Dismantling Some Barriers to Evidenced-based Rehabilitation with ‘Hands-on’ Clinical Research Secondments

Dismantling Some Barriers to Evidenced-based Rehabilitation with ‘Hands-on’ Clinical Research Secondments

Dismantling Some Barriers to Evidenced-based Rehabilitation with ‘Hands-on’ Clinical Research Secondments Key Words Evidence-based activity, research...

189KB Sizes 0 Downloads 1 Views

Dismantling Some Barriers to Evidenced-based Rehabilitation with ‘Hands-on’ Clinical Research Secondments

Key Words Evidence-based activity, research training. by V M Pomeroy R C Tallis E Stitt

Initial development

Summary Background Although the number of physiotherapists with research training has increased this may not be enough to facilitate evidence-based practice. Research education may need to be combined with clinical practice and organisational support. We therefore instituted clinical research secondments to the Stroke Association’s Therapy Research Unit for therapists and nurses in the North West Region of the United Kingdom. Aims To develop ‘hands-on’ clinical research secondments to: 1. Increase research skills of senior nurses and therapists seconded to the Stroke Association’s Therapy Research Unit. 2. Facilitate an increase in evidence-based practice activity of participants when they recommence full-time work in their NHS trust clinical setting. The clinical research secondments Participants were seconded to the Stroke Association’s Therapy Research Unit for 2/3 days a week for one year. Their NHS managers had to demonstrate commitment to enabling participants to use enhanced skills when they returned to full-time clinical work. Participants were 19 clinicians (physiotherapists, occupational therapists, nurses and speech and language therapists). A clinical research tutor facilitated formal and informal learning and acted as a mentor. A medical statistician, information officer and the Stroke Association’s Therapy Research Unit supervisors of particular research projects also provided learning opportunities. In addition we held an annual conference which enabled participants to prepare and give research presentations. Appraisal All participants were sent a questionnaire between 14 and 36 months after completing the secondment. The response rate was 72%. The majority of respondents, 85%, reported improvements in their research skills and 69% reported that the secondment had enabled their involvement in evidence-based activity. Despite this positive impact participants expressed frustrations related to lack of necessary resources and support in the workplace. Conclusion This development work suggests that a clinical research secondment scheme might be a useful means to improve clinical research skills and evidenced-based practice activity but that barriers, particularly those related to implementation of research findings and organisational culture, might still be inhibiting progress. The secondment scheme now needs to be replicated and evaluated.

Introduction The need for evidence of effectiveness of rehabilitation therapy has been recognised since at least the beginning of the twentieth century (Custard, 1998) with therapists and nurses emphasising the need to increase research activity (eg Michels, 1982; Llorens and Gillette, 1985; Llorens and Snyder, 1987; Yerxa, 1987; Gilfoyle and Christiansen, 1987; Law, Physiotherapy May 2003/vol 89/no 5

1989; Polatajko et al, 1989; Delin and Wilcock, 1991; Tracey, 1992) and to use research so that evidence-based practice enhances clinical effectiveness (Tyler, 2000). Yet even though research evidence is considered important for practice (Coyle and Sokop, 1990; Wells and Baggs, 1994; Pearcey, 1995; Berggren, 1996; Meah et al, 1996; Dunn et al, 1997; Taylor et al, 1990; Metcalfe et al, 2001) and

