Promoting research use in speech and language therapy: a cluster randomized controlled trial to compare the clinical effectiveness and costs of two training strategies.

摘要

OBJECTIVE: To evaluate the clinical and cost effectiveness of two training strategies to promote the use of research evidence in speech and language therapy (SLT) management of poststroke dysphagia. DESIGN: Pragmatic, cluster randomized trial. SETTING: Seventeen SLT departments in north-west England. PARTICIPANTS: Two SLTs from each department received training and cascaded information across their department. Process of care was measured from the notes of 708 patients with acute poststroke dysphagia across eight departments allocated to training strategy A, and 762 patients across nine departments in strategy B. INTERVENTIONS: Strategy A: training on the critical appraisal of published research papers and practice guidelines. Strategy B: strategy A plus training on management of change in clinical practice. MAIN OUTCOME MEASURES: Pre- and post-training adherence to practice guidelines in poststroke dysphagia management, based on a review of case notes. Incremental cost of increased adherence to clinical guidelines. RESULTS: Departments' practice differed in adherence to guidelines. Departments changed following training (F=2.22, df 16, 1436, p=0.004). The effect of training strategy on clinical practice was not significant. Strategy B departments engaged in more activities relating to research use following training than strategy A. Total costs of training averaged l2001, 2892 Euros, Dollars 3886 (SD l502, 726 Euros, Dollars 975) for strategy A and l3366, 4866 Euros, Dollars 6537 (SD l2121, 3066 Euros, Dollars 4119) for strategy B. CONCLUSIONS: Training in research implementation in addition to critical appraisal and guideline introduction is associated with increased dissemination activities and awareness of research information, but not with changes in clinical practice within six months of training. The department in which SLTs work influences their use of research. The process of poststroke dysphagia management can be measured using a tool developed from practice guidelines.