Ataman Rebecca, Ahmed Sara, Zidan Ahlam, Thomas Aliki
School of Physical and Occupational Therapy, McGill University, Montréal, Quebec; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Quebec, Canada.
School of Physical and Occupational Therapy, McGill University, Montréal, Quebec; Clinical Epidemiology, McGill University Health Center, Montréal, Quebec; Clinical Epidemiology, McGill University Health Center, Montréal, Quebec.
Arch Phys Med Rehabil. 2022 Dec;103(12):2429-2443. doi: 10.1016/j.apmr.2022.05.016. Epub 2022 Jun 24.
We conducted a realist review to understand how (mechanism) and in what circumstances (context) evidence-based practices are sustained in rehabilitation (outcome).
MEDLINE, Embase, reference lists, and targeted websites.
Two independent reviewers calibrated study selection; then 1 reviewer screened all titles and abstracts, while the second reviewer screened a random 20%. We repeated this process for full texts. We included 115 documents representing 61 implementation projects (8.9% of identified documents). Included documents described implementation projects in which physical therapists, occupational therapists, and/or speech-language pathologists were the target users of an evidence-based practice.
Two reviewers repeated the independent process described in study selection to extract basic study and sustainability characteristics as well as context, mechanism, outcome, and strategy text.
Using basic numerical analyses, we found that only 54% of evidence-based practices in rehabilitation are sustained. Furthermore, while authors who reported sustainability planning sustained the practice 94% of the time, sustainability planning in rehabilitation is rare (only reported 26% of the time). Extracted text was synthesized using the realist technique of inductive and deductive retroduction in which context, mechanism, outcome, and strategy text are combined into narrative explanations of how sustainability works. To inform these explanations, we applied normalization process theory and the theory of planned behavior. Collectively, the 52 identified narratives provide evidence for 3 patterns: (1) implementation and sustainability phases are interconnected, (2) continued use of the evidence-based practice can be interpreted as the ultimate sustainability outcome, and (3) intermediate sustainability outcomes (ie, fit/alignment, financial support, benefits, expertise) can become contextual features influencing other sustainability outcomes.
Implementation teams can use the narrative explanations generated in this review to optimize sustainability planning. This can sustain practice changes and improve quality of care and patient outcomes. Future research should seek to iteratively refine the proposed narrative explanations.
我们进行了一项现实主义综述，以了解循证实践在康复中是如何（机制）以及在何种情况下（背景）得以维持的（结果）。
MEDLINE、Embase、参考文献列表和目标网站。
两名独立评审员校准研究选择；然后一名评审员筛选所有标题和摘要，另一名评审员随机筛选20%。全文重复此过程。我们纳入了115份文件，代表61个实施项目（占已识别文件的8.9%）。纳入的文件描述了以物理治疗师、职业治疗师和/或言语语言病理学家为循证实践目标用户的实施项目。
两名评审员重复研究选择中描述的独立过程，以提取基本研究和可持续性特征以及背景、机制、结果和策略文本。
通过基本数值分析，我们发现康复中只有54%的循证实践得以维持。此外，虽然报告了可持续性规划的作者在94%的时间里维持了实践，但康复中的可持续性规划很少见（仅26%的时间有报告）。使用归纳和演绎追溯的现实主义技术对提取的文本进行综合，其中背景、机制、结果和策略文本被组合成关于可持续性如何运作的叙述性解释。为了为这些解释提供信息，我们应用了规范化过程理论和计划行为理论。总体而言，52个已识别的叙述为三种模式提供了证据：（1）实施和可持续性阶段相互关联，（2）循证实践的持续使用可被解释为最终的可持续性结果，（3）中间可持续性结果（即契合/一致性、财政支持、益处、专业知识）可成为影响其他可持续性结果的背景特征。
实施团队可以使用本综述中生成的叙述性解释来优化可持续性规划。这可以维持实践变革并改善护理质量和患者结局。未来的研究应寻求迭代完善所提出的叙述性解释。