Research report

opportunities to increase research activity are recognised (le May et al, 1998), therapists and nurses experience barriers to using research to inform practice. Surveys of different professional groups in different countries have found that the barriers experienced include: ■ Barriers related to lack of research skills, such as lack of critical appraisal skills, lack of understanding of statistics, lack of understanding of the research process (Funk et al, 1991; Pearcey, 1995; Meah et al, 1996; Dunn et al, 1997; Walsh, 1997; Closs and Lewin, 1998; Kajermo et al, 1998; le May et al, 1998; Nolan et al, 1998; Closs et al, 2000; Pollock et al, 2000; Barnard and Wiles, 2001; Metcalfe et al, 2001; Sweetland and Craik, 2001). ■ Barriers related to implementation of research findings, such as poor dissemination/accessibility of research findings, lack of clarity of the anticipated outcomes of using research (Rodgers, 1994; Pearcey, 1995; Meah et al, 1996; Dunn et al, 1997; Walsh, 1997; le May et al, 1998; Newman et al, 1998; Upton, 1999; Pollock et al, 2000; Retsas, 2000; Barnard and Wiles, 2001; Metcalfe et al, 2001; Sweetland and Craik, 2001). ■ Barriers related to organisational culture such as lack of time and/or culture of doing rather than questioning, lack of resources, lack of access to training, resistance to change in senior staff, perceived lack of support from other health professionals and/or managers (Funk et al, 1991; Rodgers, 1994; Pearcey, 1995; Dunn et al, 1997; Walsh, 1997; Closs and Lewin, 1998; Kajermo et al, 1998; le May et al, 1998; Newman et al, 1998; Nolan et al, 1998; Upton, 1999; Closs et al, 2000; Pollock et al, 2000; Retsas, 2000; Barnard and Wiles, 2001; Metcalfe et al, 2001; Sweetland and Craik, 2001). These findings suggest that the welcome increase in the number of therapists and nurses with research training at undergraduate and postgraduate levels may not be sufficient on its own to enable evidence-based practice. Examination of the identified barriers also suggests that

267

research education needs to be combined with clinical practice and that organisations within which nurses and therapists work need to change relevant structures and processes to enable the optimal development of evidence-based practice. In response to this need two of the authors (VP and RT) instituted clinical research secondments for therapists and nurses in the North West Region of the United Kingdom. The Stroke Association’s Therapy Research Unit was the host unit and senior clinicians were seconded by their NHS managers to participate in the scheme. The overall aim was to provide ‘hands-on’ research to enhance an evidenced-based approach to clinical practice. The specific aims were: ■ To increase the research skills (eg critical appraisal, literature searching, literature synthesis, hypothesis generation and ability to extract relevant clinical information) of senior therapists and nurses who were seconded to the Stroke Association’s Therapy Research Unit by their NHS managers. ■ To facilitate an increase in evidencebased practice activity of participants when they returned to their NHS trust clinical setting at the end of the secondment.

Authors Professor V M Pomeroy PhD BA GradDipPhys FCSP is professor of rehabilitation for older people at St George’s Hospital Medical School, London. Professor R C Tallis BM BCh MA FRCP FMedSci Dlitt is professor of geriatric medicine at the University of Manchester. Ms E Stitt is library services manager for Calderstones NHS Trust, Clitheroe, Lancashire. Address for Correspondence Professor V M Pomeroy, St George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE.

This paper describes the structure and process of a secondment scheme which was developed by the Stroke Association’s Therapy Research Unit over a three-year period. It also provides the results of a long-term appraisal of this pilot version of the secondment scheme. Clinical Research Secondments The NHS North West Regional Research and Development Directorate provided funding for three years to provide senior therapists and nurses in the north west with clinical research secondments for two or three days a week for one year. Participants were nominated by their NHS managers who had to demonstrate a commitment to building on the enhanced evidence-based practice skills which participants were expected to take back into their NHS trust. During the secondment, participants worked with the Stroke Association’s Therapy Research Unit research team on a nominated

Pomeroy, V M, Tallis, R C and Stitt, E (2003). ‘Dismantling some barriers to evidenced-based rehabilitation with “hands-on” clinical research secondments: Initial development’, Physiotherapy, 89, 5, 266-275.

