Practice-Based Evidence Research in Rehabilitation: An Alternative to Randomized Controlled Trials and Traditional Observational Studies

Horn, Susan D.; DeJong, Gerben; Deutscher, Daniel

doi:10.1016/j.apmr.2011.10.031

Cited by 104 publications

(98 citation statements)

References 53 publications

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“…For example, the seasonal variation may impact on length of stay [15]. Therefore, whilst acknowledging that "practice based evidence" will often influence, complement and inform formulation of "evidence based policy" we would recommend a prospective study design to definitively answer the research question [16].…”

Section: Discussionmentioning

confidence: 99%

Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

et al. 2015

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Primary Objective: To assess the relationship between disability, length of stay (LOS) and anticholinergic burden (ACB) with people following acquired brain or spinal cord injury.Research Design: A retrospective case note review assessed total rehabilitation unit admission. Conclusions: There was a statistically significant correlation of ACB and neuro-disability measures and LOS amongst this patient cohort. Methods4

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Section: Discussionmentioning

confidence: 99%

Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

et al. 2015

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“…Whereas EBP emphasizes the transfer of new evidence from randomized controlled trials to the bedside, Horn's intent for practice-based evidence research is to emphasize new evidence derived from routine clinical practice. 12 In academic nursing curricula, EBP projects are frequently required for graduation. Shirey et al 13 synthesized the available literature to explore the distinctions between quality improvement, EBP, and research and developed a comprehensive table to compare dimensions such as purpose, types of data collection, limitations, and methods.…”

Section: Defining Quality Improvement and Researchmentioning

confidence: 99%

“…9 Ogrinc et al 10 discussed the overlapping of direct patient care, quality improvement, clinical research, and what they called "quality improvement research"-the increasingly gray area where the boundary between quality improvement activities and clinical research is extremely blurred. Other study design names for this gray area include comparative effectiveness research, 11 practice-based evidence, 12 and EBP. 13 The intent of these various research designs is to examine the real-life risks, benefits, and outcomes when evidence from experimental research is translated to the bedside and generalized to more diverse populations with a variety of co-morbid conditions.…”

Section: Defining Quality Improvement and Researchmentioning

confidence: 99%

“…Comparative effectiveness research studies are excellent ways to apply "best practice" research at the bedside and determine which therapies, in which situations, and with what patient populations truly improve patients' outcomes compared with the standard of care. 14,15 Practice-based evidence research, previously known as clinical practice improvement methodology, is a play on words developed by Horn et al 12 from the term evidencebased practice. Whereas EBP emphasizes the transfer of new evidence from randomized controlled trials to the bedside, Horn's intent for practice-based evidence research is to emphasize new evidence derived from routine clinical practice.…”

Section: Defining Quality Improvement and Researchmentioning

confidence: 99%

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Quality Improvement or Research—Deciding Which Road to Take

Stausmire

2014

Critical Care Nurse

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C ritical care nurses are constantly challenged to provide safe, high-quality patient care at a low cost with increasingly scarce resources. Additionally, they are expected to identify and implement the latest evidence-based practices (EBPs) into their own clinical practice. Ideally, advanced practice nurses would be present at every institution to assist department managers and bedside nurses with quality improvement and research projects specific to their department and organizational needs. Unfortunately, out of 4999 registered community hospitals in the United States (January 2014), only 395 (8%) have American Nurses Credentialing Center Magnet status.1 Although not a direct measure of the availability of nursing research resources at every type of institution, the low percentage underscores the important fact that many critical care units are on their own when it comes to implementing a quality improvement or clinical research project.This article is the first in a 4-part series to provide a practical quality improvement guide for critical care nurses interested in implementing projects within their own units. The purpose of this first article is to provide a broad overview of the differences between quality improvement and research, as well as a discussion of the factors that should be considered when deciding which road to take. Future articles will discuss (1) how to identify worthwhile projects; (2) project design, implementation, and documentation; and (3) how to publish quality improvement activities by using the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines. Quality ImprovementCritical care nurses are constantly challenged to provide safe, high-quality patient care at a low cost with increasingly scarce resources while implementing the latest evidence-based practices into their own clinical practice. This article is the first in a 4-part series to provide a practical quality improvement guide for critical care nurses interested in implementing system process or performance improvement projects within their own units. Part 1 is designed to answer the question "What method is better for measuring real-world patient outcomes-quality improvement or clinical research?" A broad overview of the differences between quality improvement and clinical research is provided. A newly published checklist to differentiate between attributes of each process is introduced, and readers can test their own knowledge between quality improvement and research with a quick quiz of studies recently published in Critical Care Nurse. (Critical Care Nurse.

