JCPSLP Vol 16 Issue 1 2014

Table 2. Critically appraised article

Article purpose To evaluate the clinical and cost effectiveness of two KTE interventions to promote the uptake of research evidence (clinical guideline adherence) in speech pathology management of post stroke dysphagia. Pennington et al. (2005). Promoting research use in speech and language therapy: A cluster randomized controlled trial to compare the clinical effectiveness and costs of two training strategies. Clinical Rehabilitation, 19, 387–397. Two speech pathologists from 17 departments (n = 34) participated in training with the aim of cascading the training through to their local departments. Education–professional education meetings (EPOC). Intervention A consisted of training on the principles of EBP and critical appraisal of published guidelines. Intervention B contained the same training plus information on change definition) management theory (Diffusion of innovations). Outcome measures Clinician behaviour change and service level outcomes (cost comparison of Intervention A and B). Guideline adherence measured prior to and six months after intervention using retrospective audit tool across 708 clients (Intervention A) and 762 clients (Intervention B). Results Mean adherence prior to the KTE intervention was 73%. There was great variation in pre training adherence and improvement among departments. Neither approach significantly improved adherence. SLPs who received the change management theory engaged in significantly more research activities initially, but this was not maintained at 6 months. The range of costs between intervention A and B were similar. No client outcome measures utilised and there was no blinding of the assessor. Although implementation barriers such as the generic nature of the education and whether or not the SLPs were opinion leaders were discussed by the authors, the study did not assess and target intervention to those barriers (tailored intervention). It also did not explicitly ask departments to choose opinion leaders who may have been able to encourage change. Mean initial adherence was already relatively high overall at 73% meaning that for some departments there was not a lot of room for change. Sustained change not addressed explicitly in the intervention. While there were no significant differences in the overall outcomes of the study for each KTE intervention, targeting many of the study’s limitations may have enhanced the outcome considerably and may provide important lessons for future interventions. Limitations Summary Article citation Level of evidence Level II, pragmatic cluster RCT study design Participants Intervention (including EPOC

Table 3. Summary of a variety of intervention types to influence the uptake of research evidence into practice based on the EPOC taxonomy

Intervention types for professionals Dissemination of education materials

Details. Note “providers” could be considered rehabilitation teams or clinicians.

Printed or electronic publications that contain recommendations for clinical care and evidence to improve practices,

including clinical practice guidelines – may be unsolicited through mass mailing or delivered personally. Educational meetings Conferences, workshops, lectures – may be largely dydactic “sit and listen” or more interactive events. Local consensus

Inclusion of participating providers in discussion to ensure that they agree that the chosen clinical problem was important

processes

and the approach to managing the problem was appropriate (e.g., stroke working parties).

Education outreach

Use of a trained person (may be an academic) who meets with providers in their practice settings to give information with

visits the intent of changing the provider’s practice. May include feedback on the performance of the provider(s). Local opinion leaders Individuals who are able to influence the attitudes or behaviours of others. The researchers must have explicitly stated that local colleagues identified the leaders. Client-mediated Intervention aimed at changing professionals’ behaviour through interactions with, or information provided by, or to, interventions for clients. Note: This is different to direct education of clients to change their own behaviours. professionals Audit and feedback Any summary of clinical performance of health care over a specified period of time. The summary may also have included recommendations for clinical action. The information may have been obtained from medical records, computerised databases, or observations from clients. Clinicians may be familiar with audit and feedback from quality improvement initiatives. Information provided verbally, on paper or a computer screen/device that prompts a professional to recall information. Tailored interventions Use of interviewing, group discussion (“focus groups”), or a survey of targeted providers to identify barriers to change and subsequent design of an intervention that addresses identified barriers. Mass media Use of communication that reached great numbers of people including television, radio, newspapers, posters, leaflets, and booklets, alone or in conjunction with other interventions. Multifaceted Any intervention that includes two or more components above. interventions Source: from http://www.epoc.cochrane.org Reminders

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JCPSLP Volume 16, Number 1 2014

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