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NB Part B

NB Part B. Applying Evidence cont’d. Are there social or cultural factors that might affect suitability or acceptance? What are the wishes of the patient and/or the family ?. Challenge 2. Adopting Research Findings into your Daily Clinical Practice in your Institution.

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NB Part B

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  1. NB Part B

  2. Applying Evidence cont’d • Are there social or cultural factors that might affect suitability or acceptance? • What are the wishes of the patient and/or the family ?

  3. Challenge 2 Adopting Research Findings into your Daily Clinical Practice in your Institution

  4. Barriers to Adoption of New Approaches to Treatment • Little opportunity to update skills or knowledge • Inadequate professional staffing • Lack of time or space for complicated protocols • Lack of sufficient or necessary equipment • Too few support personnel • Lack of managerial support for innovation • Insufficient team interactions for planning

  5. Remember • There are no guidelines to common sense so every guideline needs to be applied on a case to case basis • Behind the science of ‘Evidence Based Practice’ there is always a patient!!

  6. How does the EBP Process Benefit you as a Health Professional? • Patients expect effective treatment from competent, knowledgeable and up to date personnel . EBP enhances these traits. • We practice amid a knowledge explosion. It is almost impossible to keep up to date unless it is done routinely for a purpose. EBP helps us do this. • Proponents of EBP are convinced that “evidence can inform, refine, sharpen, enrich and enhance clinical experience”. Davidoff, 1999

  7. Opportunity 3 Working on a Professional Stroke Rehabilitation Team

  8. Health Care Team • “A group of two or more professionals from different disciplines who have common values and work toward common objectives”. Halstead LS. Arch Phys Med Rehabil 57:507, 1976 • “ Two or more individuals who have specific roles, perform independent tasks, are adaptable, and share a common goal” Baker et al: Role of teamwork in the professional education of physicians J Qual & Pat Safety 31:185-202. 2005

  9. Teamwork • “Coordinated, comprehensive care provided by persons who integrate observations, expertise and decisions on behalf of patients” Halstead LS. Arch Phys MedRehabil 57:507.1976 • “The seamless integration of multiple knowledge, skill and affective competencies” Salas E. Risk Management Foundation: Harvard Medical Institutions 23#3, 9,2003 • REHABILITATION IS A TEAM SPORT!

  10. Members Members from medicine, nursing, physical, occupational and speech and language therapy as well as social work, are optimal and common in stroke rehabilitation: there may be others. Fairly similar definitions of EPB have been written for most groups.

  11. Challenge 3 • Achieving a cohesive, dedicated, knowledgeable, high functioning team within a busy rehabilitation centre that advocates evidence based care and rehabilitation.

  12. Characteristics of a Well Functioning Team • Has a well defined mission • Has defined who does what in the group • Has developed a structure that focuses on patient needs • Has an open pattern of communication • Contains knowledgeable and committed individuals who deliver evidence-based care

  13. Characteristics- cont’d • Uses a decision making strategy based on who has the relevant information and who will implement the decision • Has an understanding of the small group process • Has a strategy for ongoing education and development

  14. Communicate clearly Give sufficient information Review notes from all professionals Be polite and respectful Offer timely information Respond to other members Alert team members about changes in patient’s condition Think about inter-professional communication skills Inter-Professional Communication Guides

  15. Opportunity 4 • Improving the Health-Related Quality-of-Life (HRQL) of people with residual deficits following stroke

  16. What do we mean by the term Quality of Life?

  17. Material comforts Health & personal safety Relationships with relatives Children / grandchildren Relationship with spouse Close friends Learning Understanding yourself Work Expressing yourself creatively Helping & encouraging others Participation in public affairs Socializing Passive leisure activities Active recreation Flanagan Quality of Life ScaleFlanagan JC, Am. Psychologist 33:138-47, 1978

