Knowledge Translation in BC Physiotherapy

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Knowledge Translation in BC Physiotherapy

• Alison M. Hoens
• Physical Therapy Knowledge Translation Broker
• UBC Dept of PT, FOM Physiotherapy Association of
  BC BC RSRNet (VCH, PHC, BCCW)
• Clinical Associate Professor, UBC Dept of PT
• Clinical Coordinator, Physiotherapy, PHC

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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

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What is KT?
Translational Research (KT1)
Knowledge Translation (KT2)
Lab
Clinical Research
Health Care
CIHR Hulley et al, 2007
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Many terms, same basic idea

• Applied health research
• Diffusion
• Dissemination
• Getting knowledge into practice
• Impact
• Implementation
• Knowledge communication
• Knowledge cycle
• Knowledge exchange
• Knowledge management
• Knowledge translation

• Knowledge to action
• Knowledge mobilization
• Knowledge transfer
• Linkage and exchange
• Participatory research
• Research into practice
• Research transfer
• Research translation
• Transmission
• Utilization

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Knowledge 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. CIHR

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KT closing the know-do gap
Know
Do
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But, fails to account for
Ask
Answer
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KT key concepts
Ask
Answer
Know
Do
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Researchers
Users

• 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

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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

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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
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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

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

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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).

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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

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BARRIERS

• 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)

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KT framework

• Knowledge to Action Cycle
• Ian Graham, VP, KT, CIHR
•  

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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 its
  inception
• Collaboration through research question, study
  dissemination

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How effective are variousimplementation
strategies?
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.
Single interventions
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
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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)
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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 problem
• Demonstrate value
• Adapt this knowledge to the local context
• PT vs Nrsg vs RT led respiratory rehab programs
• Assess the barriers to using the knowledge
• Knowledge of how to do it? Accessibility to
  equipment? Time?

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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

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THE ROLE OF THE KT BROKER

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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
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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 Science Dr.
David Yetman - Knowledge Mobilization Manager,
Harris Center
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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
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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
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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

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Goals Deliverables

• Establish a web presence
• UBC Dept of Physical Therapy Knowledge Broker,
  under Research
• PABC members portion of website
• Links to other partners

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Goals Deliverables

• Facilitate PT clinician / researcher partnerships
• Identify clinicians for potential partnerships
• Link clinicians researchers for integrated KT
  and end-of-grant KT collaboration opportunities

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Goals Deliverables

• Enhance access to evidence-based learning
  resources knowledge products
• Identify existing develop new learning
  resources online guides to assist clinicians in
  acquiring, appraising, synthesizing applying
  knowledge into practice
• Provide on-line access to the learning resources,
  guides other knowledge products

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Goals 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

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Best Practice for Joint Arthroplasty

• 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

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Best Practice in Skin Wound 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

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Best Practice in Skin Wound 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

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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

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Needs Assessment
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Needs Assessment
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Needs Assessment
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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/1ad
  4799af7bd4c0810fcaf2d571272f
• 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