Evidence-based Movement Research Articles

Reclaiming Social Justice

Abstract: A central tenet of the social work profession is its commitment to social justice. This commitment is outlined by the major governing bodies across social work education and practice, intra- and internationally. However, clinical social work has historically been influenced by the evidence-based movement and broadly adopted medicalized models of practice by focusing on treatment model adherence and symptom reduction. Consequently, clinical practitioners have been criticized for not adequately addressing systemic oppression and social injustices affecting vulnerable and historically marginalized populations. The absence of a social justice orientation to clinical practice not only lacks alignment with social work's core values but, in the current socio-political environment, may further perpetuate oppression. Clinical supervision, a staple in developing professional skills for graduate students and novice clinicians, offers an ideal pedagogical space for developing the cognitive, emotional, and behavioral skills and competencies needed to engage in social justice-focused practice. The aim of this article is to offer a supervisory framework, the Critical Relational Model (CRM), grounded in a metatheory that integrates principles from critical theory, critical pedagogy, and anti-oppressive and decolonizing frameworks, applied through a relational lens. A second aim is to demonstrate how the CRM can be immediately applied to practice with novice clinicians, graduate students, and any other clinical practitioner wishing to enhance their effectiveness and participation in creating a more equitable and just society for all.

A revolution against the evidence-based movement.

The author declares no conflict of interest. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Health Systems Need to Transform Data Collection to Advance Health Equity.

Health Systems Need to Transform Data Collection to Advance Health Equity.

The shiny new object: Deconstructing the patient-oriented paradigm in health sciences.

A 'patient-oriented' research paradigm, also known as patient and public engagement, has infiltrated the field of health sciences and continues to spread. At first blush, it is difficult to reprove anything labelled 'patient-oriented'; however, the patient-oriented paradigm may easily become an ideological 'good', leading to unintended consequences that may well prove more detrimental than beneficial. While patient-oriented research has its roots in more radical forms of patient and public engagement, its recent instantiation betrays its roots and forecloses on more radical forms of engagement, such as critical participatory research. The objective of this article is to deconstruct the patient-oriented research narrative and to demonstrate how such a discourse imposes itself as a dominant approach in health sciences. Following Derrida's deconstructive approach, we bring to light the unexamined presuppositions, false pretences, and presumed 'goodness' and 'naturalness' of patient-oriented discourse. By deconstructing the patient-oriented narrative we demonstrate how pre-existing power structures (biomedical, economic, etc.) shape the conduct of the approach and serve to depoliticize the truly participatory aspects of research. Rather than being modelled on the evidence-based movement or seen as its natural 'evolution', patient-oriented research should resist by affirming itself as a radical form that is both participatory and emancipatory.

Changing the paradigm of research.

Changing the paradigm of research.

The post-truth tyrannies of an evidence-based hegemony

A trend towards evidence-based practice has developed in policy and practice in the United Kingdom, the United States, and Australia in recent years, evolving to become a powerful hegemonic force. This paper considers this latest impetus to teach according to the mandates of a narrow evidence base as a symptom of the post-truth condition, one that elevates a limited body of evidence to an infallible position. Drawing on interviews with practicing teachers and critical discourse analysis of policy texts, this paper explores the homogenizing effects of a tyrannical evidence-based movement, using Antonio Gramsci’s (1971) writing on the relationship between consent, coercion, and the maintenance of cultural hegemony. This paper argues that the contemporary policy landscape obtains consent from teachers to accept its claims through a coercive paradigm built from a powerful set of hegemonic discourses, such as “what works” and “evidence-based.” These discourses, this paper suggests, need to be considered within the current post-truth context, where the dismissal of research claims is akin to scientific skepticism; a dynamic that places teachers in an impossible bind where the evidence underpinning policy is protected by a paradigm that makes it difficult to question.

Long-term effect of additional rehabilitation following botulinum toxin-A on upper limb activity in chronic stroke: the InTENSE randomised trial

BackgroundIt is common for people with persistent spasticity due to a stroke to receive an injection of botulinum toxin-A in the upper limb, however post-injection intervention varies.AimTo determine the long-term effect of additional upper limb rehabilitation following botulinum toxin-A in chronic stroke.MethodAn analysis of long-term outcomes from national, multicenter, Phase III randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis was carried out. Participants were 140 stroke survivors who were scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke greater than 3 months ago, who had completed formal rehabilitation and had no significant cognitive impairment. Experimental group received botulinum toxin-A plus 3 months of evidence-based movement training while the control group received botulinum toxin-A plus a handout of exercises. Primary outcomes were goal attainment (Goal Attainment Scale) and upper limb activity (Box and Block Test) at 12 months (ie, 9 months beyond the intervention). Secondary outcomes were spasticity, range of motion, strength, pain, burden of care, and health-related quality of life.ResultsBy 12 months, the experimental group scored the same as the control group on the Goal Attainment Scale (MD 0 T-score, 95% CI -5 to 5) and on the Box and Block Test (MD 0.01 blocks/s, 95% CI -0.01 to 0.03). There were no differences between groups on any secondary outcome.ConclusionAdditional intensive upper limb rehabilitation following botulinum toxin-A in chronic stroke survivors with a disabled upper limb is not more effective in the long-term.Trial RegistrationACTRN12615000616572 (12/06/2015).

