TWEETCHAT: How can we close the gaps between evidence and practice? Aphasia and beyond

June 10, 2019 admin Uncategorized 0

The sixth #ResNetSLT tweet-chat of 2019 will take place on Wednesday 26th June 7:30-8:30 (UK Time) and be hosted by Amy Hilton and Kerry Corley .

The tweet-chat will be based around this paper: Closing the evidence-practice gaps in aphasia management: are we there yet? Where has a decade of implementation research taken us? A review and guide for clinicians by Kirstine Shrubsole, Linda Worrall, & Emma Power.

This paper discusses the process of changing the practice of speech and language therapists using knowledge from the evidence base. The process is similar to quality improvement (QI) projects SLT services regularly undertake. The paper evaluates six examples of implementation studies which aimed to improve the practice of SLTs and other staff working with people with aphasia in settings from acute to long-term rehabilitation.

The paper proposes multiple factors which clinicians should use to know how to bring about effective change in SLT practice:

  •  Identifying a specific personal or service priority for change.
  • Specifically tailoring the clinician behaviour you want to change to this priority.
  • Being aware of and selecting high quality evidence using, in this case, stroke clinical practice guidelines based on high methodological quality evidence. Dynamic, regularly-updated evidence portals such as those available through ASHA and the RCSLT websites are recommended.
  • Identifying the barriers to changing practice behaviours, such as time and clinician beliefs in how effective a new behaviour is. These must be specific to the service as, for example, studies found acute and rehabilitation settings had different outcomes in implementing new practice behaviours effectively.
  • Using a behaviour change framework such as the Theoretical Domains Framework (Michie et al., 2005) or Behaviour Change Wheel (Mackie and colleagues, 2011) to structure the process and understand which factors did and did not lead to change. The Behaviour Change Wheel considers how Capability, Opportunity, and Motivation influence Behaviour.
  • Evaluating the change using baseline and outcome measures both immediately and some time later using audits, surveys, and feedback.
  • Outcome measures including patient-based outcomes, and not only clinician self-reports.
  • Following reporting guidelines to ensure the process and findings are transparent and replicable by other services. Reporting guidelines include the Template for Intervention Description and Replication checklist (Hoffman et al., 2014) and Standards for Reporting Implementation Studies Statement (Pinnock et al., 2017).
  • Clinicians working with researchers to easily translate research into practice and base research on clinicians’ and patient’s experiences.

The paper ultimately concludes that implementation studies rarely cover all the above factors and therefore we have taken only small steps to closing the evidence-practice gap to improve outcomes for people with aphasia.

Questions that will be covered in the tweet-chat are:

  1. How have you/has your team used the evidence base to improve clinical practice? Have any of these examples let to a quality improvement project?
  2. What factors made this easy to do, and what barriers did you face? How could we overcome these barriers?
  3. How can clinicians help improve the degree to which research stems from real/patient-led clinical needs (in aphasia/generally)?
  4. What suggestions do you have for measuring the impact of change in clinical practice? Particularly, how do you include patient outcomes?

HERE’S THE SUMMARY OF THE CHAT …

Thanks for all who participated in June’s #ResNetSLT tweet chat! As always, the discussion was a lively and varied one! It was great to hear about so many quality improvement projects and implementation of research into practice. Some of the examples we heard were:

  • Development of an oral care bundle (prompt sheet to promote oral care kept in patient notes) to use on an acute stroke ward in response to an audit around stroke-associated pneumonia.
  • Journal clubs to discuss ways to implement research, such as speeded naming.
  • A quality improvement project aiming to reduce the number of SLT-related issues in an acute setting.
  • Securing funding to buy computer-based therapy programmes to support transition from an acute stroke unit to early supported discharge services.
  • A quality improvement project to reduce waiting list times.
  • Interviewing service users to ensure clinicians, researchers, and service users are included in development of service innovations.

It was acknowledged that there are often barriers to implementation and the #ResNetSLT tweet chat was a great forum to hypothesise about how these barriers could be overcome.

We also had a question asked by the lead author of the research paper, Kirstine Shrubsole @SpeechShrubs. She was keen to gather participants’ thoughts on how to decide what aspect of an aphasia service is a priority for change, and whether consumers have been involved in this process.

Participants were keen to share resources, which we have grouped here:

It’s great to be able to share how practitioners are implementing research. The RCSLT research page requested that any practice-based research examples are shared with them to be used on the website – so please keep sharing and get in touch with @RCSLTResearch!