Date Presented 04/02/2022
This study consisted of an electronic survey distributed to licensed Ohio OTs and PTs, which identified the evidence-based interventions used by therapists for the treatment of children ages 0-3 with cerebral palsy (CP), the frequency of intervention use, and the facilitators and barriers to evidence-based practice (EBP) use. Overall, therapists view EBP as important and possess skills to engage in EBP but do not frequently use EBP because of several barriers. This study provides recommendations for workplaces to facilitate EBP use in practice.
Primary Author and Speaker: Aminah Baig
Additional Authors and Speakers: Ellie Cecala, Laney Gallagher, Elizabeth Gick
Contributing Authors: Claire Morress
PURPOSE: Evidence suggests the need for infants diagnosed with, at risk for developing, or suspected of having cerebral palsy (CP) to receive current evidence-based interventions to optimize neuroplasticity and increase functional motor outcomes (Novak et al., 2017). Past studies show occupational therapists (OTs) and physical therapists (PTs) have difficulty incorporating evidence into practice due to barriers therapists face (Alshehri et al., 2019; Dopp et al., 2012). The purpose was to identify evidence-based interventions used by Ohio OTs and PTs for the treatment of infants, ages 0 to 3 years, with CP, the frequency with which OTs and PTs use evidence-based interventions, and the facilitators and barriers to evidence-based practice (EBP).
DESIGN: A descriptive study was conducted using an anonymous online survey, including 31 questions (e.g., multiple-choice, Likert-scale, select all that apply, and open-ended questions). The survey instrument was divided into topics including demographic questions, EBP usage, barriers and facilitators to EBP use, and interventions used in the treatment of CP. Respondents were Ohio OTs and PTs who treat the population.
METHOD: Quantitative survey data were collected and analyzed using the Qualtrics Survey Software report function. Nominal data were analyzed using frequencies and percentages. Ordinal data were analyzed using frequencies, percentages, and means. Qualitative data were analyzed thematically.
RESULTS: 174 participants completed the survey; however, not all respondents answered each question, thus the sample size per question varies. Most participants (93%) believe EBP is important for making clinical decisions, but only (44%) frequently use evidence to develop interventions for infants with CP. Participants who had been practicing for ≤ 10 years stated EBP was more important compared to those practicing for ≥ 11 years. Participants with a higher level of education rated EBP as more important compared to those with a bachelor’s degree. Most participants (78%) reported having access to literature; however, 72% of participants noted the barrier of lacking time to find and read evidence. Most participants noted sufficient knowledge to find, evaluate, and use research evidence (81%) and were motivated to find new interventions (89%). Participants identified using home activity programs (96%), which have a high level of evidence, and infrequently using CIMT (43%) and bimanual therapy (57%), despite these interventions having high evidence. Therapists reported frequently using neurodevelopmental therapy (NDT; 32%) and sensory regulation (49%), which are not recommended interventions for improving motor function in infants with CP (Novak et al., 2020).
CONCLUSION: Therapists use interventions that have not shown to improve motor outcomes in infants with CP. This finding paired with infrequent use of CIMT and bimanual therapy suggests that some Ohio therapists may not be using interventions that are shown to optimize upper extremity motor function in infants with CP. Therapists possess the skills to find and use EBP and believe it is important for making clinical decisions, however barriers such as time prevent them from doing so. A facilitator to EBP use is being a newer practitioner, as these individuals recently learned how to use EBP. More therapists in this study reported access to literature and having the skills to find, evaluate, and use EBP than previously reported (Upton et al., 2014). Thus, in practice, therapists are not consistently using interventions with high levels of evidence to treat infants with CP. Evidence-based interventions are necessary for infants with CP to maximize the effectiveness of interventions during the critical period of greatest neuroplasticity.
References
Anaby, D., Korner-Bitensky, N., Steven, E., Tremblay, S., Snider, L., Avery, L., & Law, M. (2017). Current rehabilitation practices for children with cerebral palsy: Focus and gaps. Physical & Occupational Therapy In Pediatrics, 37(1), 1–15. https://doi.org/10.3109/01942638.2015.1126880
Marr, D. (2017). Centennial topics: Fostering full implementation of evidence-based practice. American Journal of Occupational Therapy, 71, 7101100050. https://doi.org/10.5014/ajot.2017.019661
Novak, I., Morgan, C., Fahey, M., Finch-Edmonson, M., Galea, C., Hines, A., Langdon, K., McNamara, M., Paton, M. CB., Popat, H., Shore, B., Khamis, A., Stanton, E., Finemore, O.P., Tricks, A,. te Velde, A., Dark, L., Morton, N., & Badawi, N. (2020). State of the evidence traffic lights 2019: Systematic review of interventions for preventing and treating children with cerebral palsy. Current Neurology and Neuroscience Reports, 20(3), 1-21. https://doi.org/10.1007/s11910-020-1022-z
Upton, D., Stephens, D., Williams, B., & Scurlock-Evans, L. (2014). Occupational therapists’ attitudes, knowledge, and implementation of evidence-based practice: a systematic review of published research. British Journal of Occupational Therapy, 77(1), 24-38. https://doi.org/10.4276/030802214X13887685335544
