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Gaid D, Eilayyan O, Ahmed S, Bussières A. Enrollment, adherence and retention rates among musculoskeletal disorders rehabilitation practitioners in knowledge translation studies: a systematic review and meta-regression. Implement Sci Commun 2024; 5:51. [PMID: 38702833 PMCID: PMC11069130 DOI: 10.1186/s43058-024-00585-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/10/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Practitioners' enrollment, adherence, and retention rates influence estimates of effectiveness in knowledge translation (KT) studies and remain important concerns for implementation researchers. This review aimed to systematically summarize the current evidence on feasibility measures as gauged by enrollment, adherence, and retention rates in KT evaluation studies targeting rehabilitation practitioners treating musculoskeletal disorders (MSDs). METHODS We searched five electronic databases from the inception to October 2022. We included KT studies that 1) had designs recommended by the Effective Practice and Organisation of Care, 2) targeted rehabilitation practitioners managing patients with MSDs, 3) delivered KT interventions according to the Expert Recommendations for Implementing Change classification, and 4) reported on the feasibility measures (e.g., enrollment, adherence, and retention). Descriptive statistics were conducted to report on study-, practitioners- and intervention-related factors influencing enrollment, adherence, and retention rates. Meta-regression weighted by the sample size of included studies was used to estimate the effect of factors on overall enrollment, adherence, and retention rates. RESULTS Findings from 33 KT studies reported weighted enrolment, adherence, and retention rate of 82% (range: 32%-100%), 74% (range: 44%-100%), and 65% (range: 36%-100%) respectively for both intervention and control groups. Factors positively influencing enrollment, adherence, and retention rates included designing short study period with short duration intervention. CONCLUSIONS Intense (e.g., high frequency, short duration) single KT intervention was more appealing for practitioners. Future evaluation studies should clearly report follow-up data, and practitioners' prior training, Results may not apply to non-MSD healthcare providers.
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Affiliation(s)
- D Gaid
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
| | - O Eilayyan
- Department of Physical Therapy, Al-Ahliyya Amman University, Amman, Jordan
| | - S Ahmed
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC, Canada
| | - A Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Département Chiropratique, Université du Québec à Trois Rivières (UQTR), Trois-Rivières, QC, Canada
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Sawadogo A, Sogbossi ES, Everard GJ, Kpadonou T, Batcho CS. Use of standardised outcome measures among physiotherapists in French-speaking sub-Saharan Africa. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2024; 80:1981. [PMID: 38322653 PMCID: PMC10839157 DOI: 10.4102/sajp.v80i1.1981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/19/2023] [Indexed: 02/08/2024] Open
Abstract
Background The use of standardised assessment tools is a fundamental aspect of good clinical practice. However, to our knowledge, no study has documented the use of standardised assessment tools in physiotherapy in French-speaking sub-Saharan Africa. Objectives Documenting the use of standardised outcome measures in physiotherapy in French-speaking sub-Saharan Africa. Method Our cross-sectional survey used an online self-questionnaire on facilitators and barriers to the use of standardised outcome measures, distributed to physiotherapists in French-speaking sub-Saharan Africa. Results A total of 241 physiotherapists working in French-speaking sub-Saharan Africa responded to the survey. The most represented countries were Benin (36.9%), Cameroon (14.1%), and Burkina Faso (10.8%). Although 99% of participants reported using standardised outcome measures, only 27% of the respondents used them systematically (all the time). The most reported facilitators included the recognition that standardised outcome measures help to determine whether treatment is effective, help to guide care, and improve communication with patients. The most significant barriers were the lack of time, unavailability of the standardised outcome measures, and non-sensitivity of measures to patients' cultural and ethnic concerns. There was a higher proportion of use in the middle age group (30-40) (p = 0.02) and a lower proportion of use in physiotherapists simultaneously working in public and private sectors (p = 0.05). Conclusion Standardised outcome measures are still not widely used by physiotherapists in French-speaking sub-Saharan Africa. Clinical implications The perceived barriers and facilitators could help to develop strategies to improve the systematic use of outcome measures in French-speaking sub-Saharan Africa.
