Knowledge Translation in BC Physiotherapy

Alison M. HoensPhysical Therapy Knowledge Translation Broker

UBC Dept of PT, FOM; Physiotherapy Association of BC; BC RSRNet (VCH, PHC, BCC&W)

Clinical Associate Professor, UBC Dept of PTClinical Coordinator, Physiotherapy, PHC

Objectives

To define & understand knowledge translation

To appreciate why KT is important To provide a framework for knowledge

translation in physical therapy in PT End of grant KT Integrated KT

To outline the role of the KT Broker To identify possibilities for your involvement

What is KT?

Lab ClinicalResearch

Translational

Research (KT1)

Knowledge Translation (KT2)

CIHR; Hulley et al, 2007

HealthCare

Many terms, same basic idea …

Applied health researchDiffusionDissemination Getting knowledge into practiceImpactImplementation Knowledge communicationKnowledge cycleKnowledge exchange Knowledge managementKnowledge translation

Knowledge to actionKnowledge mobilization Knowledge transfer Linkage and exchangeParticipatory researchResearch into practiceResearch transferResearch translation Transmission Utilization

Knowledge TranslationKnowledge Translation

CIHR definition Knowledge translation is the exchange,

synthesis and ethically-sound application of researcher findings within a complex system of relationships among researchers and

knowledge users. CIHRCIHR

KT “closing the know-do gap”

Know Do

But, fails to account for …

Ask Answer

KT key concepts

Ask Answer

Do Know

Knowledge translation is about ensuring that: ‘users’ are aware of and use research

evidence to inform their decision making Research is informed by current available

evidence and the experiences and information needs of ‘end users’

Researchers Users

WHY IS KT IMPORTANT IN PT?

Mikhail et al, 2005: Physical Therapists’ use of interventions with high evidence of effectiveness in the management of a hypothetical typical patient with acute LBP

68% of PTs used interventions with strong or mod evidence of effectiveness

90% used interventions with limited evidence

96% used interventions with absence of evidence of effectiveness

WHY IS KT IMPORTANT IN PT?

Stevenson, T et al. (2005). Influences on Treatment Choices in Stroke Rehabilitation: Survey of Canadian Physiotherapists. Physiotherapy Canada.

Ranking of importance of factors influencing current practice:

Experience Continuing education (practical) Colleague Influence Continuing Education (theory) Professional Literature * secondary sources Entry Level Training

Most impt infuence

Least impt infuence

BARRIERS

I had considerable freedom of clinical choice of therapy: my trouble was that I did not know which to use and when. I would gladly have sacrificed my freedom for a little knowledge.

Sir Archie Cochrane. Effectiveness and Efficiency: Random Reflections on Health Services

There seems to be little relation between the quality of the evidence and its diffusion into practice (Fitzgerald et al 2002)

BARRIERS Lack of time, computing resources, not enough

evidence, lack of access; lack of skills for searching, appraising, and interpreting; lack of incentives (Bennett S. et al, 2003. Australian OT Journal, 50, 13-22.)

Relevant literature not compiled all in one place (Closs & Lewin, 1998. Br J of Therapy & Rehab, 5, 151-155).

Publication bias, indexing issues, language issues, assessing internal validity, access to electronic databases, access to full text, assessing applicability, drawing conclusions (Maher. C. et al. Phys Ther, 84: 645-654).

BARRIERS

Information overload Rich with diversity yet highly chaotic Need tools/processes that can reliably

and sensibly address the info • Agency for Healthcare Research & Quality

http://www.ahrq.gov/research/physprac.htm

xx

Structural (e.g. financial disincentives)

Organisational (e.g. inappropriate skill mix, lack of facilities or equipment)

Peer group (e.g. local standards of care not in line with desired practice)

Individual (e.g. knowledge, attitudes, skills)

Professional - patient interaction (e.g. problems with information processing)

BARRIERS

KT framework

‘Knowledge to Action’ Cycle

Ian Graham, VP, KT, CIHR

   

