The Physical Therapy Clinical Research Network (PTClinResNet): Methods, Efficacy, and Benefits of a Rehabilitation Research Network

The Benefits, Challenges, and Strategies toward Establishing a Community-Engaged Knowledge Hub: An Integrative Review

Current knowledge creation and mobilization efforts are concentrated in academic institutions. A community-engaged knowledge hub (CEKH) has the potential for transdisciplinary and cross-sectorial collaboration between knowledge producers, mobilizers, and users to develop more relevant and effective research practices as well as to increase community capacity in terms of knowledge production. Objective: To summarize existing original research articles on knowledge hubs or platforms and to identify the benefits, challenges, and ways to address challenges when developing a CEKH. Methods: This study followed a systematic integrative review design. Following a comprehensive search of academic and grey literature databases, we screened 9030 unique articles using predetermined inclusion criteria and identified 20 studies for the final synthesis. We employed thematic analysis to summarize the results. Results: The focus of the majority of these knowledge mobilization hubs was related to health and wellness. Knowledge hubs have a multitude of benefits for the key stakeholders including academics, communities, service providers, and policymakers, including improving dissemination processes, providing more effective community interventions, ensuring informed care, and creating policy assessment tools. Challenges in creating knowledge hubs are generally consistent for all stakeholders, rather than for individual stakeholders, and typically pertain to funding, resources, and conflicting perspectives. As such, strategies to address challenges are also emphasized and should be executed in unison. Conclusions: This study informs the development of a future CEKH through the identification of the benefits, challenges, and strategies to mitigate challenges when developing knowledge hubs. This study addresses a literature gap regarding the comparisons of knowledge hubs and stakeholder experiences.

Secondary mediation and regression analyses of the PTClinResNet database: determining causal relationships among the International Classification of Functioning, Disability and Health levels for four physical therapy intervention trials

BACKGROUND

Each of the 4 randomized clinical trials (RCTs) hosted by the Physical Therapy Clinical Research Network (PTClinResNet) targeted a different disability group (low back disorder in the Muscle-Specific Strength Training Effectiveness After Lumbar Microdiskectomy [MUSSEL] trial, chronic spinal cord injury in the Strengthening and Optimal Movements for Painful Shoulders in Chronic Spinal Cord Injury [STOMPS] trial, adult stroke in the Strength Training Effectiveness Post-Stroke [STEPS] trial, and pediatric cerebral palsy in the Pediatric Endurance and Limb Strengthening [PEDALS] trial for children with spastic diplegic cerebral palsy) and tested the effectiveness of a muscle-specific or functional activity-based intervention on primary outcomes that captured pain (STOMPS, MUSSEL) or locomotor function (STEPS, PEDALS).

OBJECTIVE

The focus of these secondary analyses was to determine causal relationships among outcomes across levels of the International Classification of Functioning, Disability and Health (ICF) framework for the 4 RCTs.

METHOD AND DESIGN

With the database from PTClinResNet, we used 2 separate secondary statistical approaches-mediation analysis for the MUSSEL and STOMPS trials and regression analysis for the STEPS and PEDALS trials-to test relationships among muscle performance, primary outcomes (pain related and locomotor related), activity and participation measures, and overall quality of life.

RESULTS

Predictive models were stronger for the 2 studies with pain-related primary outcomes. Change in muscle performance mediated or predicted reductions in pain for the MUSSEL and STOMPS trials and, to some extent, walking speed for the STEPS trial. Changes in primary outcome variables were significantly related to changes in activity and participation variables for all 4 trials. Improvement in activity and participation outcomes mediated or predicted increases in overall quality of life for the 3 trials with adult populations.

LIMITATIONS

Variables included in the statistical models were limited to those measured in the 4 RCTs. It is possible that other variables also mediated or predicted the changes in outcomes. The relatively small sample size in the PEDALS trial limited statistical power for those analyses.

CONCLUSIONS

Evaluating the mediators or predictors of change between each ICF level and for 2 fundamentally different outcome variables (pain versus walking) provided insights into the complexities inherent across 4 prevalent disability groups.

