GOOD, BETTER, BEST PRACTICE: LEVERAGING

OT STUDENT AND CAPSTONE PROJECTS

Lindsay Marth, MA, OTR/L, BCPR

Tonya Rich, PhD, OTR/L

MOTA Conference – October 26, 2019

DISCLOSURE

• Lindsay Marth & Tonya Rich work for the Department of Veterans Affairs. The content of this presentation does not represent the position of the VA nor are any of the topics/content endorsed by the Federal Government.

Good Better Best Practice- Marth and Rich for MOTA 2019

OBJECTIVES

Through engagement in the course participants will be able to:

•Describe the traffic light system as a tool for evaluating evidence.

•Identify strategies to communicate evidence with traffic light model in a format understandable to clinicians, family, and clients.

•Describe methods to structure Level II fieldwork and capstone projects for clinical utility and application of evidence based practice.

Good Better Best Practice- Marth and Rich for MOTA 2019

STAGES OF TRANSLATIONAL RESEARCH

Clinical Research

Efficacy StudiesPreliminary Support

Comparative Effectiveness

What works best?Who responds to what intervention?Generate practice guidelines

Implementation Research

Observation of changing practice patterns.What are the barriers and facilitators to changing practice?How can we influence adoption?

(Unpublished)Good Better Best Practice- Marth and Rich for MOTA 2019

EVIDENCED-BASED PRACTICE TO GUIDE CLINICAL DECISION MAKING

Research

Clinician Expertise

Client's Values and

Beliefs

The sweet spot…Evidenced Based Practice

(Unpublished)Good Better Best Practice- Marth and Rich for MOTA 2019

LEVELS OF EVIDENCE FOR OT2

Systematic Reviews, Meta

Analyses

RCTs

Non-RCT, 2 groups

Non-RCT, 1 group

Descriptive Studies

Narratives, Case Studies, Expert Opinion, Consensus Statements

(Unpublished)Good Better Best Practice- Marth and Rich for MOTA 2019

TRAFFIC LIGHT MODEL-MAKING EVIDENCE ACCESSIBLE FOR ALL

Good Better Best Practice- Marth and Rich for MOTA 2019

http://www.connecthealth.co.uk/blog/stop-traffic-lights-signal-best-clinical-outcomes-connect/

WHAT IS THE EVIDENCE FOR OUR INTERVENTIONS?

Good Better Best Practice- Marth and Rich for MOTA 2019

Ideal Scenario

Good Better Best Practice- Marth and Rich for MOTA 2019

Constraint Induced Movement Therapy?

Bimanual Motor Training?

NMES + and technology?

Pediatric Case-young boy s/p CVA what is the treatment plan?

Now We Have Evidence Guiding Treatment

Good Better Best Practice- Marth and Rich for MOTA 2019

Constraint Induced Movement Therapy

NMES + and technology

Bimanual Motor Training

Pediatric Case-young boy s/p CVA treatment plan

WHAT IS THE EVIDENCE FOR OT (GULP!) ?

Good Better Best Practice- Marth and Rich for MOTA 2019

Adapted from the AOTA EBP course with crediting Novak, Russel, & Ketelaar 2013

Lack of Evidence

• Education

Low Quality Evidence

• Small Group Meetings

• Communities of Practice

• Subject Matter Experts

Higher Quality Evidence

• Audit

• Peer Feedback

• Quality Improvement

Good Better Best Practice- Marth and Rich for MOTA 2019

STUDENTS!!!

MVAHCS STUDENT PROGRAM

• 16-20 Level II OT Students/ Yr

• Projects

• Collaborative with supervisor

• Proposal including supporting evidence

• Journal club and needs assessment with focus group

• Project development

• Presentation to OT department and additional as applicable

•How can they better support department EBP efforts?

•How can we create OTD capstone experiences that meet the needs of the students and the department?

Good Better Best Practice- Marth and Rich for MOTA 2019

• “Through the partnership between a clinician and OTD student, implementing evidence-based practice increased clinician knowledge and confidence with a high-risk condition and facilitated meaningful changes in practice, ultimately leading to improved client outcomes.”

• Supports effort to increase practical usability and for student projects to support larger clinician and leadership goals.

Reifenberg, G. & Heinekamp, A. Using the Traffic Light System to Implement Evidence-Based Practice. OT Practice Nov 2018

Good Better Best Practice- Marth and Rich for MOTA 2019

REIFENBERG & HEINEKAMP OT PRACTICE ARTICLE

Good Better Best Practice- Marth and Rich for MOTA 2019

Reifenberg, G. & Heinekamp, A. Using the Traffic Light System to Implement Evidence-Based Practice. OT Practice Nov 2018

OTD CAPSTONE EXPERIENCES

•Various Capstone Formats D.1.0 (ACOTE 2018) ▪Clinical practice skills

▪Research skills

▪Administration

▪Leadership

▪Program & policy development

▪Advocacy

▪Education

▪Theory development

Good Better Best Practice- Marth and Rich for MOTA 2019

Polytrauma Specialty Care• InterD team• Community

Integration• IADL skill

development• Literature

Review and Case presentation

-Strongly recommend that occupational therapy practitioners routinely provide the intervention to eligible clients.

