ENVIRONMENTAL SUPPORTS AND BARRIERS TO PHYSICAL AND OCCUPATIONAL THERAPISTS USING EVIDENCE BASED PRACTICE IN A NEUROLOGICAL REHABILITATION SETTING

Abstract

Purpose/Hypothesis: While physical and occupational therapists support the idea of evidence based practice (EBP), the ability to implement it in the clinic has been limited. The purpose of this study was to describe perceptions of physical and occupational therapists regarding the environmental supports and barriers to performing EBP within a neurological rehabilitation setting. Number of Subjects: Seventeen clinicians from the neurological service of a large rehabilitation hospital participated. There were 8 occupational therapists, 8 physical therapists and 1 physical therapy assistant. The amount of time during which the participants have been clinicians ranged from 6 months to 18 years, with the mean being 6.6 years. Materials/Methods: Four to five therapists participated in each of four focus groups. Open-ended questions were asked regarding attitudes, environmental supports and barriers related to evidence based practice. Transcripts of each of the focus groups were independently analyzed by four researchers. After the independent analyses, all the researchers met together to discuss and reach consensus on the important themes that emerged and key words that would be used to recode the transcripts. After recoding the transcripts, the research team met again to achieve consensus on analysis and interpretation of the themes. Findings from the focus groups were triangulated with the findings of relevant published literature to assess the validity of the results. Results: Participants described the culture of the rehabilitation facility as one that valued learning, helping each other, and prioritizing direct patient care. The primary barrier to EBP was perceived to be lack of time. Other perceived barriers included limited access to research literature, limited EBP skills, difficulty implementing new interventions that required participation of other team members, and frustration from previous unsuccessful attempts to find applicable research. Conclusions: Instruction in EBP skills may be necessary but not sufficient for clinicians to be able to use EBP in daily practice. Achieving EBP in a clinical setting may require organizational changes to improve access to informational resources and to provide mechanisms for achieving buy-in from other members of the health care team. In a busy clinic, EBP will require a system that enables optimal sharing of the current evidence with minimal person-hours spent searching and critically appraising. Optimal strategies for finding best evidence may vary depending on the practice specialization and the current state of research in that field, and EBP education should address these differences. Clinical Relevance: Currently many courses teach EBP without taking into account factors related to the clinical specialty, environment and culture that may interfere with implementation of EBP in the clinic. A more comprehensive approach may facilitate the process of enabling physical and occupational therapists to achieve EBP in their daily clinical practices.