Knowledge Translation for Effecting Practice Change

Abstract Background and Purpose Current approaches to upper limb rehabilitation are not sufficient to drive neural reorganization and maximize recovery after stroke. To address this evidence-practice gap, a knowledge translation intervention using the Behaviour Change Wheel was developed. The intervention involves collaboratively working with stroke therapy teams to change their practice and increase therapy intensity by therapists prescribing supplementary self-directed arm exercise. The purposes of this case series are: (1) to provide an illustrative example of how a research-informed process changed clinical practice and (2) to report on staff members' and patients' perceptions of the utility of the developed intervention. Case Descriptions A participatory action research approach was used in 3 stroke rehabilitation units in the United Kingdom. The intervention aimed to change 4 therapist-level behaviors: (1) screening patients for suitability for supplementary self-directed arm exercise, (2) provision of exercises, (3) involving family and caregivers in assisting with exercises, and (4) monitoring and progressing exercises. Data on changes in practice were collected by therapy teams using a bespoke audit tool. Utility of the intervention was explored in qualitative interviews with patients and staff. Outcomes Components of the intervention were successfully embedded in 2 of the 3 stroke units. At these sites, almost all admitted patients were screened for suitability for supplementary self-directed exercise. Exercises were provided to 77%, 70%, and 88% of suitable patients across the 3 sites. Involving family and caregivers and monitoring and progressing exercises were not performed consistently. Conclusions This case series is an example of how a rigorous research-informed knowledge translation process resulted in practice change. Research is needed to demonstrate that these changes can translate into increased intensity of upper limb exercise and affect patient outcomes.

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The Use of a Knowledge Translation Program to Increase Use of Standardized Outcome Measures in an Outpatient Pediatric Physical Therapy Clinic: Administrative Case Report

Physical Therapy ◽

10.2522/ptj.20130434 ◽

2015 ◽

Vol 95 (4) ◽

pp. 613-629 ◽

Cited By ~ 20

Author(s):

Joseph Schreiber ◽

Gregory F. Marchetti ◽

Brook Racicot ◽

Ellen Kaminski

Keyword(s):

Case Report ◽

Physical Therapy ◽

Knowledge Translation ◽

Outcome Measures ◽

Physical Therapists ◽

Practice Change ◽

Knowledge Broker ◽

Self Report ◽

Knowledge Assessment ◽

Frequency Of Use

Background and Purpose Pediatric physical therapists face many challenges related to the application of research evidence to clinical practice. A multicomponent knowledge translation (KT) program may be an effective strategy to support practice change. The purpose of this case report is to describe the use of a KT program to improve the knowledge and frequency of use of standardized outcome measures by pediatric physical therapists practicing in an outpatient clinic. Case Description This program occurred at a pediatric outpatient facility with 1 primary clinic and 3 additional satellite clinics, and a total of 17 physical therapists. The initial underlying problem was inconsistency across staff recommendations for frequency and duration of physical therapist services. Formal and informal discussion with the department administrator and staff identified a need for increased use of standardized outcome measures to inform these decisions. The KT program to address this need spanned 6 months and included identification of barriers, the use of a knowledge broker, multiple workshop and practice sessions, online and hard-copy resources, and ongoing evaluation of the KT program with dissemination of results to staff. Outcome measures included pre- and post-knowledge assessment and self-report surveys and chart review data on use of outcome measures. Outcomes Participants (N=17) gained knowledge and increased the frequency of use of standardized outcome measures based on data from self-report surveys, a knowledge assessment, and chart reviews. Discussion Administrators and others interested in supporting practice change in physical therapy may consider implementing a systematic KT program that includes a knowledge broker, ongoing engagement with staff, and a variety of accessible resources.

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Getting Evidence into Practice-Understanding Knowledge Translation to Achieve Practice Change

Worldviews on Evidence-Based Nursing ◽

10.1111/j.1741-6787.2009.00165.x ◽

2009 ◽

Vol 6 (3) ◽

pp. 183-185 ◽

Cited By ~ 13

Author(s):

Bridie Kent ◽

Alison M. Hutchinson ◽

Ellen Fineout-Overholt

Keyword(s):

Knowledge Translation ◽

Practice Change

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Factors influencing allied health professionals’ implementation of upper limb sensory rehabilitation for stroke survivors: a qualitative study to inform knowledge translation

BMJ Open ◽

10.1136/bmjopen-2020-042879 ◽

2021 ◽

Vol 11 (2) ◽

pp. e042879

Author(s):

Liana S Cahill ◽

Leeanne M Carey ◽

Yvonne Mak-Yuen ◽

Annie McCluskey ◽

Cheryl Neilson ◽

...

Keyword(s):

Clinical Practice ◽

Qualitative Study ◽

Knowledge Translation ◽

Upper Limb ◽

Occupational Therapists ◽

Practice Change ◽

Normalisation Process Theory ◽

Evidence Based ◽

Implementation Theory ◽

Factors Influencing

ObjectivesSomatosensory loss is common after stroke with one-in-two individuals affected. Although clinical practice guidelines recommend providing somatosensory rehabilitation, this impairment often remains unassessed and untreated. To address the gap between guideline recommendations and clinical practice, this study sought to understand the factors influencing delivery of evidence-based upper limb sensory rehabilitation after stroke.DesignQualitative study involving focus groups and interviews. Data analysis used an inductive approach (thematic analysis) and deductive analysis using implementation theory (the Theoretical Domains Framework and Normalisation Process Theory).SettingEight healthcare organisations in metropolitan and regional areas of Victoria and New South Wales, Australia.ParticipantsEighty-seven rehabilitation therapists (79% occupational therapists and 21% physiotherapists) were purposively sampled and participated in a knowledge translation study with staggered recruitment from 2014 to 2018.ResultsThree types of factors influenced therapists’ delivery of upper limb somatosensory rehabilitation: individual (‘The uncertain, unskilled therapist’), patient (‘Patient understanding and priorities’) and organisational (‘System pressures and resources’). Deductive analysis using implementation theory identified key determinants of practice change, such as opportunities to consolidate new skills, the anticipated benefits of upskilling as a therapy team and the work anticipated by therapists to incorporate a new somatosensory rehabilitation approach.ConclusionsOccupational therapists and physiotherapists hold valuable insights towards practice change in somatosensory rehabilitation from the ‘frontline’. Therapists experience barriers to change including a lack of knowledge and skills, lack of resources and organisational pressures. Facilitators for change were identified, including social support and therapists’ perceived legitimacy in using new somatosensory rehabilitation approaches. Results will inform the design of a tailored implementation strategy to increase the use of evidence-based somatosensory rehabilitation in Australia.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12615000933550).

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