Facilitation of Research-Based Evidence within Occupational Therapy in Stroke Rehabilitation
Kristensen, Hanne Kaae, Borg, Tove, Hounsgaard, Lise, British Journal of Occupational Therapy
In order to provide knowledge about evidence-based occupational therapy, the aim of this study was to investigate aspects that facilitate occupational therapists' reasoning when implementing evidence-based practice within stroke rehabilitation. The paper presents an implementation study, based on an action research approach in collaboration with three occupational therapy settings, which included 25 occupational therapists. Field observations, focus group interviews and case report-based interviews were used for data gathering. The findings concerning the facilitation of the implementation processes are presented and discussed. Finally, new knowledge of how occupational therapy cultures and evidence-based practice interact is deduced.
Occupational therapy in stroke rehabilitation
Occupational therapy interventions improve the outcomes for stroke patients in everyday life occupations, including activities of daily living and social participation (Legg et al 2006). Occupational therapy is, therefore, a recommended part of early rehabilitation in stroke units, according to the National Clinical Guidelines for Stroke from Denmark, the United Kingdom, Australia, the United States, New Zealand and Sweden (Kristensen et al 2010).
Acute stroke is the one of the leading causes of morbidity and mortality worldwide. Stroke is the most important cause of morbidity and long-term disability in Europe, and imposes an enormous economic burden (European Stroke Organisation 2009). Stroke often affects the individual performance of everyday life activities and participation. Everyday life activities are a central concept in occupational therapy practice, and are considered to give meaning to and organisation in everyday life (Townsend et al 2002). In this framework, health and wellbeing are influenced by having choice, control and the ability to engage in everyday life activities. New patterns of everyday life activities are required when health is challenged.
Evidence-based practice, initially developed in the area of medicine, has current interest for every health profession (Law 2002). Evidence-based medicine was defined as 'The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients' (Sackett et al 1996, p71), and has expanded into evidence-based practice in which the practitioner aims at creating a practice, integrating knowledge from patients' experiences and preferences, research-based evidence and clinical expertise while making clinical decisions in local contexts (Rycroft-Malone et al 2004). Due to increasing demands for documentation and evidence-based practice, many professionals in health services experience changes in organisation and working practice. These trends are seen as the result of social and economic changes, thus dictating demands for higher quality combined with efficient use of resources (Bennett and Bennett 2000). Nevertheless, a lack of the use of evidence from research to make informed decisions in health services is evident among all groups of decision makers (Straus et al 2009).
Implementation of evidence-based occupational therapy
The shift to evidence-based practice is critical to the continued development of occupational therapy (Finlayson et al 2005). In recent years, much emphasis has been placed on occupational therapists learning to read and evaluate research literature and then to integrate the new knowledge into clinical practices to support decision making and to enhance outcomes for their clients (Law 2002). However, when discussing the gap between research and practice, Kielhofner (2005) pointed to the fact that there is evidence that the growth theory and research produced by academics are not consistently translated into occupational therapy practice. Practitioners report that they find theory and research to be of limited relevance or difficult to implement in their everyday work (Kielhofner 2005). …