The De-Implementation of Longstanding Low-Value Clinical Practices: The Case of Sensory Integration
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.041 | 0.077 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.010 | 0.038 |
| Scholarly communication | 0.011 | 0.012 |
| Open science | 0.003 | 0.010 |
| Research integrity | 0.005 | 0.008 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".