Качественная методология и доказательные практики в психологии и образовании

The article is dedicated to the relationship of qualitative research and evidence-based movement in psychology and education. We analyze the ways in which they enrich and reshape each other. The qualitative research methods open up additional opportunities for evaluating the social validity of practices, ways of their implementation, and allow taking into account contextual factors in studying the efficacy of practices. To meet the demand to increase evidence, qualitative researchers are developing the principles and procedures of meta-synthesis (as an equivalent of meta-analysis in quantitative research) aimed at integrating the results of many qualitative studies on a specific topic. The article focuses on the role of the qualitative research methods in the development of causal explanation. We follow the realist approach to causality and accept the view that qualitative research is a particular way of identifying causal processes. The explanatory possibilities of the qualitative research methods for the studies of practice efficacy are discussed.

From domestication to imperial patronage: Deconstructing the biomedicalisation of occupational therapy.

Occupational therapy knowledge emerged in the 19th century as reformist movements responded to the industrialisation of society and capitalist expansion. In the Global North, it was institutionalised by State apparatuses during the First and Second World Wars. Although biomedicine contributed to the rapid expansion and establishment of occupational therapy as a health discipline, its domestication by the biomedical model led to an overly regulated profession that betrays its reformist ideals. Drawing on the work of Deleuze and Guattari, our aim in this article is to deconstruct the biomedicalisation of occupational therapy and demonstrate how resistance to this process is critical for the future of this discipline. The use of arts and crafts in occupational therapy may be conceptualised as a 'nomad science' aesthetically resisting the domination of industrialism and medical reductionism. Through the war efforts, a coalition of progressive nurses, social workers, teachers, artisans and activists metamorphosed into occupational therapists. As it did with nursing, biomedicine proceeded to domesticate occupational therapy through a form of 'imperial' patronage subsequently embodied in the evidence-based movement. 'Occupational' jargon is widely used today and may be viewed as the product of a profession trying to establish itself as an autonomous discipline that imposes its own regime of truth. Given the symbolic violence underlying this patronage, the future of occupational therapy should not mean behaving according to biomedicine's terms. As a discipline, occupational therapy must resist the appropriation of its 'war machine' and craft its own terms through the release of new creative energy.

Teaching Medical Epistemology within an Evidence-Based Medicine Curriculum

Issue: Epistemology, the branch of philosophy that deals with the nature, value, and use of knowledge, receives little or no formal attention in medical education. Yet the understanding of medical epistemology - focused on what kinds of medical knowledge are relevant to clinical decisions, the strengths and limitations of those different kinds of knowledge, and how they relate to one another and to clinical expertise - represents a critical aspect of medical practice. Evidence: Understanding the meaning of the term “evidence” is one of the fundamental tasks of medical epistemology. Other foundations of the evidence-based medicine movement, such as the “hierarchy of evidence” and the concept of “best” evidence, rest upon epistemological assertions, claims regarding the appropriate kinds and relative value of knowledge in medicine. Here we rely upon the work of philosophers of medicine who have been engaged in debates regarding the epistemic tenets of the evidence-based medicine movement. We argue that medical students and physicians-in-training should learn basic terminology and methods of epistemology as they are being introduced to the concepts and techniques of evidence-based medicine. Implications: The skepticism and critical analysis encouraged by EBM can and should be applied to the underlying assumptions and primary tenets of EBM itself. It is not enough for philosophers to partake in this endeavor; students, trainees, and clinicians need to carefully and constantly examine the reasons and reasoning that coalesce into clinical acumen. Our role as medical educators is to give them the tools, including a basic understanding of epistemology, to do that over a lifetime.

