Promoting Evidence-Based Practice: The Influence of Novel Structural Change to Accelerate Translational Rehabilitation

• Published in: Archives of physical medicine and rehabilitation Vol. 104; no. 8; pp. 1289 - 1299
• Main Authors: Rafferty, Miriam, Stoff, Laura, Smith, Justin D., Hansen, Piper, Briody, Melissa, Diaz, Carmen, O'Donnell, Leslie, Heinemann, Allen W., Brown, C. Hendricks, Lieber, Richard L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2023
• Subjects: Attitude of Health Personnel; Evidence-Based Practice; Health Personnel; Hehabilitation; Hospital; Humans; Implementation science; Interdisciplinary communication; Interdisciplinary health team; Learning health system; Physical medicine and rehabilitation; Physicians; Rehabilitation centers; Rehabilitation research; Surveys and Questionnaires; Translational research; Interdisciplinary health team; Evidence-based practice; Implementation science; Rehabilitation centers; Learning health system; EBPAS; SRAlab; Interdisciplinary communication; Translational research; EBP; ANOVA; OCRBS; Hospital; Hehabilitation; Physical medicine and rehabilitation; EBPQ; Rehabilitation research
• ISSN: 0003-9993; 1532-821X; 1532-821X
• DOI: 10.1016/j.apmr.2023.02.014

To evaluate changes in clinicians’ use of evidence-based practice (EBP), openness toward EBP, and their acceptance of organizational changes after a rehabilitation hospital transitioned to a new facility designed to accelerate clinician-researcher collaborations.
Three repeated surveys of clinicians before, 7-9 months, and 2.5 years after transition to the new facility.
Inpatient rehabilitation hospital.
Physicians, nurses, therapists, and other health care professionals (n=410, 442, and 448 respondents at Times 1, 2, and 3, respectively).
Implementation of physical (architecture, design) and team-focused (champions, leaders, incentives) changes in a new model of care to promote clinician-researcher collaborations.
Adapted versions of the Evidence-Based Practice Questionnaire (EBPQ), the Evidence-Based Practice Attitudes Scale (EBPAS), and the Organizational Change Recipients’ Beliefs Scale (OCRBS) were used. Open-ended survey questions were analyzed through exploratory content analysis.
Response rates at Times 1, 2, and 3 were 67% (n=410), 69% (n=422), and 71% (n=448), respectively. After accounting for familiarity with the model of care, there was greater reported use of EBP at Time 3 compared with Time 2 (adjusted meant2=3.51, standard error (SE)=0.05; adj. meant3=3.64, SE=0.05; P=.043). Attitudes toward EBPs were similar over time. Acceptance of the new model of care was lower at Time 2 compared with Time 1, but rebounded at Time 3 (adjusted meant1=3.44, SE=0.04; adj. meant2=3.19, SE=0.04; P<.0001; adj. meant3=3.51, SE=0.04; P<.0001). Analysis of open-ended responses suggested that clinicians’ optimism for the model of care was greater over time, but continued quality improvement should focus on cultivating communication between clinicians and researchers.
Accelerating clinician-researcher collaborations in a rehabilitation setting requires sustained effort for successful implementation beyond novel physical changes. Organizations must be responsive to clinicians’ changing concerns to adapt and sustain a collaborative translational medicine model and allow sufficient time, probably years, for such transitions to occur.