Systematic review of the effectiveness of evidence based practice EBP educational programs on knowle

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Systematic review of the effectiveness of
evidence based practice (EBP) educational
programs on knowledge, skills, attitudes and
behaviour of allied health practitioners
Janine Margarita R. Dizon, MSPT PhD Candidate

• DirectorUniversity of Santo Tomas, Philippines
  JBI Collaborating Centre

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Background

• Evidence-based practice has been defined as the
  conscientious, explicit and judicious use of
  current best evidence in making decisions about
  the care of individual patients
  Sackett et al
  2000

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Background

• The drive to use EBP aims to 1. use evidence to
  guide practice and 2. build the body of
  knowledge that will support effectiveness of that
  practice for managing patients
  Schreiber and Stern 2005

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Background

• In the last ten years studies in the medical
  field have looked into evidence based programs,
  described their components and evaluated them in
  terms of the EBP domains.
• Coomarasamy and Khan (2004) have classified EBM
  programs to 1. standalone teaching and 2.
  clinical practice based programs (integrated
  EBM teaching) among post graduate students.

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Objective

• Assess the evidence for effectiveness of Evidence
  Based Programs (EBP) training programs on
  knowledge, skills attitudes and behaviour of
  allied health practitioners.

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Methods
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Methods Question?

• What is the evidence for use of EBP programs
  or components of EBP on the knowledge, skills,
  attitudes and behavior of allied health
  practitioners

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Methods Searching the literature
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Methods Searching the literature

• Databases searched
• Cochrane library
• EMBASE
• ERIC (Educational Resources Information Center)
• MEDLINE
• Cinahl
• OVID
• Physiotherapy Evidence Database (PEDro)
• Turning Research into Practice (TRIP)
• Hand searching

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Methods Searching the literature

• Criteria for inclusion
• Study type RCTs, CCTs, before and after study
• Study intervention EBP program or part of an
  EBP program.
• Study participants allied health professionals
• Study outcomes knowledge, skills, attitudes
  and behaviour to EBP

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Methods Assessment of Methodological Quality

• JBI Critical Appraisal of Evidence
  Effectiveness- RCTs
• McMaster Critical Appraisal Tool- before and
  afters studies

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Methods Data Extraction

• study aim
• study design
• study population
• intervention (EBP program design)
• control
• outcomes
• findings
• result of study analysis.

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Methods Data Synthesis

• Data pooling not possible due to heterogeneous
  data
• Narrative summary of findings

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Results

• Characteristics of studies
• 6 studies were included in this review.
• published between 1998- 2005.

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Results

• 4 RCTs1. Villanueva 20012. Cheng 20033.
  Stevenson 2003 4. Taylor 2004
• 2 before and after studies1. Ibbotson 1998 2.
  McCluskey 2005

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Results

• Assessment of study qualityStudy Quality.docx

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Summary of findings
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Discussion

• This review aimed to assess the effectiveness of
  EBP programs or part of the program in improving
  knowledge, skills, attitudes and behaviour among
  allied health professionals.
• To date, no systematic review has been published
  in the area of EBP in this group of population.
• This review therefore provides significant
  groundwork on EBP use in the allied health field.
  

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Discussion

• There is evidence found from the studies included
  in this review that EBP programs or components of
  it increased the knowledge and skills of the
  target participants.
• However, there is conflicting evidence on their
  effects on attitudes and behaviour.

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Discussion

• Findings are similar to other systematic reviews
  done to a different group who are postgraduate
  medical practitioners (Fritsche et al 2002 and
  Coomarasamy and Khan 2004)
• Evidence based medicine (EBM) programs led to
  improvements in knowledge and skills domain but
  there is not enough evidence in terms of
  attitudes and behaviour.

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Discussion

• The findings should be considered in the light of
  these concerns1. Characteristics of the
  studies included2. Types of intervention or the
  EBP programs administered and3. Lack of
  standardized outcome measures/ instruments

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Discussion

• Characteristics of the studies included
• limited number of studies looking into EBP
  programs in the field of allied health
• data pooling was not possible due to a
  heterogeneous studies effect size not computed
• studies fulfilled more than 50 of the criteria
  for methodological quality assessment

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Discussion

• Types of intervention or the EBP programs
• varied in terms of components of the program,
  teaching style and strategies to deliver the
  program and the duration or length of the program

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Discussion

• Lack of standardized outcome measures/
  instruments
• It was not possible to objectively measure the
  actual effects of the EBP program or the EBP
  component in the outcomes identified due to the
  lack of a standardized assessment tool

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Summary points

• There is evidence that knowledge and skills are
  improved given any EBP program
• Limited evidence on attitudes and behaviour
• Lack of standardized EBP programs and tools to
  measure outcomes of EBP domains

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What is there to do?

• More RCTs to be done
• If EBP programs are effective in improving
  knowledge and skills, what are the components of
  a good EBP program?
• Develop and validate a standard tool to assess
  EBP domains objectively

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Thank you and good day