Olsen Nina Rydland, Bradley Peter, Espehaug Birgitte, Nortvedt Monica Wammen, Lygren Hildegunn, Frisk Bente, Bjordal Jan Magnus
Centre for Evidence Based Practice, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway; Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Public Health Wales, Cardiff, United Kingdom.
PLoS One. 2015 Apr 20;10(4):e0124332. doi: 10.1371/journal.pone.0124332. eCollection 2015.
Physiotherapists practicing at clinical placement sites assigned the role as clinical instructors (CIs), are responsible for supervising physiotherapy students. For CIs to role model evidence-based practice (EBP) they need EBP competence. The aim of this study was to assess the short and long term impact of a six-month multifaceted and clinically integrated training program in EBP on the knowledge, skills, beliefs and behaviour of CIs supervising physiotherapy students.
We invited 37 CIs to participate in this non-randomized controlled study. Three self-administered questionnaires were used pre- and post-intervention, and at six-month follow-up: 1) The Adapted Fresno test (AFT), 2) the EBP Belief Scale and 3) the EBP Implementation Scale. The analysis approach was linear regression modeling using Generalized Estimating Equations.
In total, 29 CIs agreed to participate in the study: 14 were invited to participate in the intervention group and 15 were invited to participate in the control group. One in the intervention group and five in the control group were lost to follow-up. At follow-up, the group difference was statistically significant for the AFT (mean difference = 37, 95% CI (15.9 -58.1), p < 0.001) and the EBP Beliefs scale (mean difference = 8.1, 95% CI (3.1 -13.2), p = 0.002), but not for the EBP Implementation scale (mean difference = 1.8. 95% CI (-4.5-8.1), p = 0.574). Comparing measurements over time, we found a statistically significant increase in mean scores related to all outcome measures for the intervention group only.
A multifaceted and clinically integrated training program in EBP was successful in improving EBP knowledge, skills and beliefs among CIs. Future studies need to ensure long-term EBP behaviour change, in addition to assessing CIs' abilities to apply EBP knowledge and skills when supervising students.
在临床实习点担任临床带教老师（CIs）的物理治疗师负责指导物理治疗专业学生。为了让临床带教老师成为循证实践（EBP）的榜样，他们需要具备循证实践能力。本研究的目的是评估一项为期六个月的多方面且临床整合的循证实践培训项目对指导物理治疗专业学生的临床带教老师的知识、技能、信念和行为的短期和长期影响。
我们邀请了37名临床带教老师参与这项非随机对照研究。在干预前、干预后以及六个月随访时使用了三份自填式问卷：1）改编的弗雷斯诺测试（AFT），2）循证实践信念量表，3）循证实践实施量表。分析方法是使用广义估计方程的线性回归模型。
共有29名临床带教老师同意参与研究：14名被邀请参加干预组，15名被邀请参加对照组。干预组有1名、对照组有5名失访。随访时，AFT（平均差异 = 37，95%可信区间（15.9 - 58.1），p < 0.001）和循证实践信念量表（平均差异 = 8.1，95%可信区间（3.1 - 13.2），p = 0.002）的组间差异具有统计学意义，但循证实践实施量表（平均差异 = 1.8，95%可信区间（-4.5 - 8.1），p = 0.574）没有。比较不同时间的测量结果，我们发现仅干预组与所有结局指标相关的平均得分有统计学意义的增加。
一项多方面且临床整合的循证实践培训项目成功提高了临床带教老师的循证实践知识、技能和信念。未来的研究除了评估临床带教老师在指导学生时应用循证实践知识和技能的能力外，还需要确保长期的循证实践行为改变。
