Smyth Rachael E, Theurer Julie, Archibald Lisa Md, Oram Cardy Janis
Health and Rehabilitation Sciences, The University of Western Ontario, London, Canada.
Communication Sciences & Disorders, The University of Western Ontario, London, Canada.
Autism Dev Lang Impair. 2020 Apr 3;5:2396941520913482. doi: 10.1177/2396941520913482. eCollection 2020 Jan-Dec.
Practice-based research holds potential as a promising solution to closing the research-practice gap, because it addresses research questions based on problems that arise in clinical practice and tests whether systems and interventions are effective and sustainable in a clinical setting. One type of practice-based research involves capturing practice by collecting evidence within clinical settings to evaluate the effectiveness of current practices. Here, we describe our collaboration between researchers and clinicians that sought to answer clinician-driven questions about community-based language interventions for young children (Are our interventions effective? What predicts response to our interventions?) and to address questions about the characteristics, strengths, and challenges of engaging in practice-based research.
We performed a retrospective chart review of 59 young children who had participated in three group language interventions at one publicly funded community clinic between 2012 and 2017. Change on the Focus on the Outcomes of Communication Under Six (FOCUS), a government mandated communicative participation measure, was extracted as the main outcome measure. Potential predictors of growth during intervention were also extracted from the charts, including type of intervention received, attendance, age at the start of intervention, functional communication ability pre-intervention, and time between pre- and post-intervention FOCUS scores.
Overall, 49% of children demonstrated meaningful clinical change on the FOCUS after their participation in the language groups. Only 3% of participants showed possibly meaningful clinical change, while the remaining 46% of participants demonstrated not likely meaningful clinical change. There were no significant predictors of communicative participation growth during intervention.
Using a practice-based research approach aimed at capturing current practice, we were able to answer questions about the effectiveness of interventions delivered in real-world settings and learn about factors that do not appear to influence growth during these interventions. We also learned about benefits associated with engaging in practice-based research, including high clinical motivation, high external validity, and minimal time/cost investment. Challenges identified were helpful in informing our future efforts to examine other possible predictors through development of a new, clinically feasible checklist, and to pursue methods for improving collection of outcome data in the clinical setting. Clinicians and researchers can successfully collaborate to answer clinically informed research questions while considering realistic clinical practice and using research-informed methods and principles. Practice-based research partnerships between researchers and clinicians are both valuable and feasible.
基于实践的研究有望弥合研究与实践之间的差距，因为它基于临床实践中出现的问题来解决研究问题，并检验系统和干预措施在临床环境中的有效性和可持续性。一种基于实践的研究类型是通过在临床环境中收集证据来记录实践情况，以评估当前实践的有效性。在此，我们描述了研究人员与临床医生之间的合作，旨在回答临床医生提出的关于针对幼儿的社区语言干预的问题（我们的干预措施有效吗？哪些因素可预测对我们干预措施的反应？），并探讨参与基于实践的研究的特点、优势和挑战。
我们对2012年至2017年期间在一家公立社区诊所参加过三次小组语言干预的59名幼儿进行了回顾性病历审查。提取了政府规定的沟通参与度衡量指标“六岁以下沟通结果关注量表”（FOCUS）上的变化作为主要结局指标。还从病历中提取了干预期间成长的潜在预测因素，包括接受的干预类型、出勤率、干预开始时的年龄、干预前的功能沟通能力以及干预前后FOCUS评分之间的时间间隔。
总体而言，49%的儿童在参加语言小组后在FOCUS量表上显示出有意义的临床变化。只有3%的参与者显示出可能有意义的临床变化，其余46%的参与者显示出不太可能有意义的临床变化。干预期间沟通参与度增长没有显著的预测因素。
采用旨在记录当前实践的基于实践的研究方法，我们能够回答关于在现实环境中实施的干预措施有效性的问题，并了解在这些干预措施中似乎不影响成长的因素。我们还了解到参与基于实践的研究的好处，包括高临床积极性、高外部效度以及最少的时间/成本投入。确定的挑战有助于为我们未来的工作提供信息，即通过制定新的、临床可行的清单来研究其他可能的预测因素，并寻求改善临床环境中结局数据收集的方法。临床医生和研究人员可以成功合作，在考虑实际临床实践的同时，使用基于研究的方法和原则来回答具有临床依据的研究问题。研究人员与临床医生之间基于实践的研究伙伴关系既宝贵又可行。
