Intersection of the Elements of Evidence-Based Practice in Interdisciplinary Stroke Rehabilitation: A Qualitative Study
Authors: Catherine Vingerhoets, Jean Hay-Smith, Fiona Graham
Within the health sector evidence-based practice (EBP) is “a foundational approach to clinical decision-making that integrates scientific research; clinical expertise; and patient preferences, values and circumstances.”
The authors of this study, published in the latest edition of the New Zealand Journal of Physiotherapy, set out to explore how these three elements of EBP intersected in care planning within an interdisciplinary stroke rehabilitation team based in a Canadian hospital.
The principal investigator (responsible for the recruitment, data collection and analysis) observed a ‘rehabilitation round’ where the allied health team, along with the patient’s primary nurse, met with each patient in their room to discuss care plans and set goals.
Immediately after the rehabilitation round, the principal investigator facilitated a focus group where the rehabilitation team were asked four key questions:
How do you value each of the three elements of EBP?
How does the team utilise EBP for decision-making?
Is there one element of EBP that is most influential during care planning?
What contributes to an unequal weighting of EBP elements?
“Patient preferences were at the forefront of discussion, and clinicians continually came back to the patient as the primary influence on care planning and team-patient negotiation.”
Each element of EBP was evident, however “the patient was the dominant influence in decision-making.”
The study looks at the primacy of patient-centeredness, patient-directed goals, being patient-specific as well as EBP as a fluid process, and the collaborative aspects of both within the team, patient-clinician, and professional.
Barriers to “accessing and utilising research evidence” were identified but clinicians were more concerned with “limitations to providing patient-centred care than adherence to research-informed treatment”.
Each patient brings their own needs, circumstances and preferences to the situation and they have the greatest influence on the clinicians. In order to deliver care that fully incorporates all three elements of EBP, a wholly collaborative approach is essential.
You can read the full article here.