The De-Implementation of Longstanding Low-Value Clinical Practices: The Case of Sensory Integration
Notice bibliographique
Résumé
Background. Current knowledge translation science applies the same theories, frameworks, and barriers assessments to both the implementation of new clinical practices and the de-implementation of well-established clinical practices. The continued use of longstanding, low- value practices is likely to be heavily influenced by societal and collective-level factors, such as professional culture, tradition, and historical context, which may warrant a different approach to understanding de-implementation. For over 50 years in occupational therapy practice, Ayres Sensory Integration® (ASI®) and related sensory-based interventions (SBIs) have been used with children with developmental differences, despite limited evidence to support their use. There has been limited research to understand what drives the research-practice gap in the practice of ASI® or SBIs or to identify the barriers to de-implementation of these interventions in occupational therapy. There has been no theoretically driven research that aims to understand the factors involved in continued use of ASI® and of SBIs, despite a lack of scientific evidence to support the effectiveness of these interventions. Objective. The objective of this doctoral dissertation was to determine the contributing factors to continued use of ASI® and SBIs in pediatric occupational therapy. The three sub-objectives were to 1) determine historical publication trends in the production of knowledge on ASI®/SBIs with children (i.e. scientific factors); 2) identify beliefs of occupational therapists that perpetuate the continued delivery of ASI®/SBIs and, specifically, to identify key barriers and facilitators to ASI®/SBI behaviours among Canadian pediatric occupational therapists (i.e. cognitive and social factors); and 3) describe how the content and sentiment in current Canadian occupational therapy curricula encourages or discourages the use of ASI®/SBIs in pediatric practice (i.e. educational factors). Methods. Scoping review, Theoretical Domains Framework, and environmental scanning methodologies were used to meet each sub-objective, respectively. Results and Implications. The use of ASI®/SBIs appears to be influenced by a myriad of scientific, social, cognitive, and educational factors, most of which are difficult to target in a knowledge translation intervention. Use of ASI®/SBIs is likely influenced by the consumption of a vast and conflicting literature base, strong beliefs of occupational therapists in the benefits of the interventions and rejection of the evidence against them, and strong discouragement of the use of ASI®/SBIs from educators in occupational therapy programs. The findings of this collection of studies can provide guidance for the exploration of other longstanding, low-value practices. The model representing the findings of this dissertation can broadly inform a comprehensive assessment of barriers and facilitators across historical and modern contexts of longstanding low- value practices and prompt a larger dialogue in the field of evidence-based practice for occupational therapy.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,041 | 0,077 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,010 | 0,038 |
| Communication savante | 0,011 | 0,012 |
| Science ouverte | 0,003 | 0,010 |
| Intégrité de la recherche | 0,005 | 0,008 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».