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“…199 Horn and colleagues also note that studies using this research method "answer questions in the real world where multiple variables and factors can affect the outcomes, and therefore have the potential to influence and improve real world clinical care for the benefit of the patients. 200 Given the complex nature of intensive comprehensive aphasia treatment, practice-based research would allow for the variation in participant demographics and the inclusion of a variety of treatments. A database of structures, processes, and outcomes from many different ICAPS would enable some real-world questions about ICAPs (e.g.…”

Section: Future Researchmentioning

confidence: 99%

Outcomes of an Intensive Comprehensive Aphasia Program

Babbitt¹

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Intensive comprehensive aphasia programs (ICAP) have increased over the last decade in the US and abroad. The increase in the number of clinical programs has outpaced the research that is necessary to establish the efficacy and effectiveness of these specialized treatment programs. The ICAP model incorporates principles from neuroplasticity, that is, intensive treatment provides a platform for the massed practice and repetition required to change the brain. It also incorporates comprehensive treatment that addresses not only impairment-based language deficits but also personal goals related to participation.Programs which offer intensive comprehensive treatment can provide up to 120 hours of treatment over several weeks (e.g., six hours a day, five days a week for four weeks). ICAPs are different from other types of aphasia services which generally provide two to three hours of therapy a week. This thesis examined one ICAP in depth to describe the structure, process, and outcomes using Donabedian's model of health care evaluation. This thesis also described the experiences of the ICAP from the perspectives of the primary stakeholders.Study One (Chapter Two) was a retrospective quantitative study using behavioral measures from an existing database that documented the outcomes of participants with aphasia. It found that first-time participants improved significantly in impairment-and participationbased measures, demonstrating moderate to large effect sizes. Participant characteristics were examined to determine if improvements were related to age, time post-onset, or type and severity of aphasia. None of these factors had an impact on the amount of change measured. Given that some participants did not make significant gains on a primary outcome measure, the Western Aphasia Battery -Revised Aphasia Quotient (WAB-R AQ), Study Two (Chapter Three) examined whether participant characteristics at baseline could predict who would make significant gains on the WAB-R AQ. Age and months post-onset were significantly different between the responder and the non-responder groups. Those who showed most gains on average were younger and a longer time post-onset. A logistic regression was performed and results indicated that only age (younger participants) predicted who would respond to treatment. Time post-onset, type and severity of aphasia, naming, non-verbal cognition, and communication confidence did not show significance in a predictive model. Studies Three and Four were qualitative studies involving interviews with therapists (Chapter Four) and people with aphasia and their families (Chapter Five). Both studies were 3 conducted using a phenomenological approach which allowed for the interviewees to describe their experiences in a semi-structured interview. The clinicians described the intensity of the therapy, the rewards, and challenges of the program. Therapists also considered that the ICAP model of service delivery had several positive benefits for them, but acknowledged that the intensity of therapy was challe...

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Practice-Based Evidence Research in Rehabilitation: An Alternative to Randomized Controlled Trials and Traditional Observational Studies

Cited by 104 publications

References 53 publications

Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

Quality Improvement or Research—Deciding Which Road to Take

Outcomes of an Intensive Comprehensive Aphasia Program

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