A systematic review of the individual determinants of research evidence use in allied health

Background: The use of evidence-based practice (EBP) is often not reflected in allied health (AH) practitioners’ day-to-day practice (the research-practice gap). Research suggests that considerable differences between and within AH disciplines exist, which require different approaches in order to influence practice behavior. It is therefore important to develop a better understanding of what influences individual AH practitioners’ adoption of evidence into daily practice. Objective: This systematic review aims to examine the individual characteristics of AH practitioners which determine their uptake of evidence into practice. Methods: Studies which examined individual factors or variables that influence research evidence use by any AH practitioner were included in the review. The methodological quality of the included papers was assessed using the Quality Assessment and Validity Tool for Cross-sectional Studies. A narrative summary of the findings was presented. Results: Six studies were included and the methodological quality scores indicated that two were weak and the remainder had moderate–weak quality. The review demonstrated that factors such as educational degree or academic qualification, involvement in research or EBP-related activities, and practitioners’ perceptions, attitudes and beliefs about research and EBP are significant predictors of self-reported research evidence use in AH. The effect of other factors such as professional characteristics, clinical setting/work environment, information-seeking behavior and sociodemographic variables are less clear. Whether there is an interaction effect between evidence-uptake factors has not been tested. Conclusion: Improving the research knowledge of clinicians and overcoming negative attitudes toward EBP have the potential to move AH practitioners towards regularly utilizing evidence in practice. Allied health practitioners may benefit from participation in regular educational opportunities such as case studies or journal clubs which can put them at the same level of thinking and awareness of research evidence. Future research should aim to review organizational and contextual factors and explore their interaction with individual determinants of research evidence use.L Lizarondo, K Grimmer-Somers, S Kuma

Exploring the individual determinants of evidence uptake in allied health using a journal club as a medium

Purpose: A recent trial which examined the impact of a structured model of journal club (JC) demonstrated variability in evidence-based practice (EBP) outcomes across allied health disciplines. The aim of the current study was to determine if there are individual practitioner characteristics that could explain this variability and identify potential predictors of EBP outcomes. Method: This exploratory study used the data obtained from the JC trial. The predictive value of practitioner-related variables including academic degree, previous exposure to EBP training, and previous research involvement was analyzed using univariate logistic regression models. The dose of intervention was also included in the exploratory analysis. Results: The change in self-reported knowledge, evidence uptake, and attitude following participation in a JC was influenced by individual practitioner characteristics including their discipline, academic background, previous EBP training, previous research involvement, and JC attendance. Improvement in objective knowledge did not seem to be affected by any of these variables. Whether these individual characteristics have the ability to predict who will achieve less than, or greater than, 50% change in knowledge, attitude, and evidence uptake, is not known, except for academic background which predicted physiotherapists' improvement in attitude. Conclusion: Participation in a structured JC can lead to significant improvements in EBP knowledge irrespective of the characteristics of individual practitioners. The change in attitude and evidence uptake, however, may be influenced by individual characteristics which will therefore require careful consideration when designing EBP interventions. An EBP intervention is likely to be successful if a systematic assessment of the barriers at different levels (ie, individual, organizational, and contextual) informs the choice of evidence implementation strategy.Lucylynn Lizarondo, Karen Grimmer, Saravana Kuma

The Adapted Fresno test for speech pathologists, social workers, and dieticians/nutritionists: validation and reliability testing

Purpose: The current versions of the Adapted Fresno test (AFT) are limited to physiotherapists and occupational therapists, and new scenarios and scoring rubrics are required for other allied health disciplines. The aim of this study was to examine the validity, reliability, and internal consistency of the AFT developed for speech pathologists (SPs), social workers (SWs), and dieticians/nutritionists (DNs). Materials and methods: An expert panel from each discipline was formed to content-validate the AFT. A draft instrument, including clinical scenarios, questionnaire, and scoring rubric, was developed. The new versions were completed by ten SPs, 16 SWs, and 12 DNs, and scored by four raters. Interrater reliability was calculated using intraclass correlation coefficients (2,1) for the individual AFT items and the total score. The internal consistency of the AFT was examined using Cronbach's α. Results: Two new clinical scenarios and a revised scoring rubric were developed for each discipline. The reliability among raters was excellent for questions 1, 3, and 6 across all disciplines. Question 7 showed excellent reliability for SPs, but not for SWs and DNs. All other reliability coefficients increased to moderate or excellent levels following training. Cronbach's α was 0.71 for SPs, 0.68 for SWs, and 0.74 for DNs, indicating that internal consistency was acceptable for all disciplines. Conclusion: There is preliminary evidence to show that AFT is a valid and reliable tool for the assessment of evidence-based practice knowledge and skills of SPs, SWs, and DNs. Further research is required to establish its sensitivity to detect change in knowledge and skills following an educational program.Lucylynn Lizarondo, Karen Grimmer, Saravana Kuma

