Browsing by Subject "evidence-based practice"

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    Open Access
    A South African perspective: audiologists' and otologists' orientation to, and use of evidence-based practice with reference to benign paroxysmal positional vertigo
    (2021) Naidoo, Tanaya Ellen Ravi; Rogers, Christine
    Evidence-based practice, whose roots emanate from the mid-1960s, aims to provide fair, high-quality, and soundly researched health care with patients' best interests as a priority. Clinical practice guidelines are evidence-based and designed to assist clinicians with sound decision making. Despite the importance of evidence-based practice and the efforts invested into its development and dissemination, its uptake and implementation are poor. The disconnect between evidence-based practice and its translation into clinical practice was previously reported in low-to-middle income countries. This study investigated South African audiologists' and otorhinolaryngologists' (ear, nose and throat specialists') self-reported orientation to evidence-based practice. Second, adherence to evidence-based clinical practice guidelines was assessed with reference to the diagnosis and management of benign paroxysmal positional vertigo, a common vestibular condition for which a firm evidence base supporting treatment exists. A two-part quantitative approach was adopted. Part one surveyed South African audiologists and otorhinolaryngologists with the Evidence-Based Practice Profile Questionnaire and an additional researcher-developed questionnaire pertaining to the diagnosis and management of benign paroxysmal positional vertigo. A total of 130 survey responses were included in this study. Independent sample t-tests, one-way ANOVAs and Fisher's Exact tests were used to analyse the survey data. Part two used a retrospective record review at a tertiary academic hospital in the Western Cape of South Africa. Medical folders of patients diagnosed with benign paroxysmal positional vertigo, between 2010 – 2018 (n = 80), were analysed. The diagnosis and management strategies were recorded and compared against a gold standard evidence based guideline for congruence. Descriptive statistics were used to analyse and understand the data. Survey scores showed a positive association between increased years of experience and healthcare professionals' knowledge (p = .008) and confidence (p = .003) in evidence-based practice. Otorhinolaryngologists might be more knowledgeable than audiologists in evidence-based practice due to their increased training and exposure to evidence-based practice in their specialising years. Findings from the retrospective record review suggested adherence to the clinical practice guidelines in the diagnosis and management of posterior semi circular canal benign paroxysmal positional vertigo. The study outcomes propose that evidence-based clinical practice guidelines developed in the Global North may not be appropriate for the different health contexts that exist in low-to-middle income South Africa (e.g., rural settings). However, the benign paroxysmal positional vertigo clinical practice guidelines were adhered to at a tertiary, academic hospital in Cape Town. The results also support the notion that increased exposure to evidence-based practice reinforces its approach. Outcomes from this study raise implications for the development and dissemination of context-appropriate, evidence-based clinical practice guidelines.
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    Clinicians' knowledge, attitudes and behaviours towards evidence-based practice using clinical presentations of dizziness and vertigo as an exemplar
    (2022) Clarke, Richard Matthew; Rogers, Christine
    Evidence-based practice (EBP) is an approach to clinical decision-making that incorporates well-researched and established scientific knowledge with other sources of knowledge such as practitioner experience, patient preferences, and clinical context. Use of EBP aims to provide standardised care, which is rooted in the best available evidence. Among the most important and arguably clinically relevant outcomes of EBP are Clinical Practice Guidelines (CPG), which cover a variety of topics in medicine and associated professions. CPG exist for vestibular conditions, which are prevalent in the general and medical populations. Nevertheless, there is some suggestion that EBP regarding dizziness is sub-optimal in wealthy countries, and little is known about CPG use in LMIC, particularly across the professions that would be expected to use them. However, despite the availability and proliferation of evidence in the health sciences, research has shown that uptake and utilisation of EBP is poor even in the Global North. In low- and middle-income countries (LMIC) such as South Africa where resources are scarce, previous research has suggested that additional challenges exist which are specific to the developing context. There is, however, little research on translation of EBP into clinical practice. Thus, this study sought to investigate the knowledge, attitudes, and practices towards evidence-based practice of a specific subset of South African clinicians (audiologists, otorhinolaryngologists, and physiotherapists) in South Africa, using assessment and management of dizzy patients as an exemplar. Mixed methodology achieved the study's aims. Phase one employed a two-part questionnaire. Fifty-four participants, comprising 37 audiologists, five Ear, nose and throat surgeons (ENTs), and nine physiotherapists were surveyed to identify their orientation towards EBP using the Evidence-Based Practice Profile Questionnaire (EBP2Q). Independent samples t-tests and one-way ANOVAs were used to analyse the EBP2Q data. Three cases of common vestibular pathologies (Ménière's disease, vestibular migraine, and persistent postural perceptual dizziness) based on the CPG, were developed by the researcher and a Delphi panel of experts. Survey participants answered questions regarding implementation of CPGs in each case. Cases were scored according to matches with the CPGs. Phase two adopted a qualitative, descriptive approach and comprised four mini focus groups with a total of 10 participants representing the three professions surveyed. The focus groups aimed to explore participants' self-perceived barriers and facilitators to the use of EBP in general as well as in the context of dizzy patients. The most clinically relevant result was that the case questionnaire analysis revealed that approximately half of participants were able to identify Meniere's disease and vestibular migraine, whereas only one quarter of participants could identify the case of functional dizziness. Focus groups revealed barriers to the use of EBP such as lack of access to research and lack of time to research. Furthermore, participants recognised that the complexity of dizzy patients had led to sub-optimal assessment and management of such patients. Quantitative results of the current study suggested that participants with additional exposure to research through postgraduate training had higher scores on the EBP2Q in four out of five domains and the total questionnaire score than those with undergraduate training only. These results were consistent with previous research from wealthy countries which suggested that increased exposure through postgraduate training and working at academic facilities results in better orientation towards EBP. However, mean domain scores amongst participants in studies from wealthy countries appear to be higher than those from the sample on the current South African study, although it is difficult to tell whether the difference is statistically significant. Additionally, there was no apparent influence of years' experience on orientation towards EBP, contradicting what has been found in previous research. Outcomes of the study suggest that while healthcare practitioners have good attitudes towards EBP, it is more effectively implemented by clinicians with postgraduate training. Further, ease of access and exposure to research is the greatest facilitator to use of research and EBP by clinicians. Despite that, barriers to uptake and utilisation of EBP such as lack of access to research, lack of contextually relevant research, and low confidence at appraising literature were described. In addition, barriers common to the Global North and Global South were recognised such as lack of time to conduct literature searches and overburdening of clinical staff. Finally, a gap was noted in the knowledge of practitioners managing dizzy patients, specifically regarding patients with functional dizziness. Thus, this study highlights the need for use and application of EBP to the management of dizzy patients. Additional training of audiologists, ENTs and physiotherapists may be required regarding effective, multidisciplinary management of dizzy patients.
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    Comparison of an interactive with a didactic educational intervention for improving the evidence-based practice knowledge of occupational therapists in the public health sector in South Africa: a randomised controlled trial
    (2014-06-10) Buchanan, Helen; Siegfried, Nandi; Jelsma, Jennifer; Lombard, Carl
    Background: Despite efforts to identify effective interventions to implement evidence-based practice (EBP), uncertainty remains. Few existing studies involve occupational therapists or resource-constrained contexts. This study aimed to determine whether an interactive educational intervention (IE) was more effective than a didactic educational intervention (DE) in improving EBP knowledge, attitudes and behaviour at 12 weeks. Methods: A matched pairs design, randomised controlled trial was conducted in the Western Cape of South Africa. Occupational therapists employed by the Department of Health were randomised using matched-pair stratification by type (clinician or manager) and knowledge score. Allocation to an IE or a DE was by coin-tossing. A self-report questionnaire (measuring objective knowledge and subjective attitudes) and audit checklist (measuring objective behaviour) were completed at baseline and 12 weeks. The primary outcome was EBP knowledge at 12 weeks while secondary outcomes were attitudes and behaviour at 12 weeks. Data collection occurred at participants’ places of employment. Audit raters were blinded, but participants and the provider could not be blinded. Results: Twenty-one of 28 pairs reported outcomes, but due to incomplete data for two participants, 19 pairs were included in the analysis. There was a median increase of 1.0 points (95% CI = -4.0, 1.0) in the IE for the primary outcome (knowledge) compared with the DE, but this difference was not significant (P = 0.098). There were no significant differences on any of the attitude subscale scores. The median 12-week audit score was 8.6 points higher in the IE (95% CI = -7.7, 27.0) but this was not significant (P = 0.196). Within-group analyses showed significant increases in knowledge in both groups (IE: T = 4.0, P <0.001; DE: T = 12.0, P = 0.002) but no significant differences in attitudes or behaviour. Conclusions: The results suggest that the interventions had similar outcomes at 12 weeks and that the interactive component had little additional effect.