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Affiliation(s)
- Abdoulaye Sawadogo
- School of Physiotherapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Emmanuel Segnon Sogbossi
- School of Physiotherapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
- University Clinic of Physical Medicine and Rehabilitation, Centre National Hospitalier Universitaire Hubert Koutoukou MAGA, Cotonou, Benin
| | - Gauthier J. Everard
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Université Laval, Quebec, Canada
- Department of Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, UCLouvain, Brussels, Belgium
| | - Toussaint Kpadonou
- University Clinic of Physical Medicine and Rehabilitation, Centre National Hospitalier Universitaire Hubert Koutoukou MAGA, Cotonou, Benin
| | - Charles Sèbiyo Batcho
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Université Laval, Quebec, Canada
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Pepin ME, Astronomo R, Brown A, Fritz NE. Standardized screening of cognitive and affective tendencies in persons with low back pain: A knowledge translation project. Physiother Theory Pract 2023:1-13. [PMID: 37377094 DOI: 10.1080/09593985.2023.2229902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The use of screening questionnaires (SQ) to evaluate affective or cognitive tendencies (CAT) in persons with low back pain (LBP) is recommended by clinical practice guidelines (CPG) yet few physical therapists (PTs) have adopted these recommendations. OBJECTIVE To develop and implement a tailored knowledge translation (KT) intervention in an outpatient rehabilitation practice to facilitate the uptake of SQ for CAT in persons with LBP. METHODS In a mixed-methods study, using the knowledge to action framework, PTs (n = 12) collaborated with research clinicians to improve the use of three SQ: 1) Primary Care Evaluation of Mental Disorders for Depressive Symptoms; 2) Fear-Avoidance Beliefs Questionnaire; and 3) Pain Catastrophizing Scale. Success of the intervention was measured through questionnaires, focus groups and chart audit. RESULTS A multimodal intervention to overcome specific identified barriers (i.e. time, forgetfulness, and lack of knowledge) was implemented. There was a 10% increase in the use of at least one SQ. PTs reported increased knowledge and use of the SQ but reported time and lack of confidence as barriers to implementation. CONCLUSION It was concluded that SQ for CAT can be successfully implemented; however, PTs felt unprepared to use the screening results to evaluate persons with CAT and more extensive training is recommended to change this practice pattern.
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Affiliation(s)
- Marie-Eve Pepin
- Department of Healthcare Sciences, Program in Physical Therapy, Wayne State University, Detroit, MI, USA
| | - Rhoda Astronomo
- Department of Physical Therapy, Detroit Medical Center Rehabilitation Institute of Michigan, Detroit, MI, USA
| | - Ariana Brown
- Department of Healthcare Sciences, Program in Physical Therapy, Wayne State University, Detroit, MI, USA
| | - Nora E Fritz
- Department of Healthcare Sciences, Program in Physical Therapy, Wayne State University, Detroit, MI, USA
- Department of Neurology, Wayne State University, Detroit, MI, USA
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Gruenig S. Clinician's Commentary on Hiser et al. 1. Physiother Can 2022; 74:247-248. [PMID: 37325212 PMCID: PMC10262834 DOI: 10.3138/ptc-2020-0096-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Simone Gruenig
- Lecturer, Cardiorespiratory Stream & Indigenous Stream Coordinator, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapist, Vancouver Coastal Health; Vancouver, British Columbia, Canada;
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Paus A, Grafe M, Stenzel R, Heitmann S, Brümmer W. Eine theoriegeleitete Implementierung von Messinstrumenten in der physiotherapeutischen Versorgung einer Stroke Unit. PHYSIOSCIENCE 2022. [DOI: 10.1055/a-1748-3069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Hintergrund Der Einsatz von Messinstrumenten objektiviert und unterstützt die klinische Entscheidungsfindung von Physiotherapierenden bei Planung, Durchführung und Evaluation einer Therapie. Die dadurch erhaltenen Informationen ermöglichen eine patientenzentrierte Versorgung und haben das Potential, die interprofessionelle Kommunikation zu verbessern. Trotz der genannten Vorteile findet die Nutzung von Messinstrumenten im klinischen Alltag bislang keine ausreichende Anwendung.
Ziel Systematische Implementierung von Messinstrumenten in die physiotherapeutische Versorgung der Stroke Unit des Universitätsklinikums Münster mithilfe des „Implementation of Change Model“. Zudem wird evaluiert, ob durch eine Anwendung des Modells eine gesteigerte Nutzung der Messinstrumente festgestellt werden kann.
