Characterizing clinical questions of occupational therapists, physical therapists, and speech-language pathologists
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Medical Library Association Annual Meeting, May 2012, Seattle
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Characterizing clinical questions of occupational therapists, physical therapists, and speech-language pathologists
- 1. Characterizing clinical questions of occupational therapists, physical therapists, & speech-language pathologists Lorie A. Kloda, MLIS, PhD(c), AHIP Joan C. Bartlett, MLS, PhD McGill University Medical Library Association Annual Meeting May 2012, Seattle
- 2. Research objective To explore the clinical questions of rehabilitation therapists in the context of their everyday practice
- 3. Research questions 1 2
- 4. Research questions What types of questions do rehabilitation therapists ask? 2
- 5. Research questions What types of questions do rehabilitation therapists ask? How do rehabilitation therapists formulate their clinical questions?
- 6. Sampling& recruitment Stroke rehabilitation Purposeful, snowball sampling
- 7. Methods clinical narrative template question journal interview analysis
- 8. Informants 4 Occupational therapists 4 Physical therapists + 7 Speech-language pathologists ________ 15
- 9. Clinical questions 26 Occupational therapists 44 Physical therapists + 59 Speech-language pathologists ________ 129
- 10. Findings 12 Foci 8 Structural elements
- 11. Clinical question foci Treatment selection 33% Clinical manifestations of disease 17% Prognosis 13% Assessment tool selection 9% Terminology 9% Treatment procedures 9% Etiology 5% Practice-related self-improvement 4% Assessment tool procedures 3% Patient or family’s experiences and concerns 2% Anatomy, physiology, and pathophysiology 2% Epidemiology 1%
- 12. Clinical question foci Treatment selection 50% Clinical manifestations of disease Prognosis 13% Assessment tool selection 9% Terminology 9% Treatment procedures 9% Etiology 5% Practice-related self-improvement 4% Assessment tool procedures 3% Patient or family’s experiences and concerns 2% Anatomy, physiology, and pathophysiology 2% Epidemiology 1%
- 13. Clinical question structure Problem 69% Intervention 41% Population 39% Outcome measure 11% Temporality 7% Context 5% Professional stakeholder 3% Patient or family stakeholder 1%
- 14. Discussion
- 15. Implications Reference interview Information literacy instruction Resource design and selection
- 16. Conclusions Evidence-based practice framework inadequate for rehabilitation 12 possible foci 8 possible structural elements
- 17. Acknowledgements Dissertation committee Joan Bartlett (chair), France Bouthillier, NicolKorner-Bitensky, Andrew Large & Pierre Pluye Funding Thomson Scientific / MLA Doctoral Fellowship Fondsquébecois de la recherchesur la société et la culture Canadian Library Association World Book Scholarship Study informants
Notas del editor
- I am an associate librarian at McGill Libraries, and PhD candidate at the School of Information StudiesJoan Bartlett is Associate Professor at the McGill School of Information Studies
- Research was exploratory in nature. Expectations is to raise more research questions.Part of a larger study. This was one of the research questions with the goal of characterizing CQs of this particular group of health professionals which has not been the focus of much research to date.A clinical question is an information need arising from everyday clinical practice that is formalized linguistically. It is not restricted to PICO or any specific formulation. It is not only a question which can conceivably be answered by literature. It is not the same as search terms entered into a resource or search engine. (Mention Taylor’s definition of information needs if there is time)
- Population of interest: stroke rehabPurposeful, snowball sampling, with the goal of max variation5 different sites, ethics from each institution
- I conducted this research using an Interpretive, social constructivist approach. This entailed the careful selection of the sample, and the gathering and analysis of qualitative data resulting in categories or “themes”, which could then potentially be transferred to other settings.
- Acute and rehab hospitals, in/out-patients, various years of experience
- Average of about 8 CQs per informant.Most were related to stroke, others related to neuro, and a few were more general.
- Answers the 2 research questions:Categorized 129 CQ into one or more of 12 fociIdentified 8 possible elements in each clinical question, leading to the proposal of a CQ structure for rehab
- Explain the difference between “selection” and “procedure” questions.Treatment selection: “Identifies one or more treatments and inquired as to their effectiveness, sometimes in comparison to one another. Other questions identified a condition, disorder, or disease, and inquired as to possible treatments or the most effective treatment.” Also included secondary prevention.Clinical questions focusing on treatment procedures were distinguishable from those focusing on selection. These questions were concerned with the implementation of a process of conducting a specified intervention. “how to…” or “when to…” questions.5% of CQs exhibited more than 1 focus – that is, they could have separated into multiple CQs.
- Not a quantitative study with goal of statistical generalizability or prediction. BUT these findings suggest avenues for future research and hypotheses.CMoD: “questions to improve their understanding of diseases and disorders, including signs, symptoms, and clinical course. These questions asked about information to help the therapist understand what they were observing or to predict what they could expect to see in patients with a particular condition.”
- The percentage represents the proportion of CQs which contained this element. It was possible for an element to be present more than once in the same questions. For instance, two problems, or a comparison of 2 or more interventions.Most clinical questions contained one or two structural elements:30% included only 1 elementAlmost half included 2 elementsWhen there were 2 or more elements, these tended to be a combination of PROBLEM & INTERVENTION, or PROBLEM & POPULATIONIf you are familiar with the PICO structure, something might be very obvious form this….
- Distinction between Problem and Population (compared to PICO and all other structures)Newer elementsVery low numbers for many elements, which suggests that these are optional, and only present when relevantWhile all the other elements have been (or are similar to those) previously proposed, none of the existing structures includes all 8 elements. In other words, I found each of these elements within the set of 129 CQs recorded by these stroke therapistsDiscuss the differences between categories/foci as well – therapy, diagnosis, prognosis & etiology/harm in medicine (EBM)[if time enough:] Importance of situating CQ research within theoretical framework of IB, and consistent definitions of CQ for cumulative and comparable research findings.
- Librarians working with students and therapists in rehab can employ knowledge of the 12 foci and the question structure to guide the reference interview.They can also suggest appropriate sources based on the focus of the question.While future research to support the utility of the question formulation structure in rehab is required, instructional designers in academic and hospital libraries can employ the new structure for question formulation, offering students and therapists an alternative to the less useful PICO structure.Information products, including biblio databases and synopses services, can tailor their interfaces according to question foci, and allow users to enter search terms corresponding to any of the 8 elements found in their clinical questions. Such enhancements to existing resources such as OTseeker, PEDro, and SpeechBITE would allow users to pose queries that more closely match their clinical questions, and this improve the relevance of search results.
- The structural elements that emerged in the analysis of the 129 clinical questions suggest that the PICO question-formulation structure is inadequate in representing rehabilitation therapists’ formalized information needs. The findings suggest that the evidence-based practice framework is inadequate for describing how rehabilitation therapists’ formulate their clinical questions.