Model of disablement and recovery: knowledge translation in rehabilitation research and practice

Disablement is a multifactorial and complex process that creates a challenge for both the rehabilitation researcher and the clinical practitioner; however, each seeks to improve quality health outcomes for the adult or child with disability. Knowledge translation (KT) is an approach to evidence-based medicine where various evidence sources are aggregated so that clinical decisions regarding intervention selection and dosing result in beneficial care for an individual. Structural equation modeling was used to test a theoretical model of disablement based on the impairment, activity, and participation categories of the International Classification of Functioning, Disability and Health (ICF) level of functioning. Using available cohort data from a randomized controlled trial of people with poststroke walking disability, exploratory and confirmatory factor analysis revealed that the latent variables-impairment and activity-are separate disablement constructs that limit participation for a person with disability. Path analysis revealed that the direct effect of impairment on participation was not statistically significant; however, the indirect path from impairment to participation through activity was significant (indirect effect). The direct effect of activity on participation was significant. Model assumptions were tested with postintervention data from the same cohort. For people with disability after stroke, the probability that functional tasks could be performed with less effort was greater for those individuals who met or exceeded a physiologic walking threshold after a structured, progressive intervention provided by a physical therapist 6 months earlier. This article discusses how structural equation modeling can be used as a statistical method to explore the causal paths from disability to ability. The knowledge inquiry and synthesis phases of the knowledge-to-action KT framework parallel the essential elements of structural equation modeling; knowledge is created that is theoretically driven, supported by prior research, and analyzed, refined, validated, and tailored to address real-world problems. Using a theoretical framework of disablement with clinical judgment and quantitative research methods, a clinically intuitive model of disablement was validated. The positive dimension is a model of recovery where causal paths lead from disablement to ablement. Innovative approaches in rehabilitation research design along with pragmatic application of research to practice are needed to improve today's health outcomes for people with disability.

Establishing a multicentre clinical research network: lessons learned

BACKGROUND

Within many health care disciplines, research networks have emerged to connect researchers who are physically separated, to facilitate sharing of expertise and resources, and to exchange valuable skills. A multicentre research network committed to studying difficult cancer pain problems was launched in 2004 as part of a Canadian initiative to increase palliative and end-of-life care research capacity. Funding was received for 5 years to support network activities.

METHODS

Mid-way through the 5-year granting period, an external review panel provided a formal mid-grant evaluation. Concurrently, an internal evaluation of the network by survey of its members was conducted. Based on feedback from both evaluations and on a review of the literature, we identified several components believed to be relevant to the development of a successful clinical cancer research network.

RESULTS

THESE COMMON ELEMENTS OF SUCCESSFUL CLINICAL CANCER RESEARCH NETWORKS WERE IDENTIFIED: shared vision, formal governance policies and terms of reference, infrastructure support, regular and effective communication, an accountability framework, a succession planning strategy to address membership change over time, multiple strategies to engage network members, regular review of goals and timelines, and a balance between structure and creativity.

CONCLUSIONS

In establishing and conducting a multi-year, multicentre clinical cancer research network, network members were led to reflect on the factors that contributed most to the achievement of network goals. Several specific factors were identified that seemed to be highly relevant in promoting success. These observations are presented to foster further discussion on the successful design and operation of research networks.

Sharing of lessons learned from multisite research

PURPOSE

To highlight key considerations for planning and implementing multisite research based on experiences and reflections in conducting a large, international, multisite study.

DESCRIPTION

Successes and challenges encountered throughout a multisite study process, and collective recommendations for future researchers are presented. Considerations addressed include creation of the research team and a "community of practice," study preparation and management time, approval by institutional review boards, training of future researchers, recruitment and retention of participants, and dissemination and translation of study materials to consumers.

IMPORTANCE TO MEMBERS

Multisite research has the potential to create knowledge for pediatric physical therapy through collaboration among knowledgeable researchers and expert practitioners and by increasing the potential for generalization of findings. Effective planning, including anticipation of challenges, is critical to a successful study. Our collective experiences may assist practitioners and researchers in planning, implementing, and completing future multisite studies.