Methode Zur Implementierung von Messinstrumenten wurde das Implementation of Change Model schrittweise mit diversen Methoden umgesetzt. Zur Ergebnisevaluation wurden quantitative (Fragebogenerhebung) und qualitative Forschungsmethoden (Fokusgruppendiskussion) angewandt.
Ergebnisse Nach Abschluss der Erprobungsphase, Auswertung der Dokumentation, der Befragungen sowie einer Diskussion zeigte sich, dass durch Anwendung des Implementation of Change Models die Nutzung von Messinstrumenten bei Patient*innen mit Schlaganfall gesteigert werden konnte. Aus Sicht der Befragten nahm die Überzeugung über den klinischen Nutzen von Messinstrumenten zu. Es konnte auch eine subjektive Verbesserung der Qualität der Behandlung festgestellt werden.
Schlussfolgerung Das Implementation of Change Model eignet sich zur systematischen Anwendung durch eine Gruppe von Physiotherapierenden in der Akutversorgung, wodurch sich die Nutzung von Messinstrumenten bei Patient*innen mit Schlaganfall steigerte. Es wird empfohlen, weitere Erkenntnisse mit einer größeren Gruppe von Therapierenden und in anderen Versorgungsbereichen durchzuführen.
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Affiliation(s)
- Annalena Paus
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
| | - Marion Grafe
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
| | - Romina Stenzel
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
| | - Steffen Heitmann
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
| | - Werner Brümmer
- Universitätsklinikum Münster, Zentrale Einrichtung Therapeutische Gesundheitsberufe/Stabsstelle Therapiewissenschaften, Münster, Deutschland
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Dür M, Wenzel C, Simon P, Tucek G. Patients' and professionals' perspectives on the consideration of patients' convenient therapy periods as part of personalised rehabilitation: a focus group study with patients and therapists from inpatient neurological rehabilitation. BMC Health Serv Res 2022; 22:372. [PMID: 35313879 PMCID: PMC8939130 DOI: 10.1186/s12913-022-07755-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/07/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Research on the optimal period for administering health services, especially rehabilitation interventions, is scarce. The aims of this study were to explore the construct of patients' convenient therapy periods and to identify indicators based on the perspectives of patients and different health professionals from inpatient neurological rehabilitation clinics. METHODS This study was part of a larger project on patients' convenient therapy periods following a mixed methods approach. In the current study a grounded theory approach was employed based on the use of focus group interviews. Focus group interviews were conducted in three different inpatient neurological rehabilitation clinics. Patients and therapists from inpatient neurological rehabilitation clinics who were able to speak and to participate in conversations were included. RESULTS A total of 41 persons, including 23 patients and 18 therapists, such as music and occupational therapists, participated in a total of six focus group interviews. The analysis of the focus group interviews resulted in the identification of a total of 1261 codes, which could be summarised in fifteen categories. However, these categories could be divided into five indicators and ten impact factors of convenient therapy periods. Identified indicators were verbal and non-verbal communication, mental functions, physiological needs, recreational needs, and therapy initiation. CONCLUSIONS The results provide initial evidence that convenient therapy periods are clinically relevant for patients and therapists. Different states of patients' ability to effectively participate in a rehabilitation intervention exist. A systematic consideration of patients' convenient therapy periods could contribute to a personalised and more efficient delivery of intervention in neurological rehabilitation. To our knowledge, this study is one of the first attempts to research convenient therapy periods.
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Affiliation(s)
- Mona Dür
- Department of Health Sciences, IMC University of Applied Sciences, Applied Health Sciences Master Degree Programme, Piaristengasse 1, 3500, Krems, Austria. .,IMC University of Applied Sciences, Josef Ressel Centre for Horizons of personalised music therapy, University of Applied Sciences Krems, Piaristengasse 1, 3500, Krems, Austria. .,Duervation, Spitalgasse 6/1, 3500, Krems, Austria.
