RehabWire - Volume 6, Number 10, December 2004.

RehabWire for December reviews and publications highlighting evidence-based practice. What does this paradigm shift mean for the disability and rehabilitation community?

NIDRR Projects: Focused to Innovate.

Rehabilitation Research and Training Center on Traumatic Brain Injury Interventions, Mount Sinai School of Medicine (H133B040033) led by Wayne A. Gordon, PhD. Cate Miller, PhD, Project Officer.
Abstract: One facet of this RRTC is Support for Evidence-Based Practice, which evaluates all published research on post-TBI interventions and assessment of outcomes; it serves as a national resource for disseminating the results. It also implements three PAR-based analyses of high priority areas, including meta-analyses if appropriate. A major focus of the RRTC is placed on capacity building of clinical and research professionals: to address the need for better day-to-day interventions in the lives of people with TBI. Often their medical needs are misread, their brain injury goes unidentified and they find services and accommodations inappropriate. Capacity building focuses on students early in their educational career - to help shape career choice and points of view; graduate and post-graduate students; and practicing “gate keepers” in the community, primarily psychologists and physicians.
Find out more at www.mssm.edu/tbinet

Rehabilitation Research and Training Center on Health and Wellness in Long Term Disability, Oregon Health and Science University (H133B040034) led by Gloria Krahn, PhD, MPH. Theresa San Agustin, MD, Project Officer.
Abstract: The vision of the RRTC is to contribute to the reduction of health disparities for person with disabilities through an integrated program of research, training, technical assistance, and dissemination. The Center has three inter-related strands of work to address its three intended outcomes/goals. (1) Identify strategies to overcome barriers that impede access to routine healthcare for individuals with disabilities; (2) Identify interventions in areas such as exercise, nutrition, pain management, or complementary and alternative therapies that promote health and wellness and minimize the occurrence of secondary conditions for persons with disabilities; and (3) Develop improved status measurement tool(s) to assess health and well-being of individuals with disabilities regardless of functional ability. In order to achieve these outcomes, the RRTC conducts a coordinated program of research and training activities using a logic model framework. RRTC projects summarize and validate existing research findings on barriers to health care access as well as rigorously test and compare new strategies to overcoming identified barriers. The RRTC also examines and evaluates the practices of exemplary generic and specialized health promotion programs for people with disabilities in order to create an evidence-based set of evaluation and planning criteria.
Find out more at www.healthwellness.org

Integrating Assertive Community Treatment (ACT) and Illness Management and Recovery (IMR) for Clients with Severe Mental Illness (SMI), Indiana University Purdue University Indianapolis (IUPUI) (H133G030106) led by Michelle P. Salyers, PhD. Bonnie Gracer, Project Officer.
Abstract: This project targets the subgroup of 20 percent of consumers with severe mental illness identified with the most severe disabilities, that is, the subgroup most often excluded from rehabilitation services and mental health treatment. The project involves: (1) the systematic integration and high-fidelity implementation of two evidence-based practices for consumers with severe mental illness: assertive community treatment and illness management and recovery; (2) enhancing integration by employing a consumer specialist on treatment teams in a well-defined role; and (3) providing the first empirical test of a comprehensive package of techniques designed to help consumers learn to manage their own illness and foster recovery. Outcome measures include achievement of recovery goals, such as competitive employment and independent living, as well as indicators of illness management, such as prevention of hospitalization.
Find out more at psych.iupui.edu/ACTCenter

Development of an Assistive Technology Outcomes Measurement System Utilizing the International Classification of Functioning (ICIDH-2/ICF), University of Colorado Health Sciences Center (H133G030187) led by Cathy Bodine. David W. Keer, Project Officer.
Abstract: This project furthers the development of a secure, Health Insurance Privacy and Accountability Act of 1996 (HIPAA) compliant, multi-site, web-based assistive technology (AT) outcomes system designed to capture data that enables the measurement of the impact of AT devices and services for children and adults with disabilities. Information gained leads to maximizing the full inclusion and integration into society, employment, independent living, family support, and economic and social self-sufficiency of individuals with disabilities, especially individuals with the most severe disabilities; and will lead to improved information and research on the effectiveness of AT devices and evidence-based practices.
Find out more at www.uchsc.edu/atp

Evidence-based practice “de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision-making, and stresses the examination of evidence from clinical research. [It] requires new skills of the physician, including efficient literature-searching, and the application of formal rules of evidence in evaluating the clinical literature.” Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine www.cche.net/usersguides/ebm.asp

EBP resources from the AHRQ: www.ahrq.gov/clinic/epcix.htm

National Guidelines Clearinghouse: www.guideline.gov

New Research: Selections from REHABDATA

Murphy, M. A., Roberts-Warrior, D. (2003) A review of motor performance measures and treatment intervention for patients with stroke. Topics in Geriatric Rehabilitation, 19(1), 3-42. NARIC Accession Number: J45059.
Abstract: Article presents an overview of measures of motor function impairment and disability and interventions to improve motor function after stroke. Includes measures of muscle strength, movement, and balance impairments, as well as measures of basic mobility, upper extremity, physical activities of daily living, and global disability. Provides a brief description of each measure, including its reliability, validity, and sensitivity. Presents a history of physical therapy treatment for motor function and discusses the trend toward evidence-based practice in rehabilitation. Guidelines for stroke rehabilitation, systematic reviews about interventions for motor recovery in the upper extremity and electrical stimulation, and studies about strengthening exercise are also discussed.

