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

Arch Phys Med Rehabil. 2023 Mar 14:S0003-9993(23)00149-1. doi: 10.1016/j.apmr.2023.02.014. Online ahead of print.


OBJECTIVE: To evaluate changes in clinicians’ use of evidence-based practice, openness toward evidence-based practice, and their acceptance of organizational changes after a rehabilitation hospital transitioned to a new facility designed to accelerate clinician-researcher collaborations.

DESIGN: Three repeated surveys of clinicians before, 7-9 months and 2.5 years after transition to the new facility.

SETTING: Inpatient rehabilitation hospital.

PARTICIPANTS: Physicians, nurses, therapists, and other healthcare professionals (410, 442, and 448 respondents at time 1, 2, and 3 respectively).

INTERVENTIONS: Implementation of physical (architecture, design) and team-focused (champions, leaders, incentives) changes in a new model of care to promote clinician-researcher collaborations.

MAIN OUTCOME MEASURES: 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.

RESULTS: 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 evidence-based practice at Time 3 compared to Time 2 (adjusted meant2=3.51, standard error (SE)=0.05; adj. meant3=3.64, SE=0.05; p=0.043). Attitudes toward evidence-based practices were similar over time. Acceptance of the new model of care was lower at Time 2 compared to 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.

CONCLUSIONS: 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.

PMID:36924817 | DOI:10.1016/j.apmr.2023.02.014

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