| | - Claudia Wenzel
- IMC University of Applied Sciences, Josef Ressel Centre for Horizons of personalised music therapy, University of Applied Sciences Krems, Piaristengasse 1, 3500, Krems, Austria.,Department of Health Sciences, IMC University of Applied Sciences, Music Therapy Bachelor and Master Degree Programme, Piaristengasse 1, 3500, Krems, Austria
| | - Patrick Simon
- IMC University of Applied Sciences, Josef Ressel Centre for Horizons of personalised music therapy, University of Applied Sciences Krems, Piaristengasse 1, 3500, Krems, Austria.,Department of Health Sciences, IMC University of Applied Sciences, Music Therapy Bachelor and Master Degree Programme, Piaristengasse 1, 3500, Krems, Austria
| | - Gerhard Tucek
- IMC University of Applied Sciences, Josef Ressel Centre for Horizons of personalised music therapy, University of Applied Sciences Krems, Piaristengasse 1, 3500, Krems, Austria.,Department of Health Sciences, IMC University of Applied Sciences, Music Therapy Bachelor and Master Degree Programme, Piaristengasse 1, 3500, Krems, Austria
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7
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Are patient reported outcome measures (PROMs) useful in low back pain? Experiences of physiotherapists in primary health care in Sweden. Musculoskelet Sci Pract 2021; 55:102414. [PMID: 34153691 DOI: 10.1016/j.msksp.2021.102414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Physiotherapists in primary health care are required to use patient reported outcome measures (PROMs) to manage patients with low back pain (LBP). OBJECTIVE Our aim was to explore and describe how physiotherapists in primary care managing patients with LBP, experience the use of PROMs with a focus on facilitating and hindering factors. METHODS We undertook a qualitative study with semi-structured interviews. Fifteen physiotherapists (9 female and 6 male) were included. The interviews were audio-recorded and transcribed verbatim and analysed by inductive manifest content analysis. RESULTS Our findings resulted in eight main categories: PROMs give structure and increase patient involvement; Patients' motivations to use PROMs; Time and the physiotherapist's clinical priorities; Physiotherapists' routines steer their use of PROMs; Physiotherapists' competences in using PROMs; Organizations and managers steer the use of PROMs; Prerequisites for future use of PROMs; Using PROMs develops the physiotherapy profession. CONCLUSION Our findings show that using PROMs gives structure and increases patient involvement, but the patient's motivation to use PROMs needs to be taken into consideration. Time and routines influence the use of PROMs and these factors depend on organizational and managerial levels. Using PROMs is believed to help develop the physiotherapy profession. Prerequisites for future use, such as digitalization and increased competence, need to be fulfilled. Future studies should focus on increasing physiotherapists' knowledge about relevant PROMs, and study implementation in clinical practice, thereby improving the physiotherapy profession's quality of care.
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Romney W, Wormley M, Veneri D, Oberlander A, Grevelding P, Rice J, Moore J. Knowledge translation intervention increased the use of outcome measures by physical therapists in inpatient rehabilitation. Physiother Theory Pract 2021; 38:2019-2028. [PMID: 33706647 DOI: 10.1080/09593985.2021.1898065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background and Purpose: Outcome measures (OMs) have been emphasized by healthcare professions to optimize patient examination; however, a lack of regular use of OMs exists. The purpose of this study was to describe the outcome of a knowledge translation (KT) intervention to increase the use of OMs by physical therapists in an inpatient rehabilitation setting.Methods: A quasi-experimental pre-post study design was used. A multi-component KT intervention including education, organizational support, documentation, and environmental changes to increase the use of five OMs was implemented. Audit and feedback (A&F) was added to the KT intervention at month 6. Documented use of OMs was determined through manual chart audit (n = 864) and electronically (n = 2599). Regression analyses were used to identify factors associated with OMs use across time and diagnoses.Results: Following the addition of A&F to the KT intervention at month 6, there was a significant increase in the odds of OMs use across all time intervals (months 6-12, 12-18, 18-24)(Odds Ratio (OR) 5.9, 95% Confidence Interval (CI) 4.1-8.5; OR 8.5, 95% CI 6.0-12.1; OR 10.8, 95% CI 7.6-15). There was also a significant increase in the odds of documenting OMs on individuals with neurological diagnoses (OR 0.3, 95% CI 0.5-0.8).Conclusions: This KT intervention increased and sustained OMs use over 24-months. This intervention can be replicated to improve the evidence-based practices of physical therapists.