  18. Favorite DefinitionQuality of Life “Individuals’ perception of their position in life in the context of the culture in which they live and in relation to their goals, expectations, standards and concerns.” WHOQOL Group, Soc. Sci Med. 41: 1403-09,1995

  19. Is Quality of Life Different from Health-related Quality of Life ? “Jobs, housing, schools and the neighborhood are not attributes of an individual’s health and they are well outside the purview of the (personal) health care system.” J Ware, J Chron Dis 40: 473-80, 1987

  20. What isHealth-Related Quality of Life HRQOL?

  21. Health-related quality of life builds on the WHO definition of health • Health: “A state of complete physical, mental and social well being, not merely the absence of disease or infirmity. WHO 1948 • HRQL respects the spirit of this definition and adds the individual’s personal perceptions of health, functional status, social well being and perhaps how long one anticipates living. Guyatt et al. Ann Int Med118:632,1993

  22. Favorite DefinitionHealth-related Quality of Life “The value assigned to duration of life as modified by impairments, functional states, perceptions and opportunities and influenced by disease, injury, treatment and policy.” Patrick D & Erickson P. Drug Ther Res 13:152-8, 1988

  23. State of the Science • Numerous measures of HRQL • Virtually all are patient-reported outcomes (PROs) • Information comes directly from the patient • Scales reflect actual health, performance and feelings at that point in time • Scales are widely used in research and are gaining in use in clinical and rehabilitation practice

  24. State of Our Knowledge • Health care professionals, particularly those who work with patients over a sustained period of time have a pretty good idea of the components of daily living that could enhance the lives of people who have had a stroke and who now have residual problems.

  25. Challenge 4 Helping people with stroke achieve a better quality of life -despite their stroke

  26. Getting on with the Rest of your Life after Stroke: A Cross-Canada Program Aimed at Enhanced Life Participation, Prevention of Deterioration and Optimization of Health Care Utilization

  27. Ruth Barclay Goddard: Uni. Manitoba Marilyn Mackey Lyons: Dalhousie Uni. Carol Richards: Uni. Laval Mark Bayley: Uni. Toronto Janice Ing Uni. BC Robert Teasel: Uni. Western Ontario Sharon Anderson: Community Nancy Mayo PI, McGill University

  28. Mission Possible • Randomized clinical trial • Ongoing in 9 Canadian cities (11 sites) • Following formal rehabilitation 254 people were enrolled to immediate or delayed entry to study • Content of program focused on meaningful physical activities done in a group setting, sometimes led by a group member, to foster increased participation in life events and satisfaction with life

  29. Meets weekly at most sites • Activities often planned by group members • Or they may be led by group members

  30. What is the Mission? To assist participants to formulate life goals that are then staged into a series of realistic projects that the person can meet by developing internal resources and using existing community-based resources

  31. Who is in need? Two thirds of people with acute stroke go home after stroke Half of these are fine: the other half are not Average life-expectancy is 7 years Many people with stroke have need for meaningful activity

  32. What do stroke survivors want? Learning Exercise • Transportation Sense of Belonging Fun 2-3 x per week

  33. To be Integrated & in the Community

  34. This is one of the activities I get to do with the group. Just hit the ball see what happens. That’s why I come, there is always something to do!

  35. Thanks • The Canadian Stroke Network, • Toronto Rehabilitation Institute, • Ministry of Health & Long Term Care of Ontario. • Heart and Stroke Foundation of Ontario

  36. Contributors • Nancy Mayo PT PhD McGill University • Nicol Korner Bitensky OT PhD, McGill University • Robert Teasel MD University of Western Ontario • Ruth Barkley Goddard PT PhD Winnipeg • Mark Bayley MD FRCPC University of Toronto

  37. Readings • Menon A. et al. Strategies for rehabilitation professionals to move evidence-based knowledge into practice: A systematic review. J Rehabil Med 2009: 41:1024-32 • Johansson BB. Current trends in stroke rehabilitation. A review with focus on brain plasticity. Acta Neurol Scand 2011:147-59

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