Physiotherapy May 2003/vol 89/no 5

268

Acknowledgements We gratefully acknowledge the funding provided for this secondment scheme by the NHS North West Research and Development Directorate. We also are grateful for the funding provided to our research programme by the Stroke Association, the Medical Research Council, the Wolfson Foundation, Booth Charities, the Edward Holt Trust, the Muriel Edith Rickman Trust and the NHS NEAT programme. We thank Alison Brettle, our first information officer, for setting up the critical appraisal and information systems and all the Stroke Association’s Therapy Research Unit team members for supervising participants and contributing to the formal and informal learning environment. We are particularly grateful to all the nurses and therapists who were seconded to the Stroke Association’s Therapy Research Unit for enriching our research programme with their clinical expertise and to the NHS managers who freely gave their time to help make the initiative better. The constructive feedback was very helpful.

project and also participated in a facilitated learning programme. Towards the end of the secondment, participants presented their research activity and learning experiences to delegates at the annual Stroke Association’s Therapy Research Unit secondment conference. Specific details are given in the following subsections. Recruitment to Secondments Providing information about the secondments took three main forms: 1. Information about the secondments was sent to research and development directors, therapy managers and nursing managers in North West Region NHS trusts. 2. A summary of the initiative was included in the North West Research and Development Directorate’s leaflet about all the support units in the North West Region. This was reinforced through informal contact with many therapists and nurses in the North West Region, through more formal talks to groups of clinicians and also with articles in the professional press (eg Therapy Weekly) and local press. 3. Information about the annual conference was sent to research and development directors, therapy managers and nursing managers in North West Region NHS trusts. Clinicians were nominated for the secondment programme by their managers who had to demonstrate commitment to, and understanding of, how they planned to use the enhanced evidence-based practice skills of participants on their return to full-time clinical work so that the new skills did not disappear into a ‘black hole’. Each of the managers nominating potential participants was a member of the selection committee who interviewed all potential candidates. Other members of the selection committee were drawn from the support unit and from the North West Research and Development Directorate. The interview was competitive and candidates had to display evidence of: ■ An evaluative approach. ■ Some ideas of how they would use their enhanced skills on return to full-

Physiotherapy May 2003/vol 89/no 5

■ ■ ■ ■

time clinical work and evidence that they had discussed this with their managers. Sufficient clinical experience to work independently. Openness to undertaking a designated project. An understanding of the research and development culture in the NHS. Evidence that they had thought through how they would manage two jobs.

Participants During the three years of the support unit 19 clinicians from seven North West NHS trusts participated in the programme. Their professional bases were: ■ Physiotherapy (n = 10). ■ Occupational therapy (n = 4). ■ Nursing (n = 3). ■ Speech and language therapy (n = 1). Structure and Process of Secondment During the first two years of this project secondments were for two days a week for one year. Following participants’ feedback we made changes so that all participants had the option for a two or three days a week secondment; arranged for one of their days to be the day when all participants attended; started their secondment on the same day; worked from the same office; and had a formal induction programme in the first week. During all three years of the secondment scheme we encouraged and responded to feedback from participants so that content and process were shaped and refined. The description that follows therefore outlines the final form of the secondment scheme. The process of the secondment was coordinated by a clinical research tutor who also facilitated formal and informal learning and acted as mentor to participants. The tutor was supported by input from a medical statistician and an information officer who provided specialist learning resources for group activities and the research projects. The Stroke Association’s Therapy Research Unit researchers provided supervision for participants’ research projects. Unfortunately, no tutor could be appointed during the first year of this scheme, but this part-time post was filled during years 2 and 3.

Research report

Content of the Secondment Four types of learning experiences were provided: 1. Experiential learning through participation in an ongoing research project under the supervision of a Stroke Association’s Therapy Research Unit researcher. 2. Informal learning through attendance at the Stroke Association’s Therapy Research Unit seminars, informal discussions within the research environment and access to the hospital and university libraries for independent learning. 3. Tutor-facilitated learning, which took the form of group tutorials and personal mentoring. In addition there were additional tutorials from the medical statistician, information officer and other Stroke Association’s Therapy Research Unit staff. 4. The annual secondment conference. These four main sources of learning are described separately to aid clarity. However in practice they were integrated and the uniqueness of the Stroke Association’s Therapy Research Unit secondment programme was that participants were exposed to all four. Supervised research assistant experience The projects, and therefore the experience gained varied widely. Some participants joined a project in the early stages of its development and provided intellectual input from their clinical experience into the design and methodology. Other participants joined projects at a more advanced stage of development and thus gained direct experience of the ethical approval process, subject recruitment and data collection. Some participants joined projects which were at the stage of data analysis and also became involved in the early stages of designing a subsequent study and preparing a grant application. Another difference between project experiences was that in some cases several participants worked together whereas other projects employed only one participant. To ensure that participants gained a broader perspective of the research process they were encouraged to share experiences on a formal and informal basis.