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Affiliation(s)
- Wendy Romney
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA.,Physical Therapy, Gaylord Specialty Healthcare, Wallingford, CT, USA.,Institute of Knowledge Translation, Carmel, IN, USA
| | - Michelle Wormley
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
| | - Diana Veneri
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA.,Physical Therapy, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | - Andrea Oberlander
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA.,Physical Therapy, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | - Peter Grevelding
- Physical Therapy, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | - Jennifer Rice
- Physical Therapy, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | - Jennifer Moore
- Institute of Knowledge Translation, Carmel, IN, USA.,Southeastern Regional Center for Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo, Norway
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Romney W, Bellows DM, Tavernite JP, Salbach N, Deutsch JE. Knowledge Translation Research to Promote Behavior Changes in Rehabilitation: Use of Theoretical Frameworks and Tailored Interventions: A Scoping Review. Arch Phys Med Rehabil 2021; 103:S276-S296. [PMID: 33561438 DOI: 10.1016/j.apmr.2021.01.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/27/2020] [Accepted: 01/01/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To describe knowledge translation (KT) research as a means of changing practice behaviors in rehabilitation. We specifically aimed to explore how theories, models, and frameworks (TMFs) are used to guide KT, guide methods to tailor KT interventions, and evaluate outcomes. We hypothesized these methods would have increased over the past 10 years. DATA SOURCES We identified articles through searches conducted using databases Cumulative Index to Nursing and Allied Health, MEDLINE, PubMed, Academic Search Premier, and previous reviews from January 2000 to April 2020. Search terms included physical therapy, occupational therapy, speech-language pathology, knowledge translation, and knowledge-to-action (KTA). STUDY SELECTION Two authors interpedently screened titles, abstracts, and full-text articles. Studies were included if behavior change of rehabilitation practitioners was measured. Systematic reviews, protocols, and capacity-building interventions were excluded. DATA EXTRACTION Three authors extracted information on study design, theoretical frameworks, intervention strategies, and outcome evaluation. DATA SYNTHESIS Fifty-six studies were included in the review. Sixteen (29%) reported the use of a theoretical framework to guide the KT process. Since 2013, the KTA framework was used 35% of the time. Twenty-two studies (39%) reported barrier assessments to tailor interventions, and 82% were published after 2013. However, barrier assessment in the local context was only conducted 64% of the time. Outcomes of tailored interventions were most frequently measured using chart audits (50%) and questionnaires (41%). Further, the link between KT theory, specific barriers, and selection of intervention strategies was not consistently described. CONCLUSIONS Over the past 7 years, there has been an increase in the use of KT TMFs and tailored interventions. Recommendations for future research include the use of TMFs to guide local barrier assessment, KT strategy selection, intervention development, and overall KT process and mapping barriers to selected intervention strategies.
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Affiliation(s)
- Wendy Romney
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT; Department of Rehabilitation and Movement Sciences, RIVERS Lab, Rutgers University, Newark, NJ.
| | | | - Jake P Tavernite
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT
| | - Nancy Salbach
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; KITE-Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Judith E Deutsch
- Department of Rehabilitation and Movement Sciences, RIVERS Lab, Rutgers University, Newark, NJ
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Yorke AM, Trojanowski S, Fritz NE, Ludwa A, Schroeder M. Standardizing Outcome Assessment in Parkinson Disease: A Knowledge Translation Project. J Neurol Phys Ther 2021; 45:21-27. [PMID: 33252456 DOI: 10.1097/npt.0000000000000343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Rehabilitation therapists do not consistently utilize standardized outcome measures. The purpose of this study was to develop and implement a tailored knowledge translation (KT) intervention to facilitate application of standardized outcome measures used in patients with Parkinson disease (PD) receiving outpatient rehabilitation. METHODS Four clinics within a hospital-based outpatient system including physical therapists (n = 7) and occupational therapists (n = 2) collaborated with researcher clinicians. A mixed-methods study, using the knowledge to action (KTA) framework, was executed to standardize the assessment battery completed on patients with PD. The project was titled iKNOW-PD (integrating KNOWledge translation for Parkinson Disease). RESULTS Four measures were selected for iKNOW-PD (9-Hole Peg Test, miniBESTest, 10-m walk test, and 5 times sit-to-stand). A multimodal intervention that overcame specific identified barriers (equipment, time) was implemented to ensure successful uptake. Consistency of utilizing iKNOW-PD measures on initial evaluation and discharge, across therapists and clinics, was evaluated. Therapists significantly increased the use of iKNOW-PD measures from 1.9 to 3.1 on initial evaluation (P < 0.001). The 10-meter walk test demonstrated the greatest uptake (>50%) from pre-iKNOW-PD to post-iKNOW-PD. DISCUSSION AND CONCLUSIONS Standardizing outcome assessment for persons with PD in an outpatient setting can be successfully implemented. Overcoming identified barriers and capitalizing on facilitators promoted the uptake of standardized outcomes. Following the 6-month intervention period, therapists endorsed an improvement in their application of standardized measures and labeled iKNOW-PD as a positive experience that allowed them to minimize variability in practice.Video Abstract available for more insights from the authors (see the Video, Supplemental Content 1, available at: http://links.lww.com/JNPT/A329).
