Developments in the evidence‐based health care debate – 2004

Miles, Andrew; Grey, Joseph E; Polychronis, Andreas; Price, Nicholas C.; Melchiorri, C

doi:10.1111/j.1365-2753.2004.00501.x

Cited by 43 publications

(34 citation statements)

References 52 publications

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“…One third of their recommendations were informed by research evidence and the majority of decisions were based primarily on past experiences with patients with similar problems ( Figure 5). This finding is consistent with the notion of the "evidential knowledge base" which has been reported as necessary in clinical practice [91]. Scientific evidence alone, without knowledge and experience in a domain, does not speak for itself.…”

Section: Discussionsupporting

confidence: 80%

Creation of an evidence-based practice reference model in falls prevention: findings from occupational therapy

Thomas¹,

Saroyan

Lajoie

2011

Disability and Rehabilitation

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IntroductionWith advances in rehabilitation interventions and rising expectations from consumers to receive best possible care, occupational therapists (OTs) are expected to work within an evidence-based practice (EBP) context [1][2][3]. There is good evidence that findings from scientific research are not routinely used to inform decisions about patient care [4][5][6][7].In fact, although there has been a rise in available scientific evidence in areas of occupational therapy (OT) such as stroke and cerebral palsy, many clinicians continue to use practices that are not supported by this research. As a result, researchers are now shifting their focus towards identifying and applying effective strategies to help clinicians embrace and adopt EBP. To support clinicians in this endeavour, a clearer understanding of what characterizes optimal performance in an evidence-based decision-making approach is needed. Attributes of expert performance gleaned from observations of clinicians who apply EBP in their daily practice can provide useful insights into what expert EBP looks like in a particular clinical area. These attributes can then be used to design models of EBP that present clinicians with a framework for best practice. Expert models can also be useful for educators in the design of curricula that help students acquire EBP competencies [8,9]. Although falls in the elderly is a growing problem with substantial resources being allocated for prevention and management of patients with falls and that there is a large body of scientific evidence on fall prevention strategies, there is no empirical evidence on the behaviours and decisions of expert OT clinicians who apply the EBP process in this area of practice. This paper describes the process of generating an OT reference model ReseaRch papeRCreation of an evidence-based practice reference model in falls prevention: findings from occupational therapy

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Section: Discussionsupporting

confidence: 80%

Creation of an evidence-based practice reference model in falls prevention: findings from occupational therapy

Thomas¹,

Saroyan

Lajoie

2011

Disability and Rehabilitation

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“…However, it fell short in accounting for the skills that may be involved in the other steps (Steps 1, 4 and 5). Miles et al (2004) also claimed that judgment is a necessary skill in EBP because research facts ''never really speak for themselves'' and thus there needs to be an interpretative role for the therapist ''using an evidential knowledge base''. Craik and Rappolt (2003) examined the self-reported use of research in practice of expert OTs in order to identify the processes involved in translating research into practice.…”

Section: Skills That Support Ebpmentioning

confidence: 98%

“…Because EBP has been primarily grounded in quantitative approaches and experimental designs, findings from qualitative studies have seldom been considered as legitimate sources of evidence. Consequently, critics argue that qualitative research has not taken its rightful place within EBP despite the momentum this approach is gaining in the health professions, particularly for its potential to better capture the complex relationships of clients, their experience of illness, and their social circumstances (Forbes and Griffiths 2002;Hammell 2001;Herbert et al 2001;Miles et al 2004).…”

mentioning

confidence: 96%

Evidence-based practice: a review of theoretical assumptions and effectiveness of teaching and assessment interventions in health professions

