Understanding practice change following an implementation study: The how and why of evidence adoption by occupational therapists working with children with cerebral palsy

Abstract

Objective: A significant lag in uptake of new evidence into clinical practice constitutes significant worldwide research waste. A recent implementation study targeting occupational therapy practice demonstrated modest changes in clinical practice, adopting a “best evidence” approach to upper limb therapy for children with unilateral cerebral palsy (UCP). This current study aims to explore, how and why therapists changed their clinical practice behaviour when adopting evidence into practice. Design: Generic qualitative research (Caelli, 2003). Method: Three teams of occupational therapists who had participated in an implementation study to change clinical practice and management of children with UCP were included. Of the original participants in the implementation study, two (50%) in Team A (Specialist CP service; 1 left service, 1 was absent); two (66%) in Team B (Specialist paediatric rehabilitation service; 1 left service); and two (100%) from Team C (Regional hospital/community paediatric service) participated in the current study. Semi-structured interviews conducted within 1 month of completion of the implementation study were audiotaped, transcribed verbatim and independently reviewed by two researchers. Content was mapped against four main outcomes of the implementation study identifying what in relation to the outcomes had changed, how it changed, and why. Results: Formalised goal setting (Canadian Occupational Performance Measure) was implemented. Therapists had increased awareness of its usefulness, perceived the process as feasible, with surprising and unexpected benefits (greater understanding of family/child issues). Evidence of use as an outcome measure was limited. Therapists had greater awareness of the importance of increased repetitive task practice for motor learning. They experimented with constraint therapy, with observed benefits to patients which reinforced its continued use and increased therapist confidence. Therapists developed resources and programs for group delivered intervention which was perceived as an easier context for constraint therapy (vs individually delivered therapy) and increased children's opportunities for repetitive task practice. Therapists modified their views about home programs and felt better able to justify their importance based on increased knowledge of the evidence. Home programs were informed by child/parent collaborative goal setting and focused on embedding activities within family routines. There was minimal evidence of formal measurement of upper limb outcomes. Conclusion: Therapists had increased awareness and knowledge of evidence which enhanced confidence in delivering evidence- based interventions for children with UCP. Results highlight the iterative process of research translation.L6148362442017-03-21 <br />