Protocol for the economic evaluation of the InTENSE program for rehabilitation of chronic upper limb spasticity

BackgroundAssessment of the costs of care associated with chronic upper-limb spasticity following stroke in Australia and the potential benefits of adding intensive upper limb rehabilitation to botulinum toxin-A are key objectives of the InTENSE randomised controlled trial.MethodsRecruitment for the trial has been completed. A total of 139 participants from 6 stroke units across 3 Australian states are participating in the trial. A cost utility analysis will be undertaken to compare resource use and costs over 12 months with health-related quality of life outcomes associated with the intervention relative to a usual care comparator. A cost effectiveness analysis with the main clinical measure of outcome, Goal Attainment Scaling, will also be undertaken. The primary outcome measure for the cost utility analysis will be the incremental cost effectiveness ratio (ICER) generated from the incremental cost of the intervention as compared to the incremental benefit, as measured in quality adjusted life years (QALYs) gained. The utility scores generated from the EQ-5D three level instrument (EQ-5D-3 L) measured at baseline, 3 months and 12 months will be utilised to calculate the incremental Quality Adjusted Life Year (QALY) gains for the intervention relative to usual care using area-under the curve methods.DiscussionThe results of the economic evaluation will provide evidence of the total costs of care for patients with chronic upper limb spasticity following stroke. It will also provide evidence for the cost-effectiveness of adding evidence-based movement therapy to botulinum toxin-A as a treatment, providing important information for health system decision makers tasked with the planning and provision of services.

The Cultural Politics of \u2018Implementation Science\u2019

Despite the growing profile of ‘implementation science’, its status as a field of study remains ambiguous. Implementation science originates in the evidence-based movement and attempts to broaden the scope of evidence-based medicine to improve ‘clinical effectiveness’ and close the ‘implementation gap’. To achieve this agenda, implementation science draws on methodologies from the social sciences to emphasise coherence between qualitative and quantitative approaches. In so doing, we ask if this is at the expense of ignoring the dominating tendencies of the evidence-based movement and consider if some of the methodologies being drawn on should be considered irreconcilable with evidence-based methodologies.

Nudge and evidence based policy: fertile ground

Nudge is an approach to public policy that changes the decision-making environment to encourage citizens to make a particular choice. The approach has been eagerly adopted by administrations around the world, with some governments establishing dedicated nudge units to advance their use. One reason proposed for nudge’s popularity is that it supports evidence-based policy. Nudging seems to be firmly positioned in evidence-based policy rhetoric, and encourages the use of Randomised Control Trials to determine the effectiveness of a policy. There is little empirical understanding on whether nudge’s association with this rhetoric has contributed to its increasingly widespread application. This research explores how nudge is understood in relation to the evidence-based movement, from the perspective of those designing, developing and implementing nudge policies. In-depth, qualitative interviews were undertaken with policymakers in Australia. This paper finds policymakers perceive an interconnected relationship between nudging and evidence-based policy, with each providing fertile ground for the growth of the other. Consequences for scholarship and practice are discussed including implications for what constitutes legitimate evidence in the public service.

DSM-5: the definitive inclusion of psychiatry in medicine?

DSM-5 is a significant factor in promoting the "remedicalization" of psychiatry as the focus of psychiatric knowledge, developed by the evidence-based medicine movement, shifted from the clinically-based biopsychosocial model to a research-based medical model. DSM-5 purposes are 1]clinical: diagnosis, prevention, early identification, management, outcome, assessment of improvement; 2] clinical research: etiology, course, effective treatments, cost-effective treatments, reliability and validity and utility of diagnosis; 3] a worldwide common language of diagnostic criteria used by mental health professionals; and 4] to improve communication with users of services, caregivers, and society in general. In the absence of a "gold standard" there are two basic questions still without answers 1] what kind of entities are psychiatric disorders?; and 2] How to integrate the multiple explanatory perspectives of psychiatric illness?.

What constitutes globalised evidence? Cultural tensions and critical reflections of the evidence-based movement in New Zealand.

The evidence-based movement (EBM) is grounded in a well-intentioned desire to ensure resources are invested in high quality initiatives that generate the intended impact. Nevertheless, recent critiques contest the appropriateness of translating an approach rooted in a medical model to socially complex initiatives. Globalised notions of evidence can also be damaging for programs operating in small, culturally diverse countries with limited resources. Given these polemic views, our aim was to examine local perceptions of the EBM in New Zealand, a small, vibrant, bicultural society with a mix of homegrown and imported programs. Using a snowball sampling approach, 79 professionals working in the education and social sectors completed an anonymous online survey that contained a series of closed and open-ended questions. The results show that although participants positively endorsed a variety of quality evidence markers, traditionally positivist methodological leanings received lower and more varied endorsements compared to more inclusive and pluralistic approaches. Many also expressed concern that the EBM emphasises a narrow and colonised view of evidence that does not align with Māori and Pacific worldviews, and undermines innovation. We discuss the implications as an avenue for advancing intervention and social programming research in an increasingly multicultural and globalised world.

An Evaluation of “Transforming Youth Justice: A Leadership Development Program”

As part of the modern evidence-based movement in juvenile justice, effective leadership is necessary for planning, implementing, and evaluating policies, programs, and practices, along with guiding innovative reform efforts. Leadership development programs hold promise for advancing the field of juvenile justice, by enhancing participant leadership skills and abilities, as well as increasing opportunities for networking and further professional development. The purpose of the current study was to evaluate a juvenile justice leadership program in Connecticut. Overall, the findings from the mixed-methods research were supportive. Implications for similar programs and future research also are discussed.

