GOOD, BETTER, BEST PRACTICE: LEVERAGING OT STUDENT … · GOOD, BETTER, BEST PRACTICE: LEVERAGING...
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GOOD, BETTER, BEST PRACTICE: LEVERAGING
OT STUDENT AND CAPSTONE PROJECTS
Lindsay Marth, MA, OTR/L, BCPR
Tonya Rich, PhD, OTR/L
MOTA Conference – October 26, 2019
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DISCLOSURE
• Lindsay Marth & Tonya Rich work for the Department of Veterans Affairs. The content of this presentation does not represent the position of the VA nor are any of the topics/content endorsed by the Federal Government.
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OBJECTIVES
Through engagement in the course participants will be able to:
•Describe the traffic light system as a tool for evaluating evidence.
•Identify strategies to communicate evidence with traffic light model in a format understandable to clinicians, family, and clients.
•Describe methods to structure Level II fieldwork and capstone projects for clinical utility and application of evidence based practice.
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STAGES OF TRANSLATIONAL RESEARCH
Clinical Research
Efficacy StudiesPreliminary Support
Comparative Effectiveness
What works best?Who responds to what intervention?Generate practice guidelines
Implementation Research
Observation of changing practice patterns.What are the barriers and facilitators to changing practice?How can we influence adoption?
(Unpublished)Good Better Best Practice- Marth and Rich for MOTA 2019
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EVIDENCED-BASED PRACTICE TO GUIDE CLINICAL DECISION MAKING
Research
Clinician Expertise
Client's Values and
Beliefs
The sweet spot…Evidenced Based Practice
(Unpublished)Good Better Best Practice- Marth and Rich for MOTA 2019
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LEVELS OF EVIDENCE FOR OT2
Systematic Reviews, Meta
Analyses
RCTs
Non-RCT, 2 groups
Non-RCT, 1 group
Descriptive Studies
Narratives, Case Studies, Expert Opinion, Consensus Statements
(Unpublished)Good Better Best Practice- Marth and Rich for MOTA 2019
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TRAFFIC LIGHT MODEL-MAKING EVIDENCE ACCESSIBLE FOR ALL
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http://www.connecthealth.co.uk/blog/stop-traffic-lights-signal-best-clinical-outcomes-connect/
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WHAT IS THE EVIDENCE FOR OUR INTERVENTIONS?
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Ideal Scenario
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Constraint Induced Movement Therapy?
Bimanual Motor Training?
NMES + and technology?
Pediatric Case-young boy s/p CVA what is the treatment plan?
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Now We Have Evidence Guiding Treatment
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Constraint Induced Movement Therapy
NMES + and technology
Bimanual Motor Training
Pediatric Case-young boy s/p CVA treatment plan
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WHAT IS THE EVIDENCE FOR OT (GULP!) ?
Good Better Best Practice- Marth and Rich for MOTA 2019
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Adapted from the AOTA EBP course with crediting Novak, Russel, & Ketelaar 2013
Lack of Evidence
• Education
Low Quality Evidence
• Small Group Meetings
• Communities of Practice
• Subject Matter Experts
Higher Quality Evidence
• Audit
• Peer Feedback
• Quality Improvement
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STUDENTS!!!
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MVAHCS STUDENT PROGRAM
• 16-20 Level II OT Students/ Yr
• Projects
• Collaborative with supervisor
• Proposal including supporting evidence
• Journal club and needs assessment with focus group
• Project development
• Presentation to OT department and additional as applicable
•How can they better support department EBP efforts?
•How can we create OTD capstone experiences that meet the needs of the students and the department?
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• “Through the partnership between a clinician and OTD student, implementing evidence-based practice increased clinician knowledge and confidence with a high-risk condition and facilitated meaningful changes in practice, ultimately leading to improved client outcomes.”
• Supports effort to increase practical usability and for student projects to support larger clinician and leadership goals.