-Good evidence was found that the intervention improves important outcomes.

-Benefits substantially outweigh harm.

-Two or more studies with Level I evidence

STRONG

EVIDENCE

-Moderate evidence that OT practitioners routinely provide the intervention to eligible clients.

-Fair evidence was found that the intervention improves important outcomes.

-At least one study with Level I evidence, and level II and III evidence

MODERATE

EVIDENCE

-Weak evidence that the intervention can improve outcomes, OR

-Insufficient evidence to recommend for or against routinely providing the intervention.

-Evidence of the intervention is lacking, of poor quality, or conflicting, and the balance of benefits and harm cannot be determined.

WEAK

EVIDENCE

Adapted from Classen, Monahan, Auten, & Yarney (2014).

Good Better Best Practice- Marth and Rich for MOTA 2019

Good Better Best Practice- Marth and Rich for MOTA 2019

Good Better Best Practice- Marth and Rich for MOTA 2019

LEVEL II PROJECT: PAIN SELF-MANAGEMENT

Good Better Best Practice- Marth and Rich for MOTA 2019

Complete Literature Review & Needs

Assessment

Develop Evidence-Supported Handout

Record Video

Vignettes

Additional Projects- Pain Management

Good Better Best Practice- Marth and Rich for MOTA 2019

Good Better Best Practice- Marth and Rich for MOTA 2019

Sample: Handout

● Provides an explanation of nine self-management strategies for patients experiencing pain while in acute care setting…based on the evidence

● Strategies include:○ Deep Breathing ○ Meditation○ Guided Imagery○ Gentle Movement○ Progressive Muscle Relaxation○ Self-Massage○ Aromatherapy○ Hot/Cold Application○ Music

Good Better Best Practice- Marth and Rich for MOTA 2019

Additional Student Projects

• Pain Treatment• Building on needs assessment and stop light, additional tools and videos to

overcome pain as barrier to ADL/IADL training in CLC

• Quality Improvement• Student with MPH and clinical research background built the “clock” for

completion of QI

• Follow-up: specialty third student completing project on driver’s pre-screen and behind the wheel

Good Better Best Practice- Marth and Rich for MOTA 2019

PLANNED CAPSTONES AY 2019-2020

• Patient and Caregiver Education• Education and clinical skills: will build on handout guide and

video formats

• LSVT Big and Loud• Program development and clinical skills: will build on QI and stop

light

• Addressing Psychosocial Factors in Acute/ Sub-acute TBI• Program development and clinical skills: will build on QI and stop

light

Good Better Best Practice- Marth and Rich for MOTA 2019

• PICO Workgroup projects & staff lead assessment of current practice

• Format to communicate information learned at a training or conference

• Method to organize education and training for new staff & students and to prioritize department education

• Format to objectively evaluate current practice areas while maintaining and respecting clinical experience/ judgment and patient choice

• Shared with national OT EBP group and on national VA OT call

Good Better Best Practice- Marth and Rich for MOTA 2019

PICTURE CREDITS/REFERENCES

1. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.

2. Classen, S., Monahan, M., Auten, B., & Yarney, A. (2014). Evidence-based review of interventions for medically at-risk older drivers. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 68(4), e107–e114. doi:10.5014/ajot.2014.010975

3. Novak, I. (2012). Evidence to Practice Commentary: The Evidence Alert Traffic Light Grading System. Physical & Occupational Therapy in Pediatrics, 32(3), 256–259. Retrieved from http://search.ebscohost.com.ezproxy.usd.edu/login.aspx?direct=true&db=eric&AN=EJ977618&site=ehost-live&scope=site

4. Novak I, Honan I. Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian Occupational Therapy Journal; April 2019. https://doi.org/10.1111/1440-1630.12573

5. Reifenberg, G. & Heinekamp, A. Using the Traffic Light System to Implement Evidence-Based Practice. OT Practice Nov 2018

6. http://www.connecthealth.co.uk/blog/stop-traffic-lights-signal-best-clinical-outcomes-connect/

Good Better Best Practice- Marth and Rich for MOTA 2019

QUESTIONS?

•Contact Information:• lindsay.marth@va.gov

•tonya.rich@va.gov

Good Better Best Practice- Marth and Rich for MOTA 2019