269

Informal learning This was the second key element. In addition to the tutorial sessions specifically organised for the programme the participants attended departmental seminars that included formal research presentations, research problem solving and external speakers. Of course the research environment itself facilitated learning and participants soon become integrated as team members and contributed to the Stroke Association’s Therapy Research Unit’s normal 'corridor' conversations and problem solving. Tutor-facilitated learning This was of two types: 1. Group tutorials were held at least once a month and covered a wide range of research topics. Topics included statistics, information-searching and critical appraisal. This approach avoided a didactic teaching approach and promoted independent learning. Several of the tutorials centred on a presentation by a participant (eg ethical issues in research) followed by group discussion. 2. Mentoring took two forms. The less common form of personal mentoring was a trouble-shooting meeting if participants were experiencing difficulties. The more common form was an individual pre-arranged meeting every four months to plan personal learning objectives and review progress. The tutor and participant agreed objectives that were documented and distributed to the participant’s trust manager, the Stroke Association’s Therapy Research Unit supervisor and the director of the Stroke Association’s Therapy Research Unit. After the initial objective setting the tutor met with each of the trust managers to discuss the objectives set and amend if necessary before these were finally agreed. Regular feedback was provided to the participant and any barriers to achieving objectives were identified so that appropriate action was implemented. During the first year of the secondment programme objective setting was less formal as there was no clinical research tutor but participants Physiotherapy May 2003/vol 89/no 5

270

in years 2 and 3 set formal objectives. Some of the common long-term objectives set by many of the participants and assessed by the clinical research tutor are listed in table 1, alongside the progress achieved during the secondment. The annual Secondment Conference organised by the Stroke Association’s Therapy Research Unit enabled participants to prepare and give a platform and poster presentation. Delegates to the conference were clinicians, managers and researchers from NHS trusts in the North West Region. The conferences were always well attended, with 50 to 80 delegates. The participants were therefore given what was often their first experience of conference presentation in a relatively ‘safe’ environment.

Table 1: Objectives set by participants in the second and third years of the Stroke Association’s Therapy Research Unit secondment programme Objective

