Washing our hands of it all...
Dijkers, Murphy and Krellman, Evidence-Based Practice for Rehabilitation Professionals: Concepts and Controversies, was released online in the Archives of Physical Medicine and Rehabilitation last week. They trace four decades of change in what is regarded as evidence, and two decades of our field attempting to employ evidence based practice. The authors review the various criticisms of evidence based practice, demonstrating they largely hold little validity and should not be barriers to applying evidence to our practice. They note, however:
"...knowledge of the principles and procedures of EBP alone may not be enough to actually use research evidence in practice. McCluskey and Lovarini tested the effectiveness of a 2-day interactive workshop in changing knowledge of and attitudes toward EBP, and tracked patterns of implementing EBP (eg, searching literature, appraising research, and using it in practice) for 8 months after the workshop. Although knowledge and attitudes significantly improved over time, there was very little implementation."
Innovation guru Tim Kastelle this week described handwashing in hospitals as the most important innovation ever:
"Oliver Wendell Holmes in the 1840s was one of the first people to suggest that hand-washing could reduce infections. Not many people paid attention.... There was about a seventy year gap between Semmelweis proving that hand washing saves lives until the practice was widely accepted. Even today, in many hospitals less than half of the health care practitioners follow the right procedures for hand washing."
Dijkers, Murphy and Krellman's paper is worth the attention of every reader. It is likely we all have some less than rigorous rehabilitation practices that we should wash our hands of. In that vein, Dijkers et al. offer specific, practical strategies that may assist. But if the experience of hand washing tells us anything, it is that mere knowledge of an effective intervention—even intimate knowledge—and the clear capacity to implement the intervention, are not alone sufficient to generate lasting, consistent behavior change.