Redeveloping the JBI Model of Evidence Based Healthcare.

In 2005, Pearson et al. presented a developmental framework of evidence-based practice that sought to situate healthcare evidence and its role and use within the complexity of practice settings globally. A decade later, it was deemed timely to re-examine the Model and its component parts to determine whether they remain relevant and a true and accurate reflection of where the evidence-based movement is today. A two-phase process was employed for this project. Phase 1 involved a citation analysis, conducted using the index citation of the original source article on the Joanna Briggs Institute (JBI) Model by Pearson et al. The databases searched were Web of Science and Google Scholar from year of publication (2005) to July 2015. Duplicates and articles in languages other than English were removed, and all results were imported and combined in an Excel spreadsheet for review, coding and interpretation. Phase 2 (model revision) occurred in two parts. Part 1 involved revision of the Model by an internal working group. This revised version of the Model was then subjected to a process of focus group discussion (Part 2) that engaged staff of the Joanna Briggs Collaboration during the 2015 annual general meeting. These data were recorded then transcribed for review and consideration. The citation analysis revealed that the Model was primarily utilized to conceptualize evidence and evidence-based healthcare, but that language used in relation to concepts within the Model was variable. Equally, the working group and focus group feedback confirmed that there was a need to ensure the language utilized in the Model was internationally appropriate and in line with current international trends. This feedback and analysis informed the revised version of the JBI Model. Based on the citation analysis, working group and focus group feedback the new JBI Model for Evidence Based Healthcare attempts to utilize more internationally appropriate language to detail the intricacies of the relationships between systems and individuals across different settings and the need for contextual localization to enable policy makers and practitioners to make evidence-based decisions at the point of care.

The Roles Foundations Are Playing in the Evidence-Based Policy Movement

Foundations are actively engaged in supporting evidence-based policymaking through collaborative funding, supporting, and creating intermediary organizations; building the infrastructure needed to support evidence-based policymaking; and improving the relevance of research for practice and policy. For a variety of reasons, they are shifting from a focus on the federal government and the identification of effective brand name innovations to an emphasis on supporting local actors to design and test solutions using local data. This article provides examples of foundation work, describes and discusses how and why it is evolving, and uses historical examples to place the change in context.

Harnessing local knowledge for scientific knowledge production: challenges and pitfalls within evidence-based sustainability studies

The calls for evidence-based public policy making have increased dramatically in the last decades, and so has the interest in evidence-based sustainability studies. But questions remain about what “evidence” actually means in different contexts and if the concept travels well between different domains of application. Some of the most relevant questions asked by sustainability studies are not, and in some cases cannot be, directly answered by relying on research evidence of the kinds favored by the evidence-based movement. Therefore, sustainability studies must also harness other forms of knowledge, based on forms of practical experience. How to integrate these two sources of knowledge is one of the most fundamental epistemological and practical problems society is facing. Identifying what kind of practical experience and research evidence we need to integrate is another challenging question. We draw on examples from our research in the Global South and suggest an efficient principle, problem-feeding, for harnessing practical experience within an adapted version of evidence-based sustainability studies. (Less)

OP119 Appraising Qualitative Research For Qualitative Evidence Syntheses

Introduction:The growth of the evidence-based policy movement sought to determine how to better assess and incorporate qualitative evidence in clinical practice and policy development. The question engendered was not whether qualitative research is valuable but how researchers can enhance its rigor. From this discussion arose over one hundred appraisal tools for the quality appraisal process of qualitative studies. For those without a deep familiarity with the qualitative research paradigm, navigating through the breadth of tools to find the most suitable tool for the task is a cumbersome process. This presentation will review the descriptive characteristics of available quality appraisal tools for assessing the quality of primary qualitative studies in qualitative evidence syntheses (QES). This presentation will also offer a critical discussion on the use of reflexivity as a de facto quality criterion, and how methodological reporting may influence the application of quality criteria in QES.Methods:We conducted a systematic search to identify quality appraisal tools of qualitative research designed for use in QES. This search built upon the work of Santiago-Delefosse and colleagues by extending their search to 2016.Results:We identified eight appraisal tools intended for use in the quality appraisal process of a QES. We provide a description of the structure, content, objectives, and philosophies of tools followed by considerations concerning their historical antecedents, common patterns regarding structure, content, and purpose, and the implications of these patterns on the QES process.Conclusions:Quality appraisal of qualitative research is an important step in QES, and there have been a proliferation of tools for this purpose. By providing an overview of available tools detailing their intent and strengths, this presentation will assist those engaging in QES to choose an appropriate tool for their work.