Number of participants (n = 11) Setting objective

Partly Achieving achieving objective objective

Increase written and/or oral dissemination skills

11

11

Develop information accessing and information technology skills

10

10

Learn how to use a statistical software package

9

2

7

Improve critical appraisal skills

8

1

7

Share learning with colleagues in home NHS trust

8

5

3

Learn how to obtain ethical approval

7

Increase knowledge of statistics

6

5

1

Increase understanding of the research process

4

4

Develop awareness of methods of obtaining grant funding

4

4

Learn how to design a research protocol

7

3

3

Develop skills to apply research methods/ findings into practice

2

3

Develop project management skills

2

Find opportunities and support for research in home NHS trust

2

Increase ability to focus thinking from general to specific

1

Compile a clinical research resource file for home NHS trust

1

Become involved in home NHS trust research groups

1

1

Expand understanding of ethical issues in research

1

1

Physiotherapy May 2003/vol 89/no 5

2 1

1 1

1

Scheme Appraisal A postal questionnaire was used to explore whether the secondment had: ■ Increased participants’ research skills. ■ Influenced their undertaking of formal training to enhance professional and/or research skills. ■ Influenced their ability to participate in evidenced-based activity. ■ Enhanced evidenced-based practice in their clinical service. In addition the questionnaire explored how and why the secondment had or had not influenced evidenced-based practice. All participants were sent the questionnaire, with a covering letter and stamped addressed envelope, in November 2001 – between 14 to 36 months after they had completed the secondment. Four weeks later participants were contacted by telephone to remind them to return the questionnaire and another was posted if required. Of the 18 questionnaires posted to participants 13 were completed and returned, a 72% response rate. Only one participant who did not return the questionnaire provided a reason (she was moving house). All three year-groups were represented with 23 participants, from 1997/98, five from 1998/99 and five from 1999/2000. Completed questionnaires were returned by seven of the ten physiotherapists; two of the four occupational therapists, two of the three nurses, and apparently two speech and language therapists (though only one participated – someone must have ticked the wrong box). Several participants reported having completed (n = 1), being registered for (n = 4) or considering undertaking an MA or MSc degree. Three participants reported that they were considering undertaking an MPhil/PhD degree and one was considering a BA/BSc degree. The majority of participants reported improvements in their research skills as a result of the secondment with only two reports of no difference. These equivocal responses were for ‘literature searching’ and ‘formulation of a research question/hypothesis’ (table 2). In addition to the research skills listed in the questionnaire, participants identified eight other research skills which they reported to have improved as a result of

Research report

the secondment including ‘presentation skills’ and ‘information technology skills’ (table 2). The next item in the questionnaire asked whether participants had been involved in evidenced-based practice as a result of the secondment. Twelve of the participants provided a response to this item with the majority (n = 9) reporting that they had. Most of this reported activity focused on reviewing published evidence in relation to clinical practice but participants also reported involvement in developing research protocols, obtaining research funding and facilitating/enhancing research skills in other clinicians. The verbatim descriptions can be summarised as follows:

Reviewing published evidence in relation to clinical practice ■ Literature searching/critically appraising relevant literature around current practice. Reflection on this. ■ Create clinical guidelines based on evidence where it exists. Facilitating/enhancing research skills in other clinicians ■ Set up journal club. ■ Alteration of in-service training aiming to incorporate literature searched, appraised information in order to formulate service developments. Protocol development ■ Development of own research protocol. ■ Involvement in writing a research protocol. Obtaining research funding ■ Three-year PhD Fellowship. ■ Part of research groups gaining research grants since finishing secondment, now working on these projects.

Participants reported several ways in which the secondment enabled them to be involved in evidenced-based activity:

271

Improvement in research skills, knowledge and confidence ■ Allowed through skills gained to be able to find/review relevant literature and facilitate others to do so within workplace. ■ Provided confidence to participate in evidence-based activity. Access to resources and support ■ Gave access to literature, used to disseminate to colleagues and inform practice. ■ Introduced to researchers. Validation of the need for research activity ■ Acknowledging importance of gathering evidence.

Table 2: Participants’ responses to the question ‘How has the secondment changed your research skills?’ Number of participants giving response Greatly Somewhat No Somewhat Greatly improved improved diff- worse worse erence Literature searching