Assisting allied health in performance evaluation: a systematic review

Background Performance evaluation raises several challenges to allied health practitioners and there is no agreed approach to measuring or monitoring allied health service performance. The aim of this review was to examine the literature on performance evaluation in healthcare to assist in the establishment of a framework that can guide the measurement and evaluation of allied health clinical service performance. This review determined the core elements of a performance evaluation system, tools for evaluating performance, and barriers to the implementation of performance evaluation. Methods A systematic review of the literature was undertaken. Five electronic databases were used to search for relevant articles: MEDLINE, Embase, CINAHL, PsychInfo, and Academic Search Premier. Articles which focussed on any allied health performance evaluation or those which examined performance in health care in general were considered in the review. Content analysis was used to synthesise the findings from individual articles. Results A total of 37 articles were included in the review. The literature suggests there are core elements involved in performance evaluation which include prioritising clinical areas for measurement, setting goals, selecting performance measures, identifying sources of feedback, undertaking performance measurement, and reporting the results to relevant stakeholders. The literature describes performance evaluation as multi-dimensional, requiring information or data from more than one perspective to provide a rich assessment of performance. A range of tools or instruments are available to capture various perspectives and gather a comprehensive picture of health care quality. Conclusions Every allied health care delivery system has different performance needs and will therefore require different approaches. However, there are core processes that can be used as a framework to evaluate allied health performance. A careful examination of barriers to performance evaluation and subsequent tailoring of strategies to overcome these barriers should be undertaken to achieve the aims of performance evaluation. The findings of this review should inform the development of a standardised framework that can be used to measure and evaluate allied health performance. Future research should explore the utility and overall impact of such framework in allied health service delivery.Lucylynn Lizarondo, Karen Grimmer, and Saravana Kuma

Enablers of and barriers to high quality clinical supervision among occupational therapists across Queensland in Australia: findings from a qualitative study

BACKGROUND Health professionals practising in countries with dispersed populations such as Australia rely on clinical supervision for professional support. While there are directives and guidelines in place to govern clinical supervision, little is known about how it is actually conducted and what makes it effective. The purpose of this study was to explore the enablers of and barriers to high quality clinical supervision among occupational therapists across Queensland in Australia. METHODS This qualitative study took place as part of a broader project. Individual, in-depth, semi-structured interviews were conducted with occupational therapy supervisees in Queensland. The interviews explored the enablers of and barriers to high quality clinical supervision in this group. They further explored some findings from the initial quantitative study. RESULTS Content analysis of the interview data resulted in eight themes. These themes were broadly around the importance of the supervisory relationship, the impact of clinical supervision and the enablers of and barriers to high quality clinical supervision. DISCUSSION This study identified a number of factors that were perceived to be associated with high quality clinical supervision. Supervisor-supervisee matching and fit, supervisory relationship and availability of supervisor for support in between clinical supervision sessions appeared to be associated with perceptions of higher quality of clinical supervision received. Some face-to-face contact augmented with telesupervision was found to improve perceptions of the quality of clinical supervision received via telephone. Lastly, dual roles where clinical supervision and line management were provided by the same person were not considered desirable by supervisees. A number of enablers of and barriers to high quality clinical supervision were also identified. CONCLUSION With clinical supervision gaining increasing prominence as part of organisational and professional governance, this study provides important lessons for successful and sustainable clinical supervision in practice contexts.Priya Martin, Saravana Kumar, Lucylynn Lizarondo, and Ans VanEr

Does journal club membership improve research evidence uptake in different allied health disciplines: a pre-post study