Thomas

Saroyan

Dauphinee

2010

Adv in Health Sci Educ

105

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Health care professionals are expected to use a systematic approach based on evidence, professional reasoning and client preferences in order to improve client outcomes. In other words, they are expected to work within an evidence-based practice (EBP) context. This expectation has had an impact on occupational therapy academic programs' mandates to prepare entry-level clinicians who demonstrate competence in the knowledge, skills and behaviors for the practice of evidence-based occupational therapy. If the EBP approach is to be entrenched in the day to day practice of future clinicians, a pedagogically sound approach would be to incorporate EBP in every aspect of the curriculum. This, however, would require a comprehensive understanding of EBP: its basis, the principles that underpin it and its effectiveness in promoting core professional competencies. The existing literature does not elucidate these details nor does it shed light on how requisite competencies for EBP are acquired in professional education in general and in occupational therapy education in particular. Drawing from educational psychology and EBP in the health professions, this paper provides a critical review of the evidence that supports EBP and the effectiveness of EBP teaching and assessment interventions in professional heath sciences programs and offers suggestions for the design of EBP instruction, grounding recommendations in educational theory for the health professions.

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“…This perceived inconsistency coincides with current debates in the literature about evidencebased medicine versus commonsense medicine and the integration of scientific evidence and clinical expertise. 32,33 Although the Dutch physical therapy guidelines for nonspecific low back pain are not intended as a "cookbook" but as a guide, 19 our participants nevertheless perceived them as rigid recommendations. Such rigidity has been challenged as being at odds with individual patient needs and practitioner preferences, not allowing for any individual variation, and as being used as a standard against which clinicians may be judged without outside variables being taken into account.…”

Section: Use Of Diffusion Of Innovations Theory To Examine Determinanmentioning

confidence: 99%

“…For a more extensive outline of Rogers' Innovation Decision Process, readers are referred to the primary source. 23 The results of this study may contribute to subsequent implementation studies, the debate on evidence-based medicine, 32,33 and recent developments in the use of theory in implementation research. 34 -36 …”

Section: Use Of Diffusion Of Innovations Theory To Examine Determinanmentioning

confidence: 99%

A Qualitative Application of the Diffusion of Innovations Theory to Examine Determinants of Guideline Adherence Among Physical Therapists

Harting¹,

Rutten²,

Rutten³

et al. 2009

Physical Therapy

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Background. Evidence-based practice has become a major issue in physical therapy. Many evidence-based guidelines, however, are not used extensively after dissemination, and interventions aimed at increasing guideline adherence often have limited effects.Objective. As a prerequisite for changing this situation, the aims of this study were to gain an in-depth understanding of the determinants of guideline adherence among physical therapists in the Netherlands and to evaluate the opportunities of a theoretical framework in this respect. Design and Methods.This observational study consisted of 3 focus group interviews (nϭ12, 10, and 8) between November 2002 and January 2003. Physical therapists were asked to discuss their opinions about and experiences with the Dutch guidelines for low back pain. Data were analyzed qualitatively using a directed approach to content analysis. Both the interview route and the analysis of the interviews were informed by Rogers' Diffusion of Innovations Theory.Results. Our study yielded in-depth insights into the various determinants of guideline adherence. Overall, the participants had rather unfavorable opinions about issues related to the dissemination of the guidelines (first phase of the diffusion process) and provided relatively little information on the subsequent adoption process (second phase of the diffusion process). The theoretical framework appeared to be a useful tool to properly structure the focus group interviews, to systematically analyze the data collected, and to determine that supplementary interviews would be necessary to cover the entire diffusion process. Conclusions.Our findings indicated that the diffusion process of guidelines among physical therapists was not yet completed. The use of theory can provide added value to guideline implementation studies.

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Developments in the evidence‐based health care debate – 2004

Cited by 43 publications

References 52 publications

Creation of an evidence-based practice reference model in falls prevention: findings from occupational therapy

Creation of an evidence-based practice reference model in falls prevention: findings from occupational therapy

Evidence-based practice: a review of theoretical assumptions and effectiveness of teaching and assessment interventions in health professions

A Qualitative Application of the Diffusion of Innovations Theory to Examine Determinants of Guideline Adherence Among Physical Therapists

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