Article type
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Abstract
Objectives: 1) To measure the gap between EBP and current practice in rheumatology, we observed the use of eight clinical practice guidelines (CPGs) (Ottawa Panel, 2004) during an Objective Structured Clinical Examination (OSCE): Step 1; 2) To identify barriers to and facilitators of the use of the Ottawa Panel CPGs, we surveyed occupational and physical therapists treating clients who have rheumatoid arthritis: Step 2.
Methods: For Step 1, eight 5-minute OSCE stations were created to assess the rehabilitation practitioners' knowledge and skills using a standardized checklist in relation to the application of the eight Ottawa Panel CPGs which were developed with the methodology of the Cochrane Collaboration. For Step 2, a cross sectional survey was E-mailed to all the practitioners (n=47) working at The Arthritis Society, Ontario Division (Canada). This E-mail survey consisted of open and closed-ended questions practitioners perceptions on barriers to and facilitators of the use of the eight specific Ottawa Panel CPGs according to four concepts: knowledge, clinical skills, work environment, and personal characteristics.
Results: For Step 1, the practitioners' performance in the OSCE has revealed an average of 65% (ranging from 43.5% and 85.2% with a standard deviation of 16), which represents a gap of 35% between current practice and EBP. Step 2: According to the practitioners, the most common barriers to the implementation of the CPGs were the lack of equipment, time constraints, the lack of appropriate knowledge, and the lack of financial resources. The most common facilitators included colleague consultation, accessibility of information and continuing education.
Conclusions: There is a need to implement effective rehabilitation interventions into the practice in the management of rheumatoid arthritis. This need was confirmed by 1) the observation of a gap between EBP and current practice, and 2) the identification of barriers to and facilitators of the use of the eight specific CPGs. The practitioners, were directly involved in the process, provided the perfect indications to build a tailored implementation strategy.
Methods: For Step 1, eight 5-minute OSCE stations were created to assess the rehabilitation practitioners' knowledge and skills using a standardized checklist in relation to the application of the eight Ottawa Panel CPGs which were developed with the methodology of the Cochrane Collaboration. For Step 2, a cross sectional survey was E-mailed to all the practitioners (n=47) working at The Arthritis Society, Ontario Division (Canada). This E-mail survey consisted of open and closed-ended questions practitioners perceptions on barriers to and facilitators of the use of the eight specific Ottawa Panel CPGs according to four concepts: knowledge, clinical skills, work environment, and personal characteristics.
Results: For Step 1, the practitioners' performance in the OSCE has revealed an average of 65% (ranging from 43.5% and 85.2% with a standard deviation of 16), which represents a gap of 35% between current practice and EBP. Step 2: According to the practitioners, the most common barriers to the implementation of the CPGs were the lack of equipment, time constraints, the lack of appropriate knowledge, and the lack of financial resources. The most common facilitators included colleague consultation, accessibility of information and continuing education.
Conclusions: There is a need to implement effective rehabilitation interventions into the practice in the management of rheumatoid arthritis. This need was confirmed by 1) the observation of a gap between EBP and current practice, and 2) the identification of barriers to and facilitators of the use of the eight specific CPGs. The practitioners, were directly involved in the process, provided the perfect indications to build a tailored implementation strategy.