Background: Although allied health is considered to be one 'unit' of healthcare providers, it comprises a range of disciplines which have different training and ways of thinking, and different tasks and methods of patient care. Very few empirical studies on evidence-based practice (EBP) have directly compared allied health professionals. The objective of this study was to examine the impact of a structured model of journal club (JC), known as iCAHE (International Centre for Allied Health Evidence) JC, on the EBP knowledge, skills and behaviour of the different allied health disciplines. Methods: A pilot, pre-post study design using maximum variation sampling was undertaken. Recruitment was conducted in groups and practitioners such as physiotherapists, occupational therapists, speech pathologists, social workers, psychologists, nutritionists/dieticians and podiatrists were invited to participate. All participating groups received the iCAHE JC for six months. Quantitative data using the Adapted Fresno Test (McCluskey & Bishop) and Evidence-based Practice Questionnaire (Upton & Upton) were collected prior to the implementation of the JC, with follow-up measurements six months later. Mean percentage change and confidence intervals were calculated to compare baseline and post JC scores for all outcome measures. Results: The results of this study demonstrate variability in EBP outcomes across disciplines after receiving the iCAHE JC. Only physiotherapists showed statistically significant improvements in all outcomes; speech pathologists and occupational therapists demonstrated a statistically significant increase in knowledge but not for attitude and evidence uptake; social workers and dieticians/nutritionists showed statistically significant positive changes in their knowledge, and evidence uptake but not for attitude. Conclusions: There is evidence to suggest that a JC such as the iCAHE model is an effective method for improving the EBP knowledge and skills of allied health practitioners. It may be used as a single intervention to facilitate evidence uptake in some allied health disciplines but may need to be integrated with other strategies to influence practice behaviour in other practitioners. An in-depth analysis of other factors (e.g. individual, contextual, organisational), or the relative contribution of these variables is required to better understand the determinants of evidence uptake in allied health.Lucylynn M Lizarondo, Karen Grimmer-Somers, Saravana Kumar and Alan Crocket

Impact and feasibility of the Allied Health Professional Enhancement Program placements – experiences from rural and remote Queensland

Background: Allied health professionals practicing in rural and remote areas are often faced with barriers that prevent them from accessing professional development opportunities. In order to address this barrier, a tailored professional development program was developed and implemented by the Cunningham Centre in Queensland, Australia. The purpose of this study was to investigate the benefits of the program to participants and their work units. Methods: This study used a concurrent mixed methods longitudinal design to investigate the medium- to long-term benefits of one Allied Health Professional Enhancement Program placement. Surveys and individual interviews provided data at 2 weeks and at 6 months post-placement. The study participants included the placement participant (a physiotherapist), their line manager, clinical supervisor, and the placement facilitator. Results: Results demonstrated that the placement resulted in various reported benefits to the placement participant, as well as to service delivery in their home location. Benefits of the placement reported by the participant included increased confidence, improved knowledge and skills, increased access to professional networks, and validation of practice. Benefits to service delivery reported included improved efficiencies, improved patient outcomes, and positive impact on other team members. Discussion: This study found that the Allied Health Professional Enhancement Program placement investigated was beneficial to the participant and to service delivery. In addition, the benefits reported were sustained at 6 months post-placement. Despite the fact that this study showcases experiences from one setting, the findings from this study and the lessons learnt may be transferrable to other similar programs elsewhere due to its methodological strengths (such as rich descriptions of the program and use of typical case sampling). While this study provides emergent evidence of usefulness of the program to participants and their work units, further studies are warranted to investigate the direct benefits of such placements on patient care, which remains as the holy grail of the impact of professional development opportunities. Conclusion: Allied Health Professional Enhancement Program placements can result in important benefits to the participant, their health service, and positively influence health care service delivery.Priya Martin, Saravana Kumar, Melinda Stone, LuJuana Abernathy, Vanessa Burge, Lucylynn Lizarond

An evidence-based framework to measure quality of allied health care

BACKGROUND: There is no standard way of describing the complexities of allied health (AH) care, or its quality. AH is an umbrella term which excludes medicine and nursing, and variably includes disciplines which provide therapy, diagnostic, or scientific services. This paper outlines a framework for a standard approach to evaluate the quality of AH therapy services. METHODS: A realist synthesis framework describing what AH does, how it does it, and what is achieved, was developed. This was populated by the findings of a systematic review of literature published since 1980 reporting concepts of quality relevant to AH. Articles were included on quality measurement concepts, theories, debates, and/or hypothetical frameworks. RESULTS: Of 139 included articles, 21 reported on descriptions of quality potentially relevant to AH. From these, 24 measures of quality were identified, with 15 potentially relating to what AH does, 17 to how AH delivers care, 8 relating to short term functional outcomes, and 9 relating to longer term functional and health system outcomes. CONCLUSIONS: A novel evidence-based quality framework was proposed to address the complexity of AH therapies. This should assist in better evaluation of AH processes and outcomes, costs, and evidence-based engagement of AH providers in healthcare teams.Karen Grimmer, Lucylynn Lizarondo, Saravana Kumar, Erica Bell, Michael Buist, and Philip Weinstei

