Rehabilitation therapists' clinical questions: Preliminary results of an exploratory study
The objective of this study is to explore rehabilitation therapists' (physical therapists, occupational therapists, and speech-language pathologists) clinical questions in the context of evidence-based patient care. Specifically, this research attempts to answer the following questions: How do rehabilitation therapists articulate their information needs? Does the evidence-based practice framework's clinical question structure of problem – intervention – comparison – outcome adequately represent the information needs of rehabilitation therapists? Why do rehabilitation therapists pursue some of their clinical questions and not others?
Taking a qualitative approach, this research will employ self-report journaling followed by semi-structured interviews of approximately fifteen rehabilitation therapists working in stroke care. Informants will be asked to record their clinical questions for a period of one or two weeks, after which interviews will be conducted to elicit more specific information about their clinical questions, and to determine reasons for pursuing some of these and not others.
We will report the preliminary findings of this study. It is anticipated that results will reveal types of clinical questions asked by rehabilitation therapists working in stroke care as well as patterns in the structure of these questions. In addition, factors influencing the decision to pursue certain types of questions will be identified.
Background and Introduction
Evidence-based practice (EBP) has emerged as an influential social movement in health care, beginning with physicians before proceeding to nurses and other health professionals. In the 21st century, health information is abundant, and the challenge is no longer to find or access information, but to locate and make use of good quality information, or evidence, in order to deliver the best possible health care. In information studies, the information behaviour of health professionals, including physicians, nurses, and rehabilitation therapists, can be studied to better understand what information these clinicians need, how they seek information, and how they use information to inform practice.
Rehabilitation therapists (occupational therapists, physiotherapists, and speech-language pathologists) play an essential role in health care. Even so, their information behaviour is overlooked in the literature of information studies. The information behaviour of health professionals such as physicians and nurses is better understood as a result of many studies conducted on their information needs, information-seeking behaviour and information use (e.g., Covell, Uman & Manning, 1985; Davies, 2007; Dawes & Sampson, 2003; Spenceley et al, 2008).
In order to improve education initiatives and information services to rehabilitation therapists in support of EBP, their information behaviour, particularly their information needs, requires understanding and explanation. This study explores the information needs of rehabilitation therapists that arise during everyday practice, as an initial step in understanding rehabilitation therapists' information behaviour and comparing it to that of other health professionals.
This study links the information needs of rehabilitation therapists to the activity of patient care, or the patient consultation, and is therefore a study of the person-in-context – the rehabilitation therapist as provider of patient care.
Research Purpose and Questions
The purpose of this research is to explore rehabilitation therapists' clinical questions in the context of evidence-based patient care.
The research can be broken down into three research questions:
RQ1:What characteristics are common among rehabilitation therapists' clinical questions?
RQ2: How are the elements present in clinical questions similar to, or different from those suggested by the EBP framework?
RQ3: Why are certain clinical questions pursued, while others are not?
These questions will guide the research study in order to gain insight into the types of clinical questions asked by researchers (RQ1), the structure these questions take (e.g., similar to or divergent from PICO or PESICO) (RQ2) and the reasons influencing information seeking (RQ3).
In the context of patient care, rehabilitation therapists working in stroke care (the study's informants) will be asked to record clinical questions as they arise. Employing purposive, snowball sampling (Patton, 2002), we will recruit informants from at least three rehabilitation centres in the Montreal area. Their clinical questions will be analyzed against existing question-framing structures proposed by EBP (Bennett & Bennett, 2000; Dawes et al., 2005; Richardson et al., 1995; Schlosser et al., 2007). In addition, we will conduct narrative interviews with each informant to elucidate more details about the clinical questions, and about why they were or were not pursued. The resulting data will be analyzed to uncover themes or patterns associated with clinical question types, structures, and whether or not answers were sought.
In this poster, we will present preliminary results following the analysis of clinical question journals and interviews conducted with informants enrolled in the study between July and September 2009.
The research has implications for healthcare professionals and librarians. The results will provide insight not only into the clinical questions in rehabilitation therapists' everyday clinical practice, but also into the motivations for answering (or not answering) these questions. As a result of an improved understanding of rehabilitation therapists' questions and their motivations, healthcare administrators and educators will be better prepared to facilitate EBP, through improved information services (including knowledge translation initiatives), and educational interventions. Facilitating EBP for this group of health professionals can then potentially improve the care provided to patients.
To enable rehabilitation therapists to locate evidence for EBP, effective strategies for teaching information skills as well as tools for disseminating research results are required. The results of this study will provide information that can be used in the design of tools by librarians and other information providers in order to teach question formulation and enable access to evidence. It will also satisfy the curiosity of health science librarians, who want to understand how to support the work of rehabilitation therapists in their everyday practice. The results of this research will supplement current knowledge about the information needs of other healthcare professionals, and add another dimension to current information behaviour models by elucidating on the nature of clinical questions as expressed information needs, and the process by which healthcare professionals move from acknowledging an information need to deciding to engage in information seeking behaviour.
This research project is supervised by the doctoral committee: J.C. Bartlett (advisor), N. Korner-Bitensky, F. Bouthillier, J. A. Large, & P. Pluye.
This work is supported in part by the Thomson Scientific / Medical Library Association Doctoral Fellowship, the Canadian Library Association World Book Graduate Scholarship, and the Doctoral Research Scholarship from the Fonds québécois de la recherche sur la société et culture.