10

2

1

0

Critical appraisal

8

5

0

0

0 0

Synthesis of literature

5

8

0

0

0

Formulation of a research question/hypothesis

9

3

1

0

0

Recognition of relevant research design to answer question posed 8

5

0

0

0

Understanding statistics in research papers

3

10

0

0

0

Extracting relevant clinical information from literature

7

6

0

0

0

Evaluation of your own clinical practice

6

7

0

0

0

Practical day-to-day skills of running a project

1

0

0

0

0

Understanding research terminology

1

Other – please list

Developing a protocol

1

0

0

0

0

Presentations

3

0

0

0

0

Information technology skills

3

0

0

0

0

Objective audits

1

0

0

0

0

Awareness/enthusiasm for research

1

0

0

0

0

Confidence in discussing research issues

1

0

0

0

0

Physiotherapy May 2003/vol 89/no 5

272

Most participants also reported that the secondment had enhanced evidencedbased practice in the service in which they worked (9 of 13). Reported activity centred on: ■ Evidence-based standard setting and audit. ■ In-service training. ■ An enhanced culture of evidencebased practice. ■ Involvement of the service in externally led research activity. Participants reported several ways in which the secondment enabled them to be involved in evidenced-based activity and these were essentially the same as those in the panel above. They are summarised below: Evidence-based standard setting and audit ■ Development of care pathways and clinical standards. ■ Improved standard of audits. ■ Use of outcome measures. ■ Involvement in clinical governance research group. In-service training ■ Passed on skills to colleagues within service. ■ Started a journal club. ■ Research day organised for department. Enhanced culture of evidence-based practice ■ Increased awareness of need continually to evaluate individual and professional practice. ■ Carrying out breakdown of intervention and looking at current practice and why and new developments. ■ The culture of constant patient activity and no ring-fenced time for professional development is (also) being addressed. Involvement of service in externally led research activity ■ Continued links to the Stroke Association’s Therapy Research Unit for service to be used in research studies.

Physiotherapy May 2003/vol 89/no 5

Those participants who reported that they had not been involved in evidencebased practice activity and/or it had not been enhanced in their service, wanted to be involved in journal clubs and examining evidence available to support specific treatment areas. Barriers to such activity were identified as: ■ Those related to lack of research skills, eg critical skills. ■ Those related to implementation of research findings, eg access to facilities. ■ Those related to organisational culture, eg time and management outlook. Participants expanded on their responses to questions in the last section of the questionnaire which invited them to tell how the secondment had or had not changed their clinical practice, role and/or outlook. Most of the comments were positive and described increased research and audit activity, undertaking study for a higher degree, getting articles published, career development, improvements in clinical practice and enjoyment of the secondment experience. Negative comments emphasised frustrations due to lack of necessary resources and support in the workplace. As there are too many comments to include them all in this paper a representative selection of comments is given as follows:

Research activity ■ I’m involved in two projects at the moment. ■ I doubt that I would be on this particular research Fellowship if I had not participated at the Stroke Association’s Therapy Research Unit. Higher degree ■ It has given me the confidence to register for an MSc and undertake a variety of modules which have changed my clinical practice and enabled me to assist in developing knowledge in others. Publications ■ I have had two articles published since the secondment and am working towards a third.

Research report

Clinical practice ■ Secondment changed my outlook and attitude towards clinical practice. I find I am more demanding of myself, ie what I am doing and why. Career development ■ I have gained promotion from ……….. to ……………. Resources available ■ On my return to work I was unable to continue to facilitate evidence-based practice as much as I would have liked due to time constraints. Within my working role there was no dedicated time to devote to evidence-based activity. The secondment was an excellent way of building research/evidence skills but follow-up after a secondment or evidence-based activity needs some sort of dedicated time. Support in workplace ■ A problem is others’ expectations re my knowledge/skill base, ie manager requesting intensive training on critical appraisal. I explain that I have a level of knowledge, however the secondment did not make me an expert in the area of research and was not intended to. Secondment experience ■ The secondment was challenging (for all) but very instructive and inspiring. ■ The secondment has moved me forward. Thank you for the opportunity.

Interpretation We have described our experience, and those of seconded clinicians, with a support unit funded by the NHS North West Research and Development Directorate. The aim of the support unit was to give substantive hands-on experience of clinical research to a wide range of therapists while they are still involved in service delivery. The overall feedback from those seconded was positive. A particular benefit of the hands-on clinical research