Smith, B. J., Strain, P. S., Snyder, P., Sandall, S. R., McLean, M. E., Ramsey, A. B., Sumi, W. C. (2003) DEC recommended practices: A review of 9 years of EI/ECSE research literature. Journal of Early Intervention, 25(2), 108-119. NARIC Accession Number: J45184.
Abstract: Article presents analysis of early intervention/early childhood special education (EI/ECSE) research literature appearing in 48 peer-reviewed journals from 1990 to 1998. This synthesis is part of a national effort by the Division for Early Childhood (DEC) of the Council for Exceptional Children and several universities to develop a set of evidence-based practice guidelines. Review of the literature reveals trends in research methods used for studying young children (age birth through 5 years), their families, providers of service, and policies and strategies related to the provision of services.

Jutai, J. W., Teasell, R. W. (2003) The necessity and limitations of evidence-based practice in stroke rehabilitation. Topics in Stroke Rehabilitation, 10(1), 71-78. NARIC Accession Number: J45820.
Abstract: Article discusses the importance and limitations of evidence-based practice in stroke rehabilitation. Describes the process of transferring research knowledge to clinical practice, while acknowledging the ethical issues associated with that process.

Jette, D. J., Bacon, K., Batty, C., Carlson, M., Ferland, A., Hemingway, R. D., Hill, J. C., Ogilvie, L., Volk, D. (2003) Evidence-based practice: Beliefs, attitudes, knowledge, and behaviors of physical therapists. Physical Therapy, 83(9), 786-805. NARIC Accession Number: J46109.
Abstract: Article describes survey conducted to determine the beliefs, attitudes, knowledge, and behaviors of physical therapists regarding the use of evidence-based practice (EBP). Researchers also wanted to determine the relationship between these attributes and the demographic and practice characteristics of the respondents. Results showed that respondents had positive attitudes and beliefs about EBP and were interested in improving their skills related to implementing evidence into practice. Seventeen percent of respondents reported reading fewer than 2 articles per month, and 25 percent of the respondents stated that they used literature in their clinical decision making less than twice per month. The primary barrier to implementing EBP was lack of time.

Cook, J. A., Toprac, M., Shore, S. E. (2004) Combining evidence-based practice with stakeholder consensus to enhance psychosocial rehabilitation in the Texas benefit design initiative. Psychiatric Rehabilitation Journal, 27(4) 307-318. NARIC Accession Number: J47591.
NIDRR Project Number: H133B000700.
Abstract: Article describes a process using evidence-based practice along with multiple stakeholder consensus to a design a benefit package of psychosocial rehabilitation (PSR) services for people using public mental health services in Texas. The Texas Benefit Design Initiative uses research evidence to define provider competencies, characteristics of the clients who will benefit most from different services, the optimal length and frequency of services, and what organizational structure should be used. PSR services include supported housing, supported employment, integrated mental health and substance abuse treatment, case management, life skills training, and peer support, self-help, and consumer operated services. Further articles in this series examining the research evidence on the quality of service delivery in each of these areas are included separately in the NARIC collection under accession numbers J47591 through J47597.

Dean-Baar, S., Pakieser-Reed, K. (2004) Closing the gap between research and clinical practice. Topics in Stroke Rehabilitation, 11(2), 60-68. NARIC Accession Number: J47676.
Abstract: Article discusses the use of evidence-based practice in stroke care. The application of research findings to practice and the use of evidence in making a clinical decision improves the quality of care delivers to patients with stroke. Variations in practice that affect the outcome of care include provider characteristic, geography, patient characteristics, market variables, and provider inconsistency. Strategies used to translate research into practice include meta-analysis, consensus statements, evidence reports, and clinical practice guidelines.

Hill, K. (2003) The use of AAC performance data to support evidence-based practice with a preschooler. In R. Simpson (Ed.), Proceedings of the RESNA 26th International Conference: Technology and Disability: Research, Design, Practice and Policy. Arlington, VA: RESNA Press. NARIC Accession Number: O15501.
Abstract: Case study presents the steps for applying the principles of evidence-based practice (EBP) during language intervention with a preschooler who uses an augmentative and alternative communication system. The intervention included the three components of EBP: (1) evidence at the field level, (2) evidence at the personal level, and (3) knowledge and skills of the clinician. Language activity monitoring was used in conjunction with evidence at the field level to report outcome measures and guide clinical decisions during the intervention.

Schlosser, R. W. (2003) The efficacy of augmentative and alternative communication: Toward evidence-based practice. Academic Press. NARIC Accession Number: R08371. Mr. Schlosser is a former Switzer Fellow (2001). Abstract: Provides information to help researchers and practitioners develop the skills necessary to improve the efficacy of services for individuals who use augmentative and alternative communication (AAC). Book is designed to: (1) increase the understanding and use of evidence-based practice, (2) provide efficacy information based on research that can help clinicians and educators make more informed decisions in practice, (3) serve as an extensive source of efficacy data, and (4) help clinicians and educators become better consumers of research and take more active roles in the research process.