台灣地區推行實證職能治療之障礙因子初探

The Barriers of Implementing Evidence-based Practice in Occupational Therapy in Taiwan-A Preliminary Study

10.6145/jme.200703_11(1).0007

莊宜靜(I-Ching Chuang)；曾美惠(Mei-Hui Tseng)；陳威勝(Wei-Sheng Chen)；楊國德(Kwok-Tak Yeung)；梁文隆(Wen-Lung Liang)

實證治療 ； 研究障礙 ； 職能治療 ； evidence-based practice ； research barriers ； occupational therapy

Journal of Medical Education

11卷1期（2007 / 03 / 01）

58 - 68

繁體中文

目的：實證治療目前已是世界各國的趨勢。在國外已有不少文獻探討推行實證職能治療之阻礙因素，然而在台灣目前尚無研究探討此問題。因此，本研究之主要目的為探討台灣職能治療從業人員推行實證職能治療之障礙。方法：研究對象為高雄市及台灣省職能治療師公會之會員，填寫基本資料與the Barriers to Research Scale問卷。結果：研究對象共有288 位職能治療師。治療師認為影響實證職能治療之推行之前2 名障礙因子，依序為：工作上缺乏足夠的時間執行新的構想以及機構缺乏適當的設備去執行新的治療方法。而前10名障礙因子中，機構環境(setting)因素佔5項，治療師(clinician)因素佔3項，研究(research)因素和研究成果呈現(presentation)因素各佔1項。不同背景特色（學歷、工作年資、工作角色、全／兼職）之治療師所感受到的障礙因子之排序也各有不同。結論：本研究結果發現機構環境因素為推行實證職能治療的最主要障礙，因此，推行實證職能治療之前提是機構之決策者需瞭解實證治療的重要性與價值。此外，與治療師因素相關的障礙也建議教育工作者，加強實證職能治療課題之教導與運用，以提升學生畢業後在臨床工作上執行實證職能治療之能力。

Objective: Evidence-based practice (EBP) has been a world-wide trend and has been promoted in Taiwan for more than 10 years. Despite a large amount of literature on the barriers of implementing EBP in western countries, there is a lack of studies on the barriers of implementing EBP in Taiwan. The purpose of this study was to investigate the possible barriers of EBP in Taiwan. Methods: Two hundred and eighty eight members of Kaohsiung city and Taiwan province occupational therapist unions were recruited. They completed a questionnaire on demographic information and the Barriers to Research Scale. Results: Top two barriers were 'there is insufficient time on the job to implement new ideas' and 'the facilities are inadequate for implementation'. Five out of the top 10 barriers were related to 'setting', three to 'clinician', one to 'research' and the other to 'presentation'. The barriers of EBP for occupational therapists with different backgrounds in academic qualification, years since working, work role, and employment status were different. Conclusion: The results of the study showed that the most important barriers of EBP were related to the 'setting' dimension. Thus, the major premise of evidence-based practice was that the decision maker needs to acknowledge the importance and the value of EBP. Furthermore, based on the barriers identified related to clinician dimension, it is essential for the educators to emphasize the course and practice of EBP in order to improve the ability of students to implement EBP at work after graduation.

1. Armitage S(1990).Research utilisation in practice.Nurs Educ Today,10,10-15.
2. Barnitt R,Salmond R(2000).Fitness for purpose of occupational therapy graduates: Two different perspectives.Br J Occup Ther,63,443-448.
3. Barta KM(1995).Information-seeking, research utilization, and barriers to research utilization of pediatric nurse educators.J Prof Nurs,11,49-57.
4. Closs SJ,Lewin BJP(1998).Perceived barriers to research utilization: A survey of four therapies.Br J Ther Rehabil,5,151-155.
5. Dubouloz CJ,Egan M,Vallerand J(1999).Occupational therapists'perceptions of evidence-based practice.Can J Occup Ther,65,136-143.
6. Dysart AM,Tomlin GS(2002).Factors related to evidencebased practical among U.S. occupational therapy clinicians.Am J Occup Ther,56,275-284.
7. Funk SG,Champagne M,Weise R(1991).BARRIERS: The barriers to research utilization scale.Appl Nurs Res,4,39-45.
8. Funk SG,Champagne M,Weise R(1991).Barriers to using research findings in practice: the clinician's perspective.Appl Nurs Res,2,90-95.
9. Ho K,Bloch R,Gondocz T(2004).Technology-enabled knowledge translation: frameworks to promote re search and practice.J Contin Educ Health Prof,24,90-99.
10. Ho K,Chockalingam A,Best A(2003).Technologyenabled knowledge translation: Building a framework for collaboration.CMAJ,168,710-711.
11. Holm MB(2000).Our mandate for the new millennium: Evidence-based practice, 2000 Eleanor Clarke Slagle lecture.Am J Occup Ther,54,575-585.
12. Humphris D,Littlejohns P,Victor C(2000).Implementing evidence-based practice: Factors that influence the use of research evidence by occupational therapists.Br J Ther Rehabil,63,516-522.
13. Kajermo KN,Nordstrom G,Kruesbrant S(1998).Barriers and facilitators of research utilization, as perceived by a group of registered nurses in Sweden.J Adv Nurs,27,798-807.
14. Lloyd-Smith W(1997).Evidence-based practice and occupational therapy.Br J of Occup Ther,60,474-478.
15. Lockyer J,Gondocz ST,Thivierge RL.(2004).Knowledge translation: the role and place of practice reflection.J Contin Educ Health Prof,24,50-56.
16. McCluskey A(2003).Occupational therapists report a low level of knowledge, skill and involvement in evidence-based practice.Aust Occup Ther J,50,3-12.
17. Rogers E(1983).Diffusion of innovations.New York:The Free Press.
18. Sackett DL,RosenbergWMC,Gray JAM(1996).Evidence-based medicine: What it is and what it isn't.Br Med J,312,71-72.
19. Thomas DC,Johnston B,Dunn K(2006).Continuing medical education, continuing professional development, and knowledge translation: improving care of older patients by practicing physicians.J Am Geriatr Soc,54,1610-1618.
20. Tickle-Degnen L(2000).Evidence-based practice forum. Monitoring and documenting evidence during assessment and intervention.Am J Occup Ther,54,434-436.
21. Tickle-Degnen L(2000).Evidence-based practice forum. Gathering current research evidence to enhance clinical reasoning.Am J Occup Ther,54,102-105.
22. Tickle-Degnen L(2000).Evidence-based practice forum. What is the best evidence to use in practice.Am J Occup Ther,54,218-221.
23. Upton D(1999).Clinical effectiveness and EBP3: Application by health-care professionals.Br J Ther Rehabil,6,86-90.
24. Upton D(1990).Clinical effectiveness and EBP2: Attitudes of healthcare professionals.Br J Ther Rehabil,6,26-30.
25. Upton D,Lewis B(1998).Clinical effectiveness and EBP: Design of a questionnaire.Br J Ther Rehabil,5,647-650.
26. 楊福麟、石明煌(2005)。以實證醫學的觀點省視加護病房之止痛和鎮靜劑的運用。慈濟醫學，17，63-69。
27. 盧美秀(2001)。實證醫學、實證護理與實證管理。新台北護理期刊，3，1-5。

1. 楊國德、黃曼聰、曾美惠、傅中珮、陳昱瑋、陳威勝、梁文隆(2007)。台灣職能治療師之研究導向初探。醫學教育，11(3)，212-221。