273

training provided via the secondments to the Stroke Association’s Therapy Research Unit was that participants reported gains in several research skills such as critical appraisal and extraction of relevant clinical information from the literature. More-over, they reported that the training had been beneficial for their own involvement in evidence-based activity and also for the enhancement of the evaluative culture within their clinical workplace. It appears that the Stroke Association’s Therapy Research Unit secondment scheme might diminish some of the barriers to using research to inform practice, particularly those related to lack of research skills. However, in addition to the positive changes, participants also reported some that were not so positive. Even those who reported improvements in personal and workplace evidence-based activity expressed some frustrations. These focused on the lack of necessary resources and organisational support. Although this was disappointing, especially as NHS managers had been involved in recruitment to and process of the secondments, it is probably not unexpected considering that it is only relatively recently that research has become a component of nursing and therapy practice. For example, physiotherapy and occupational therapy became all-degree professions as recently as the mid 1990s. In the early 1980s only a few physiotherapists in the UK had been awarded a PhD. In 1997 there were 70 physiotherapists with doctorates and eight professors (Bury, 1997). At the beginning of 2001 there were 100 physiotherapists with doctorates and 23 professors -- nine without doctorates (Bury, personal communication). This is a dramatic increase, but still only a small proportion of the 30,000 physiotherapists in the UK. It therefore seems reasonable to suggest that there is still insufficient awareness of just what is required for evidence-based activity. Not because of any mal-intent, just because of the relatively embryonic, though developing, research expertise throughout the professions. It appears therefore, from the development work reported here, that a clinical research secondment scheme might be a useful means to improve research skills but that barriers related to Physiotherapy May 2003/vol 89/no 5

274

implementation of research findings and organisational culture might still be inhibiting professional development and evidence-based clinical practice. We suggest therefore that the secondment scheme developed by The Stroke Association’s Therapy Research Unit needs to be replicated and robustly

evaluated for its effects on research skills and evidence-based activity. We also suggest that the secondment scheme alone is possibly insufficient and that it needs to be accompanied by other positive action which is focused on reducing the barriers related to organisational culture.

References

Law, M (1989). ‘Clinical research in occupational therapy: Strategies for development’, Canadian Journal of Occupational Thererapy, 56, 224-261.

Barnard, S and Wiles, R (2001). ‘Evidencebased physiotherapy: Physiotherapists' attitudes and experiences in the Wessex area’, Physiotherapy, 87, 115-124. Berggren, A C (1996). ‘Swedish midwives’ awareness of, attitudes to and use of selected research findings’, Journal of Advanced Nursing, 23, 462-470. Bury, T (1997). ‘The status and development of physiotherapy research in the United Kingdom’, Physical Therapy Reviews, 2, 165-171. Closs, S J, Baum, G, Bryar, R M, Griffiths, J and Knight, S (2000). ‘Barriers to research implementation in two Yorkshire hospitals’, Clinical Effectiveness in Nursing, 4, 3-10. Closs, S J and Lewin, B J P (1998). ‘Perceived barriers to research utilisation: A survey of four therapies’, British Journal of Therapy and Rehabilitation, 5, 151-155. Coyle, L A and Sokop, A G (1990). ‘Innovation adoption behaviour among nurses’, Nursing Research, 39, 176-180. Custard, C (1998). ‘Tracing research methodology in occupational therapy’, American Journal of Occupational Therapy, 52, 676-683. Delin, C and Wilcock, A (1991). ‘Developing occupational therapy research skills: Present actions, future outcomes’, Australian Occupational Therapy Journal, 38, 163-166. Dunn, V, Crichton, N, Roe, B, Seers, K and Williams, K (1997). ‘Using research for practice: A UK experience of the BARRIERS scale’, Journal of Advanced Nursing, 26, 1203-10. Funk, S G, Champagne, M T, Wiese, R A and Tornquist, E M (1991). ‘Barriers to using research findings in practice: The clinician’s perspective’, Applied Nursing Research, 4, 90-95. Gilfoyle, E M and Christiansen, C H (1987). ‘Research: The quest for truth and the key to excellence’, American Journal of Occupational Therapy, 41, 7-8. Kajermo, K N, Nordstrom, G, Krusebrant, A and Bjorvell, H (1998). ‘Barriers to and facilitators of research utilisation, as perceived by a group of registered nurses in Sweden’, Journal of Advanced Nursing, 27, 798-807. Physiotherapy May 2003/vol 89/no 5

