Bridging the Know-do Gap: Using Implementation Science to Translate Best Practice for the Neurologically Affected Upper Extremity

Research Objectives: To determine the barriers and facilitators to implementing evidence-based practice (EBP) for the neurologically impaired upper extremity among occupational therapists in an outpatient rehabilitation setting.

Design: A mixed methods study involving focus groups comprised of occupational therapists from an outpatient rehabilitation center, along with documentation audits and surveys. The study will be conducted in three phases: pre-implementation, implementation, and post-implementation. Pre-implementation phase includes focus groups with occupational therapists, documentation audits, and surveys. The focus groups will determine the occupational therapists’ baseline knowledge of EBP for the neurologically impaired upper extremity, perceived barriers to EBP use, and selection of implementation strategies. Documentation audits and surveys will assess baseline knowledge and use of EBP in daily practice. The implementation phase will include implementing the EBP using the strategies selected during the focus groups. The post-implementation phase includes a survey and documentation audits to determine the adoption and sustainability of EBP.

Setting: An outpatient rehabilitation center in an urban area.

Participants: Nine outpatient occupational therapists.

Interventions: This study intervention will be implementing the following strategies to facilitate EBP: identifying and preparing a champion, conducting educational meetings, developing educational materials, and creating a learning collaborative for the occupational therapists.

Main Outcome Measures: Documentation audits; surveys.

Results: A total of 8 occupational therapists completed the survey, yielding a response rate of 87%. None of the respondents reported feeling ‘very confident’ when selecting interventions supported by evidence with 75% of respondents reported feeling ‘confident’ and 25% of respondents reported feeling ‘somewhat confident’. Further, 50% of respondents reported ‘never’ using constraint induced movement therapy in clinical practice, an EBP that has strong evidence supporting its use with the neurological population. Documentation audits showed that 85.7% of documented upper extremity treatments were not evidence-based interventions. Focus groups were conducted with a total of 9 occupational therapists. The occupational therapists identified several barriers to implementing EBP including time constraints related to patient caseloads, lack of materials and equipment, struggles with relative priorities, and a need for increased motivation for change. These barriers were mapped to Consolidated Framework for Implementation Research 2.0 constructs, specifically opportunity and motivation of the intervention deliverer, tension for change, and resources of the inner setting.

Conclusions: The study aims to bridge the gap between research and practice by increasing the use of EBP. Our findings will inform how to improve the implementation of EBP in clinical practice, leading to better patient outcomes.

Author(s) Disclosures: The authors have no conflicts of interest.