GOOD, BETTER, BEST PRACTICE: LEVERAGING OT STUDENT AND CAPSTONE PROJECTS Lindsay Marth, MA, OTR/L, BCPR Tonya Rich, PhD, OTR/L MOTA Conference – October 26, 2019
DISCLOSURE • Lindsay Marth & Tonya Rich work for the Department of Veterans Affairs. The content of this presentation does not represent the position of the VA nor are any of the topics/content endorsed by the Federal Government. Good Better Best Practice- Marth and Rich for MOTA 2019
OBJECTIVES Through engagement in the course participants will be able to: • Describe the traffic light system as a tool for evaluating evidence. • Identify strategies to communicate evidence with traffic light model in a format understandable to clinicians, family, and clients. • Describe methods to structure Level II fieldwork and capstone projects for clinical utility and application of evidence based practice. Good Better Best Practice- Marth and Rich for MOTA 2019
STAGES OF TRANSLATIONAL RESEARCH Clinical Comparative Implementation Research Effectiveness Research Observation of changing practice Efficacy Studies What works best? patterns. Preliminary Support Who responds to what What are the barriers and intervention? facilitators to changing practice? Generate practice guidelines How can we influence adoption? Good Better Best Practice- Marth and Rich for MOTA 2019 (Unpublished)
EVIDENCED-BASED PRACTICE TO GUIDE CLINICAL DECISION MAKING The sweet spot… Evidenced Based Practice Research Client's Clinician Values and Expertise Beliefs (Unpublished) Good Better Best Practice- Marth and Rich for MOTA 2019
LEVELS OF EVIDENCE FOR OT 2 Systematic Reviews, Meta Analyses RCTs Non-RCT, 2 groups Non-RCT, 1 group Descriptive Studies Narratives, Case Studies, Expert Opinion, Consensus Statements (Unpublished) Good Better Best Practice- Marth and Rich for MOTA 2019
TRAFFIC LIGHT MODEL- MAKING EVIDENCE ACCESSIBLE FOR ALL http://www.connecthealth.co.uk/bl og/stop-traffic-lights-signal-best- clinical-outcomes-connect/ Good Better Best Practice- Marth and Rich for MOTA 2019
WHAT IS THE EVIDENCE FOR OUR INTERVENTIONS? Good Better Best Practice- Marth and Rich for MOTA 2019
Ideal Scenario Constraint Induced Movement Therapy? Pediatric Case- young boy s/p CVA Bimanual Motor Training? what is the treatment plan? NMES + and technology? Good Better Best Practice- Marth and Rich for MOTA 2019
Now We Have Evidence Guiding Treatment Constraint Induced Movement Therapy Pediatric Case- young boy s/p CVA treatment plan Bimanual Motor Training NMES + and technology Good Better Best Practice- Marth and Rich for MOTA 2019
WHAT IS THE EVIDENCE FOR OT (GULP!) ? Good Better Best Practice- Marth and Rich for MOTA 2019
Higher Quality Evidence • Audit Low Quality Evidence • Peer Feedback • Small Group Meetings • Quality Improvement • Communities of Practice Lack of Evidence • Subject Matter Experts • Education Adapted from the AOTA EBP course with crediting Novak, Russel, & Ketelaar 2013 Good Better Best Practice- Marth and Rich for MOTA 2019
STUDENTS!!!