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    Fostering evidence-based practice in community-based rehabilitation: strategies for implementation
    (2015-08) Buchanan, Helen; Lorenzo, Theresa; Law, Mary
    Occupational therapists around the world are taking up the challenge to implement an evidence-based practice approach to the development of occupational therapy services. The emphasis in applying evidence-based practice within occupational therapy has been strongly biomedical in focus. In South Africa, many occupational therapists work in communities where their work is largely community-based rehabilitation. With no examples of how evidence-based practice can be applied in such settings, therapists have struggled with how it may be used to inform their practice. This paper explores the concepts of evidence-based practice and community-based rehabilitation, and illustrates how evidence-based practice can be applied within community-based rehabilitation. Examples are provided to show how evidence-based practice can realistically be applied in community-based rehabilitation programmes with the intention of empowering therapists to begin using evidence as a basis for their practice. It further explores how evidence-based practice can be used by occupational therapists to inform decision-making related to the development of community-based rehabilitation programmes and services.
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    Levels of research evidence in health policy assessment in Malawi
    (2019) Mapulanga, Patrick; Raju, Jaya; Matingwina, Thomas
    Purpose – The paper examines levels of health research evidence in health policies in Malawi. Design/Methodology/Approach – The study selected a typology of health policies in Malawi from 2002 to 2017. The study adopted the SPIRIT conceptual framework and assessed the levels of research evidence in health policy, systems and services research using the revised SAGE policy assessment tool. Documentary analysis was used to assess levels of health research evidence in health policies in Malawi. Findings – In 29 (96.7%) of the health policies, policy formulators including healthcare directors and managers used generic search engines such as Google or Google Scholar to look for heath research evidence. In 28 (93.3%) of the health policies they searched for grey literature and other government documents. In only 6 (20%) of the heath policy documents, they used academic literature in a form of journal articles and randomised controlled trials. No systematic reviews or policy briefs were consulted. Overall, in 23 (76.7%) of the health policy documents research evidence played a minimal role and had very little influence on the policy documents. Research limitations/implications – The empirical evidence in the health policy documents are limited due to insufficient research citation, low retrievability of health research evidence in the policy documents and biased selectivity of what constitutes health research evidence. Practical implications – The paper indicates that unfiltered information (data from policy evaluations and registries) constitutes majority of the research evidence in health policies both in health policy, systems and services research. The paper seeks to advocate for the use of filtered information (peer reviewed, clinical trials and data from systematic reviews) in formulating health policies. Originality/value – There is dearth of literature on the levels of health research evidence in health policy-making both in health policy, systems and services research. This study seeks to bridge the gap with empirical evidence from a developing country perspective.
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    Practice-based evidence: evaluating the quality of occupational therapy patient records as evidence for practice
    (2016-04) Buchanan, Helen; Jelsma, Jennifer; Siegfried, Nandi
    Background: Occupational therapy patient records are required for legal purposes, but may also be used to produce evidence for practice. Our aim was to establish how comprehensively occupational therapists documented patient records. Methodology: We conducted a descriptive cross-sectional study of occupational therapists at public health facilities in a South African province. Trained raters audited five randomly-drawn records per participant using a checklist developed for the study. The maximum possible score was nine and the lowest was zero. Audits were checked for consistency. Results: Forty-nine occupational therapists participated and 240 records were audited. Records contained information on intervention (96%) and changes occurring at impairment (82%) and activity and participation levels (64%). Documentation of baseline assessment (impairment level: 20%; activity and participation level: 10.4%) and re-assessment (impairment level: 7%; activity and participation level: 0.0%) was limited. Audit scores were significantly better in the work practice area (H=16.10, p=0.003) and among therapists in urban areas (U=24.50, p<0.001).There was a significant negative correlation between audit score and number of clients seen per month (rs=-0.46, p<0.001). Conclusion: The low audit scores suggest that the records did not contain sufficient information to produce robust evidence. Manageable ways of documenting occupational therapy practice need to be devised.