MonitorKnowledge

Use

SustainKnowledge

Use

EvaluateOutcomes

AdaptKnowledge

to Local Context

AssessBarriers to

Knowledge Use

Select, Tailor,Implement

Interventions

Identify Problem

Identify, Review,Select Knowledge

Products/Tools

Synthesis

Knowledge Inquiry

Tailo

ring

Kno

wle

dge

KNOWLEDGE CREATION

Graham et al., 2006

Knowledge-to-Action Cycle

Types of KT

End of grant Traditional approach Knowledge creation by

researchers disseminated by publication & presentation

Improvements:• Targeted messages to

key stakeholders• More interactive

strategies Eg. interactive

material; e-classroom Opinion leader

Integrated KT Clinician involved in

research process from it’s inception

• Collaboration through research question, study & dissemination

How effective are variousimplementation strategies?

Intervention Number of CRCTs

Range Median effect size

Educational materials

4 +3.6%, +17.0% +8.1%

Audit and feedback

5 +1.3%, +16.0% +7.0%

Reminders 14 –1.0%, +34.0% +14.1%

Single interventions

Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay C, Vale L et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004.

What is effective?

Little to no effect Educational materials Didactic sessions

Sometimes effective Audit & feedback Local opinion leaders Local consensus project Patient mediated interventions

Consistently effective Reminders Interactive education (with discussion of practice) Social marketing

(Bero et al., 1998, Grimshaw et al., 2001)

An example: Inspiratory Muscle Training & COPD

Knowledge to Action Cycle

• Identify a problem that needs addressingHighly effective but greatly underutilized

• Identify, review, and select knowledge relevant to the problemDemonstrate value

• Adapt this knowledge to the local contextPT vs Nrsg vs RT led respiratory rehab programs

• Assess the barriers to using the knowledgeKnowledge of how to do it? Accessibility to equipment? Time?

An example: Inspiratory Muscle Training & COPD

Knowledge to Action Cycle

• Design transfer strategies to promote the use of this knowledge

• Monitor how the knowledge diffuses throughout the user group

• Evaluate the impact of the users’ application of the knowledge

• Sustain the ongoing use of knowledge by users

THE ROLE OF THE KT BROKER

THE ROLE OF THE KT BROKER

Knowledge Broker Definitions of ‘Broker”

• Business person who buys and sells for another in exchange for a commission

• A party who mediates between buyer & seller• An agent involved in the exchange of messages or

transactions

Definitions of ‘Knowledge Broker”:• An intermediary who connects individuals to knowledge

providers• Core function is connecting people to share & exchange

knowledge

Dr. David Yetman - Knowledge Mobilization Manager, Harris Center

THE ROLE OF THE KT BROKER

Engage stakeholders; promote interaction Involve partners in knowledge generation & dissemination Identify champions Build awareness Build relationships Strategic communication Facilitate capacity for ‘evidence-informed’

decision making Incorporate evaluation to ensure accountability

Dobbins et al (2009). Implementation ScienceDr. David Yetman - Knowledge Mobilization Manager, Harris Center

THE ROLE OF THE KT BROKER

1. Needs evaluation Identify knowledge gaps Identify opportunities

• Inventory of resources (current studies, areas of expertise, areas of interest); contact list of researchers & clinicians for specific areas of practice

2. Acquire Strategies to acquire ‘best’ knowledge

• Tools to enhance acquiring knowledge (summary of adv/disadv of search engines, databases and key skills to enhance retrieval)

• E-alerts of publications• *In conjunction with existing infrastructure eg. PABC librarian,

UBC Rehab Sciences librarian

Dobbins et al. (2009). A description of a KTB role implemented as part of a RCT evaluating 3 KT strategies

THE ROLE OF THE KT BROKER

3. Appraise Strategies to enhance ability to critically appraise quality of

evidence• Tools for appraisal of RCTs, systematic reviews, Meta-analyses

4. Apply Strategies to enhance application of clinically relevant

evidence• Development of Clinical Practice Guidelines• Development of on-line learning (pre-test, instructional video,

e-classroom, post-test)• Inclusion into policy (CPTBC)• Developing targeted resources• *Evidence-informed decision-making!