Efficient clinical evaluation of guideline quality: development and testing of a new tool

Background: Evaluating the methodological quality of clinical practice guidelines is essential before deciding which ones which could best inform policy or practice. One current method of evaluating clinical guideline quality is the research-focused AGREE II instrument. This uses 23 questions scored 1–7, arranged in six domains, which requires at least two independent testers, and uses a formulaic weighted domain scoring system. Following feedback from time-poor clinicians, policy-makers and managers that this instrument did not suit clinical need, we developed and tested a simpler, shorter, binary scored instrument (the iCAHE Guideline Quality Checklist) designed for single users. Methods: Content and construct validity, inter-tester reliability and clinical utility were tested by comparing the new iCAHE Guideline Quality Checklist with the AGREE II instrument. Firstly the questions and domains in both instruments were compared. Six randomly-selected guidelines on a similar theme were then assessed by three independent testers with different experience in guideline quality assessment, using both instruments. Per guideline, weighted domain and total AGREE II scores were calculated, using the scoring rubric for three testers. Total iCAHE scores were calculated per guideline, per tester. The linear relationship between iCAHE and AGREE II scores was assessed using Pearson r correlation coefficients. Score differences between testers were assessed for the iCAHE Guideline Quality Checklist. Results: There were congruent questions in each instrument in four domains (Scope & Purpose, Stakeholder involvement, Underlying evidence/Rigour, Clarity). The iCAHE and AGREE II scores were moderate to strongly correlated for the six guidelines. There was generally good agreement between testers for iCAHE scores, irrespective of their experience. The iCAHE instrument was preferred by all testers, and took significantly less time to administer than the AGREE II instrument. However, the use of only three testers and six guidelines compromised study power, rendering this research as pilot investigations of the psychometric properties of the iCAHE instrument. Conclusion: The iCAHE Guideline Quality Checklist has promising psychometric properties and clinical utility.Karen Grimmer, Janine Margarita Dizon, Steve Milanese, Ellena King, Kate Beaton, Olivia Thorpe, Lucylynn Lizarondo, Julie Luker, Zuzana Machotka and Saravana Kuma

Advice about diet and smoking for people with or at risk of age-related macular degeneration: a cross-sectional survey of eye care professionals in the UK.

BACKGROUND: In the absence of a cure, there has been considerable interest in attempts to prevent or reduce the progression of age-related macular degeneration (AMD) by targeting particular modifiable risk factors. The aim of this study was to conduct a cross-sectional survey of the current practice of UK eye care professionals in relation to advice given on diet and other lifestyle modifications for patients with or at risk of AMD. METHODS: Optometrists and ophthalmologists on the membership databases of professional organisations for the two professions were invited to participate in an online survey. The survey was open for 12 weeks between July and September 2012. RESULTS: A total of 1,468 responses were received (96.3% from optometrists and 3.7% from ophthalmologists). The response rate of those receiving the invitation was 16.2% (1,414/8735) for optometrists and 6% (54/1460) for ophthalmologists. A majority of respondents reported that they frequently provide dietary advice to patients with established AMD (67.9%) and those at risk of AMD (53.6%). Typical advice consisted of a recommendation to eat plenty of leafy green vegetables and eat more oily fish. The decision to recommend nutritional supplements was based on the risk of progression to advanced AMD, with approximately 93% of respondents recommending supplementation in a patient with advanced AMD in one eye. However for the majority, the type of supplement recommended did not comply with current best research evidence, based on the findings of the Age-related Eye Disease Study (AREDS). Only one in three optometrists regularly assessed smoking status and advised on smoking cessation. CONCLUSIONS: Within a large sample of eye care professionals, consisting predominantly of optometrists, who responded to a cross-sectional survey, there was active engagement in providing nutritional advice to patients with or at risk of AMD. However, the results demonstrate a need to raise awareness of the evidence underpinning the use of nutritional supplements together with an increased involvement in targeted smoking cessation