College of Occupational Therapy Annual Conference 2017 An exploration of the attitudes, knowledge and ability of Occupational Therapists in applying evidence to practice Samantha Turner Lecturer in Occupational Therapy University of Plymouth @mampy1985 #COT2017

Plan for session Provide a brief overview of the article Identify the main findings Engage in a critical discussion related to the article Discuss the recommendations Identify key learning points to take home Occupational therapists’ attitudes, knowledge, and implementation of evidence-based practice: A systematic review of published research (Upton et al., 2014)

Overview Aim- to synthesise the findings from research related to the attitudes, utilisation, knowledge and understanding of evidence-based practice (EBP) Systematic review using a narrative analysis approach Published research between 2000-2012 within peer reviewed journals 32 papers were selected - 23 quantitative, 8 qualitative and 1 mixed methods design McMaster critical appraisal tool (Law et al., 1998) PRISMA flow chart Greenhalgh (2015) identifies the importance of guiding decision making in practice by having a balance between the use of epidemiological evidence, clinical judgement and the patients’ perspective. There were a total of 32 papers selected for review. Each of the papers main findings were produced in a clear table. The findings were split into a few main headings- attitudes and values toward EBP, research based practice and traditional methods and education, knowledge surrounding EBP, implementation of EBP, perceived limits and barriers to EBP implementation Occupational therapists’ attitudes, knowledge, and implementation of evidence-based practice: A systematic review of published research (Upton et al., 2014)

Findings Disparity- attitudes and behaviour Enhances credibility Attitudes/Values Research Education Implementation Disparity- attitudes and behaviour Enhances credibility Too much effort Difficult transition Ensuring up to date knowledge Time constraints Inapplicable to practice Positive in demonstrating effectiveness Informing knowledge gaps Client centeredness & EBP Limited searching & appraisal skills Higher educational attainment = positive attitude PG study Academic hospital Recent graduates Consistent results in lack of utilisation Relying on colleagues ? Difference between OT & other AHP’s Organisational factors Years of practice As you can imagine some of these the findings were the same across the themes.

Perceived limits and barriers Workload/time Pressures Insufficient staff/resources/finances Lack of training/knowledge Lack of organisational support/culture Relevance/applicability/availability and quality of evidence Conflict with client centred practice

Critical analysis Is this really a review of EBP in its entirety? (Strauss et al., 2011) Narrative literature reviews are at risk of confirmation bias Potential publication bias due to only using peer reviewed articles Most of the reviewed research used convenience sampling ? Limited representativeness and generalisability 1. The term EBP was used however there was a lack of clarity as to whether the articles reviewed were discussing EBP in relation to the 5 step process or just parts of it Occupational therapists’ attitudes, knowledge, and implementation of evidence-based practice: A systematic review of published research (Upton et al., 2014)

Recommendations Dedicated staff members Journal clubs Mentoring Training and education initiatives Development of future generation Research collaboration Potential use of dedicated staff members in organisations who can search for relevant evidence and distribute between staff group It identifies the use of journal clubs to review evidence It highlights the importance of using mentoring as a way to support peers in developing these skills Need for educational and training initiatives to build confidence and skill Importance of HE institutions developing research confident practitioners Occupational therapists’ attitudes, knowledge, and implementation of evidence-based practice: A systematic review of published research (Upton et al., 2014)

Discussion Has this article supported your thinking related to the use of EBP or has it challenged it? Have you got any further comments in relation to the critique of this review? How has this article encouraged your thinking about EBP? Do any of the findings relate to your area of practice? What ideas could you take from this article to improve EBP in your clinical setting? Occupational therapists’ attitudes, knowledge, and implementation of evidence-based practice: A systematic review of published research (Upton et al., 2014)

Concluding thoughts… There is a disparity within our profession related to EBP While there are a range of barriers there are also a range of opportunities – consider these in your own practice Could a few minor changes lead to more effective implementation of EBP to benefit the client and our profession? Occupational therapists’ attitudes, knowledge, and implementation of evidence-based practice: A systematic review of published research (Upton et al., 2014)

Contact details Email: samantha.turner@plymouth.ac.uk Address: Plymouth University School of Health Professions Faculty of Health and Human Sciences Peninsula Allied Health Centre Room SF24 Derriford Road Plymouth PL68BH Tel: 01752586737 Twitter: @mampy1985

Reference list Critical Appraisal Skills Programme (CASP) (2013) Systematic Review Checklist. Oxford: CASP. Available at: http://www.casp-uk.net Greenhalgh, T. (2015) Real vs Rubbish EBM. Available at: https://www.youtube.com/watch?v=qYvdhA697jI Law, M., Stewart, D., Pollock, N., Letts, L., Bosch, J. & Westmorland, M. (1998) Guidelines for Critical Review Form: Quantitative Studies. Available at: http://www.srs- mcmaster.ca/Portals/20/pdf/ebp/quanguidelines.pdf Strauss, S.E., Richardson, W.S., Glaszious, P. & Haynes, R.B. (2011) Evidence-based medicine: how to practice and teach EBM (4th ed). Edinburgh, Scotland: Churchill Livingstone. Upton, D., Stephens, D., Williams, B. and Scurlock-Evans, L. (2014) ‘Occupational therapists’ attitudes, knowledge, and implementation of evidence-based practice: A systematic review of published research’, British Journal of Occupational Therapy, 77(1), pp. 24–38. Doi: 10.4276/030802214X13887685335544