Dobbins et al. (2009). A description of a KTB role implemented as part of a RCT evaluating 3 KT strategies

PT KTB Deliverables

1. Establish a web presence 2. Facilitate PT clinician / researcher

partnerships 3. Enhance access to evidence-based

learning resources & knowledge products 4. Identify & facilitate 1 KT initiative for each

funding partner 5. 1 joint PT & OT KB activity and share

outcomes from all PT KB & OT KB activities 6. Provide progress reports & year-end

report

Goals & DeliverablesGoals & Deliverables

Establish a web presence UBC Dept of Physical Therapy –

Knowledge Broker, under ‘Research’ PABC – members portion of website Links to other partners

Goals & DeliverablesGoals & Deliverables

Facilitate PT clinician / researcher partnerships Identify clinicians for potential

partnerships Link clinicians & researchers for

integrated KT and end-of-grant KT collaboration opportunities

Goals & DeliverablesGoals & Deliverables

Enhance access to evidence-based learning resources & knowledge products Identify existing & develop new learning Identify existing & develop new learning

resources & online guides to assist clinicians resources & online guides to assist clinicians in acquiring, appraising, synthesizing & in acquiring, appraising, synthesizing & applying knowledge into practiceapplying knowledge into practice

Provide on-line access to the learning Provide on-line access to the learning resources, guides & other knowledge resources, guides & other knowledge productsproducts

Goals & DeliverablesGoals & Deliverables

Identify & facilitate 1 KT initiative for each funding partner Best practice for arthroplasty patients

• Use of outcome measurement Best practice for skin & wound

management Guidelines on when it is safe to mobilize

the acute medical or post-surgical client

CLINICIAN NEEDS

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RESEARCHER NEEDS

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ADMINISTRATORS NEEDS

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Best Practice for Joint Best Practice for Joint ArthroplastyArthroplasty

Baseline: VCHRI Program Evaluation Course Regional Orthopaedic Working Group PRAG Outcome Measures SubCommittee MSc: evaluation PABC

Practice Guideline Advisors Group Communications Director

UBC Faculty sponsor: Dr. Elizabeth Dean CADTH? - Canadian Agency for Drugs and

Technologies in Health (CADTH) CESEI? – Center for Excellence in Simulated

Education and Innovation

Best Practice in Skin &Best Practice in Skin &Wound CareWound Care

VCH/PHC Skin & Wound Care PT Committee VCH/PHC OT Pressure Ulcer Guidelines – in

conjunction with OT KB VCH/PHC Interdisciplinary Skin & Wound Care

Committee PABC

Practice Guideline Advisors Group Communications Director

UBC Faculty sponsor – Alison Hoens CADTH? - Canadian Agency for Drugs and

Technologies in Health (CADTH) CESEI? – Center for Excellence in Simulated

Education and Innovation

Best Practice in Skin &Best Practice in Skin &Wound CareWound Care

1. To increase the awareness of the role of PTs in prevention & management of skin & wound issues

2. To increase the number of PTs who undertake a basic risk assessment & utilize basic interventions

3. To increase the number of PTs who know where to find guidance & information on more advanced assessment & interventions

When is it safe to mobilize the acute medical / post surgical pt? PABC

Practice Guideline Advisors Group Communications Director

UBC Faculty sponsor: Dr. Darlene Reid CADTH? - Canadian Agency for Drugs

and Technologies in Health (CADTH) CESEI? – Center for Excellence in

Simulated Education and Innovation

Needs AssessmentNeeds Assessment

Clinician Needs

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Researcher Needs

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Inventory of currentresearch

Inventory of researchers

Directory of cliniciancollaborators

Acknowledgements

The content of the preceding slides was derived from:

Dr. David Johnson “Developing a KT Plan in Grant Applications”

www.ahfmr.ab.ca/download.php/1ad4799af7bd4c0810fcaf2d571272f

CIHR website • http://www.cihr-irsc.gc.ca/e/39128.html• http://ktclearinghouse.ca/

CEBM website • www.cebm.net

McMaster KT+ website• http://plus.mcmaster.ca/KT/Default.aspx

Dr. DP Ryan, Director of Education & Knowledge Translation, Toronto

• rgps.on.ca/slides/knowledgetopracticeprocess.pdf