke. Part 2: exercise capacity, muscle activation, kinetics, and kinematics

An Evidence Based Smoking Cessation Project in Patients Admitted to an In-patient Alcohol and Drug Treatment Rehabilitation Program

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