Aspects affecting occupational therapists' reasoning when implementing research-based evidence in stroke rehabilitation

Abstract

Background: When implementing evidence-based practice in occupational therapy the investigation of clinical reasoning provides important information on research utilization. Aim: This study investigates aspects affecting occupational therapists' reasoning when implementing research-based evidence within stroke rehabilitation. Methods: The study was based on a phenomenological hermeneutical and an action research approach in collaboration with three occupational therapy settings including 25 occupational therapists. Data collection consisted of 41 field observations, 14 individual interviews, and six focus-group interviews. Results: New knowledge concerning the substantial influence of professional values in the occupational therapists' local cultures was indicated. It was of importance that the therapists as a group are given the opportunity to explicit and critically appraise values and knowledge use in order to develop their practice knowledge and new skills. Moreover personal values and clinical experiences influenced clinical reasoning. Current knowledge of the importance of local cultures and leadership was reinforced. Conclusion: The influence of professional values in the occupational therapists' local cultures was a substantial factor in the implementation processes. In addition personal values and clinical experiences influenced professional decision-making. Furthermore, the study reinforced current knowledge of the importance of culture and leadership in implementation of research-based clinical guidelines.

Key words::

• clinical reasoning
• evidence-based practice
• knowledge translation
• occupational therapy
• stroke rehabilitation

Acknowledgements

The authors wish to thank the Danish Association of Occupational Therapists for donation of a grant. They also gratefully thank Mette Boll for contributing to the development of the figures and Professor Jo Rycroft-Malone, MSc, PhD, R, University of Wales, UK, for kindly commenting on the article draft.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.