le May, A, Alexander, C and Mulhall, A (1998). ‘Research utilisation in nursing: Barriers and opportunities’, Journal of Clinical Effectiveness, 3, 59-63. Llorens, L A and Gillette, N P (1985). ‘The challenge for research in a practice profession’, American Journal of Occupational Therapy, 39, 143-145. Llorens, L A and Snyder, N V (1987). ‘Research initiatives for occupational therapy’, American Journal of Occupational Therapy, 41, 491-493. Meah, S, Luker, K A and Cullum, N A (1996). ‘An exploration of midwives’ attitudes to research and perceived barriers to research utilization’, Midwifery, 12, 73-84. Metcalfe, C, Lewin, R, Wisher, S, Perry, S, Bannigan, K and Moffett, J K (2001). ‘Barriers to implementing the evidence base in four NHS therapies’, Physiotherapy, 87, 433-441. Michels, E (1982). ‘Evaluation and research in physical therapy’, Physical Therapy, 62, 828-834. Newman, M, Papadopoulos, I and Sigsworth, J (1998). ‘Barriers to evidence-based practice’, Intensive and Critical Care Nursing, 14, 231-238. Nolan, M, Morgan, L, Curran, M, Clayton, J, Gerrish, K and Parker, K (1998). ‘Evidencebased care: Can we overcome the barriers?’ British Journal of Nursing, 7, 1273-78. Ottenbacher, K J (1987). ‘Research: Its importance to clinical practice in occupational therapy’, American Journal of Occupational Therapy, 41, 213-215. Pearcey, P A (1995). ‘Achieving research-based nursing practice’, Journal of Advanced Nursing, 22, 33-39. Polatajko, H, Miller, J, MacKinnon, J and Harburn, K (1989). ‘Occupational therapy research in Canada: Report from the Association of Canadian Occupational Therapy University Programs’, Canadian Journal of Occupational Therapy, 56, 257-261. Pollock, A S, Legg, L, Langhorne, P and Sellars, C (2000). ‘Barriers to achieving evidence-based stroke rehabilitation’, Clinical Rehabilitation, 14, 611-617.

Research report

275

Retsas, A (2000). ‘Barriers to using research evidence in nursing practice’, Journal of Advanced Nursing, 31, 599-606.

Tyler, P (2000). ‘Evidence-based nursing and community practice’, British Journal of Community Nursing, 5, 108.

Rodgers, S (1994). ‘An exploratory study of research utilisation by nurses in general medical and surgical wards’, Journal of Advanced Nursing, 20, 904-911.

Upton, D (1999). ‘Clinical effectiveness and EBP 3: Application by healthcare professionals’, British Journal of Therapy and Rehabilitation, 6, 86-90.

Sweetland, J and Craik, C (2001). ‘The use of evidence-based practice by occupational therapists who treat adult stroke patients’, British Journal of Occupational Therapy, 64, 256-260.

Walsh, M (1997). ‘Barriers to research utilisation and evidence-based practice in A&E nursing’, Emergency Nurse, 5, 24-27.

Taylor, E and Mitchell, M (1990). ‘Research attitudes and activities of occupational therapy clinicians’, American Journal of Occupational Therapy, 44, 350-355. Tracey, J E (1992). ‘Role of research in the entry-level physical therapy curriculum’, Journal of Physical Therapy Education, 6, 28-32.

Wells, N and Baggs, J G (1994). ‘A survey of practicing nurses’ research interests and activities’, Clinical Nurse Specialist, 8, 145-151. Yerxa, E J (1987). ‘Research: The key to the development of occupational therapy as an academic discipline’, American Journal of Occupational Therapy, 41, 415-419.

Key Messages ■ A clinical secondment scheme could be a useful means to improve clinical research skills and evidence-based practice activity.

■ The clinical research secondment scheme requires replication and evaluation.

■ Progress could still be inhibited by barriers related to implementation of research findings and organisational culture.

Physiotherapy May 2003/vol 89/no 5