Reifenberg, G. & Heinekamp, A. Using the Traffic Light System to Implement Evidence-Based Practice. OT Practice Nov 2018
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REIFENBERG & HEINEKAMP OT PRACTICE ARTICLE
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Reifenberg, G. & Heinekamp, A. Using the Traffic Light System to Implement Evidence-Based Practice. OT Practice Nov 2018
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OTD CAPSTONE EXPERIENCES
•Various Capstone Formats D.1.0 (ACOTE 2018) ▪Clinical practice skills
▪Research skills
▪Administration
▪Leadership
▪Program & policy development
▪Advocacy
▪Education
▪Theory development
Good Better Best Practice- Marth and Rich for MOTA 2019
Polytrauma Specialty Care• InterD team• Community
Integration• IADL skill
development• Literature
Review and Case presentation
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-Strongly recommend that occupational therapy practitioners routinely provide the intervention to eligible clients.
-Good evidence was found that the intervention improves important outcomes.
-Benefits substantially outweigh harm.
-Two or more studies with Level I evidence
STRONG
EVIDENCE
-Moderate evidence that OT practitioners routinely provide the intervention to eligible clients.
-Fair evidence was found that the intervention improves important outcomes.
-At least one study with Level I evidence, and level II and III evidence
MODERATE
EVIDENCE
-Weak evidence that the intervention can improve outcomes, OR
-Insufficient evidence to recommend for or against routinely providing the intervention.
-Evidence of the intervention is lacking, of poor quality, or conflicting, and the balance of benefits and harm cannot be determined.
WEAK
EVIDENCE
Adapted from Classen, Monahan, Auten, & Yarney (2014).
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LEVEL II PROJECT: PAIN SELF-MANAGEMENT
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Complete Literature Review & Needs
Assessment
Develop Evidence-Supported Handout
Record Video
Vignettes
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Additional Projects- Pain Management
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Sample: Handout
● Provides an explanation of nine self-management strategies for patients experiencing pain while in acute care setting…based on the evidence
● Strategies include:○ Deep Breathing ○ Meditation○ Guided Imagery○ Gentle Movement○ Progressive Muscle Relaxation○ Self-Massage○ Aromatherapy○ Hot/Cold Application○ Music
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Additional Student Projects
• Pain Treatment• Building on needs assessment and stop light, additional tools and videos to
overcome pain as barrier to ADL/IADL training in CLC
• Quality Improvement• Student with MPH and clinical research background built the “clock” for
completion of QI
• Follow-up: specialty third student completing project on driver’s pre-screen and behind the wheel
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PLANNED CAPSTONES AY 2019-2020
• Patient and Caregiver Education• Education and clinical skills: will build on handout guide and
video formats
• LSVT Big and Loud• Program development and clinical skills: will build on QI and stop
light
• Addressing Psychosocial Factors in Acute/ Sub-acute TBI• Program development and clinical skills: will build on QI and stop
light
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• PICO Workgroup projects & staff lead assessment of current practice
• Format to communicate information learned at a training or conference
• Method to organize education and training for new staff & students and to prioritize department education
• Format to objectively evaluate current practice areas while maintaining and respecting clinical experience/ judgment and patient choice
• Shared with national OT EBP group and on national VA OT call
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PICTURE CREDITS/REFERENCES
1. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
2. Classen, S., Monahan, M., Auten, B., & Yarney, A. (2014). Evidence-based review of interventions for medically at-risk older drivers. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 68(4), e107–e114. doi:10.5014/ajot.2014.010975
3. Novak, I. (2012). Evidence to Practice Commentary: The Evidence Alert Traffic Light Grading System. Physical & Occupational Therapy in Pediatrics, 32(3), 256–259. Retrieved from http://search.ebscohost.com.ezproxy.usd.edu/login.aspx?direct=true&db=eric&AN=EJ977618&site=ehost-live&scope=site
4. Novak I, Honan I. Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian Occupational Therapy Journal; April 2019. https://doi.org/10.1111/1440-1630.12573
5. Reifenberg, G. & Heinekamp, A. Using the Traffic Light System to Implement Evidence-Based Practice. OT Practice Nov 2018
6. http://www.connecthealth.co.uk/blog/stop-traffic-lights-signal-best-clinical-outcomes-connect/
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QUESTIONS?
•Contact Information:• [email protected]
Good Better Best Practice- Marth and Rich for MOTA 2019