MVAHCS STUDENT PROGRAM • 16-20 Level II OT Students/ Yr • Projects • Collaborative with supervisor • Proposal including supporting evidence • Journal club and needs assessment with focus group • Project development • Presentation to OT department and additional as applicable • How can they better support department EBP efforts? • How can we create OTD capstone experiences that meet the needs of the students and the department? Good Better Best Practice- Marth and Rich for MOTA 2019
• “Through the partnership between a clinician and OTD student, implementing evidence-based practice increased clinician knowledge and confidence with a high-risk condition and facilitated meaningful changes in practice, ultimately leading to improved client outcomes.” Reifenberg, G. & Heinekamp, A. Using the Traffic Light System to Implement Evidence-Based Practice. OT Practice Nov 2018 • Supports effort to increase practical usability and for student projects to support larger clinician and leadership goals. Good Better Best Practice- Marth and Rich for MOTA 2019
REIFENBERG & HEINEKAMP OT PRACTICE ARTICLE Reifenberg, G. & Heinekamp, A. Using the Traffic Light System to Implement Evidence-Based Practice. OT Practice Nov 2018 Good Better Best Practice- Marth and Rich for MOTA 2019
OTD CAPSTONE EXPERIENCES • Various Capstone Formats D.1.0 (ACOTE 2018) ▪ Clinical practice skills ▪ Research skills ▪ Administration Polytrauma Specialty Care ▪ Leadership • InterD team ▪ Program & policy development • Community ▪ Advocacy Integration • IADL skill ▪ Education development ▪ Theory development • Literature Review and Case presentation Good Better Best Practice- Marth and Rich for MOTA 2019
- Strongly recommend that occupational therapy practitioners routinely provide the STRONG EVIDENCE intervention to eligible clients. -Good evidence was found that the intervention improves important outcomes. -Benefits substantially outweigh harm. -Two or more studies with Level I evidence - Moderate evidence that OT practitioners routinely provide the intervention to MODERATE EVIDENCE eligible clients. -Fair evidence was found that the intervention improves important outcomes. -At least one study with Level I evidence, and level II and III evidence -Weak evidence that the intervention can improve outcomes, OR WEAK EVIDENCE -Insufficient evidence to recommend for or against routinely providing the intervention. -Evidence of the intervention is lacking, of poor quality, or conflicting, and the balance of benefits and harm cannot be determined. Good Better Best Practice- Marth and Rich for MOTA 2019 Adapted from Classen, Monahan, Auten, & Yarney (2014).
Good Better Best Practice- Marth and Rich for MOTA 2019
Good Better Best Practice- Marth and Rich for MOTA 2019
LEVEL II PROJECT: PAIN SELF-MANAGEMENT Develop Complete Literature Record Evidence- Review & Needs Video Supported Assessment Vignettes Handout Good Better Best Practice- Marth and Rich for MOTA 2019
Additional Projects- Pain Management Good Better Best Practice- Marth and Rich for MOTA 2019
Good Better Best Practice- Marth and Rich for MOTA 2019
Sample: Handout Provides an explanation of nine self-management strategies for patients ● experiencing pain while in acute care setting… based on the evidence Strategies include: ● Deep Breathing ○ Meditation ○ Guided Imagery ○ Gentle Movement ○ Progressive Muscle Relaxation ○ Self-Massage ○ Aromatherapy ○ Hot/Cold Application ○ Music ○ Good Better Best Practice- Marth and Rich for MOTA 2019
Additional Student Projects • Pain Treatment • Building on needs assessment and stop light, additional tools and videos to overcome pain as barrier to ADL/IADL training in CLC • Quality Improvement • Student with MPH and clinical research background built the “clock” for completion of QI • Follow- up: specialty third student completing project on driver’s pre -screen and behind the wheel Good Better Best Practice- Marth and Rich for MOTA 2019
PLANNED CAPSTONES AY 2019-2020 • Patient and Caregiver Education • Education and clinical skills: will build on handout guide and video formats • LSVT Big and Loud • Program development and clinical skills: will build on QI and stop light • Addressing Psychosocial Factors in Acute/ Sub-acute TBI • Program development and clinical skills: will build on QI and stop light Good Better Best Practice- Marth and Rich for MOTA 2019
• PICO Workgroup projects & staff lead assessment of current practice • Format to communicate information learned at a training or conference • Method to organize education and training for new staff & students and to prioritize department education • Format to objectively evaluate current practice areas while maintaining and respecting clinical experience/ judgment and patient choice • Shared with national OT EBP group and on national VA OT call Good Better Best Practice- Marth and Rich for MOTA 2019
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