Implementation of evidence-based assessment of upper extremity in stroke rehabilitation: From evidence to clinical practice

Despite the exponential growth in the evidence base for stroke rehabilitation, there is still a paucity of knowledge about how to consistently and sustainably deliver evidence-based stroke rehabilitation therapies in clinical practice. This means that people with stroke will not consistently benefit from research breakthroughs, simply because clinicians do not always have the skills, authority, knowledge or resources to be able to translate the findings from a research trial and apply these in clinical practice. This “point of view” article by an interdisciplinary, international team illustrates the lack of available evidence to guide the translation of evidence to practice in rehabilitation, by presenting a comprehensive and systematic content analysis of articles that were published in 2016 in leading clinical stroke rehabilitation journals commonly read by clinicians. Our review confirms that only a small fraction (2.5%) of published stroke rehabilitation research in these journals evaluate the implementation of evidence-based interventions into health care practice. We argue that in order for stroke rehabilitation research to contribute to enhanced health and well-being of people with stroke, journals, funders, policy makers, researchers, clinicians, and professional associations alike need to actively support and promote (through funding, conducting, or disseminating) implementation and evaluation research.

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Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation

Topics in Stroke Rehabilitation ◽

10.1310/3tkx-7xec-2dtg-xqkh ◽

2006 ◽

Vol 13 (2) ◽

pp. 1-269 ◽

Cited By ~ 52

Author(s):

Ottawa Panel

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Stroke Rehabilitation ◽

Evidence Based ◽

Post Stroke

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Building a Knowledge to Action Program in Stroke Rehabilitation

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.258 ◽

2016 ◽

Vol 43 (5) ◽

pp. 619-625 ◽

Cited By ~ 3

Author(s):

Shannon Janzen ◽

Amanda McIntyre ◽

Marina Richardson ◽

Eileen Britt ◽

Robert Teasell

Keyword(s):

Clinical Practice ◽

Knowledge Creation ◽

Stroke Rehabilitation ◽

Best Practice ◽

Evidence Based ◽

Clinical Implementation ◽

Evidence Based Practices ◽

Knowledge To Action ◽

Best Practice Guidelines ◽

Action Project

AbstractThe knowledge to action (KTA) process proposed by Graham et al (2006) is a framework to facilitate the development and application of research evidence into clinical practice. The KTA process consists of the knowledge creation cycle and the action cycle. The Evidence Based Review of Stroke Rehabilitation is a foundational part of the knowledge creation cycle and has helped guide the development of best practice recommendations in stroke. The Rehabilitation Knowledge to Action Project is an audit-feedback process for the clinical implementation of best practice guidelines, which follows the action cycle. The objective of this review was to: (1) contextualize the Evidence Based Review of Stroke Rehabilitation and Rehabilitation Knowledge to Action Project within the KTA model and (2) show how this process led to improved evidence-based practice in stroke rehabilitation. Through this process, a single centre was able to change clinical practice and promote a culture that supports the use of evidence-based practices in stroke rehabilitation.

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Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

American Journal of Audiology ◽

10.1044/2019_aja-18-0156 ◽

2019 ◽

Vol 28 (4) ◽

pp. 877-894

Author(s):

Nur Azyani Amri ◽

Tian Kar Quar ◽

Foong Yen Chong

Keyword(s):

Clinical Practice ◽

Hearing Aids ◽

Best Practice ◽

Hearing Aid ◽

Evidence Based ◽

Future Directions ◽

Major Barrier ◽

Klang Valley ◽

Age Range ◽

Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

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What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-19-00171 ◽

2020 ◽

Vol 29 (2) ◽

pp. 688-704

Author(s):

Katrina Fulcher-Rood ◽

Anny Castilla-Earls ◽

Jeff Higginbotham

Keyword(s):

Clinical Practice ◽

Research Evidence ◽

Evidence Based Practice ◽

Evidence Based ◽

Clinical Expertise ◽

Speech Language Pathologists ◽

School Based ◽

Research Findings ◽

Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

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