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Affiliation(s)
- Amy M Yorke
- Physical Therapy Department, University of Michigan-Flint, Flint (A.M.Y., S.T.); Physical Therapy Program, Wayne State University, Detroit, Michigan (N.F.); and Ascension Genesys Physical Therapy, Grand Blanc, Michigan (A.L., M.S.)
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11
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Briggs MS, Rethman KK, Crookes J, Cheek F, Pottkotter K, McGrath S, DeWitt J, Harmon-Matthews LE, Quatman-Yates CC. Implementing Patient-Reported Outcome Measures in Outpatient Rehabilitation Settings: A Systematic Review of Facilitators and Barriers Using the Consolidated Framework for Implementation Research. Arch Phys Med Rehabil 2020; 101:1796-1812. [PMID: 32416149 DOI: 10.1016/j.apmr.2020.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review examines the facilitators and barriers to the use of patient-reported outcome measures (PROMs) in outpatient rehabilitation settings and provides strategies to improve care to maximize patient outcomes. DATA SOURCES Eleven databases were systematically searched from November 2018 to May 2019. STUDY SELECTION Two reviewers independently assessed articles based on the following inclusion criteria: English text, evaluate barriers and facilitators, include PROMs, and occur in an outpatient rehabilitation setting (physical therapy, occupational therapy, speech language pathology, or athletic training). Of the 10,164 articles initially screened, 15 articles were included in this study. DATA EXTRACTION Data were extracted from the selected articles by 2 independent reviewers and put into an extraction template and into the Consolidated Framework for Implementation Research (CFIR) model. The Appraisal Tool for Cross-Sectional Studies (AXIS) was conducted on each study to assess study design, risk of bias, and reporting quality of the eligible studies. DATA SYNTHESIS Ten studies were identified as high quality, according to the AXIS. Based on the CFIR model, the top barriers identified focused on clinician training and time in the implementation process, lack of recognized value and knowledge at the individual level, lack of access and support in the inner setting, and inability of patients to complete PROMs in the intervention process. Facilitators were identified as education in the implementation process, support and availability of PROMs in the inner setting, and recognized value at the individual level. CONCLUSIONS More barriers than facilitators have been identified, which is consistent with PROM underuse. Clinicians and administrators should find opportunities to overcome the barriers identified and leverage the facilitators to improve routine PROM use and maximize patient outcomes.
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Affiliation(s)
- Matthew S Briggs
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio; OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Katherine Kozak Rethman
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio; OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Justin Crookes
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine Ohio State University, Columbus, Ohio
| | - Fern Cheek
- Health Sciences Library, The Ohio State University, Columbus, Ohio
| | - Kristy Pottkotter
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio; OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shana McGrath
- OSUWMC Outpatient Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John DeWitt
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine Ohio State University, Columbus, Ohio
| | - Lindsay E Harmon-Matthews
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio; OSUWMC Outpatient Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Catherine C Quatman-Yates
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio; Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine Ohio State University, Columbus, Ohio
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12
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Bernhardsson S, Larsson MEH. Does a tailored guideline implementation strategy have an impact on clinical physiotherapy practice? A nonrandomized controlled study. J Eval Clin Pract 2019; 25:575-584. [PMID: 29806112 DOI: 10.1111/jep.12958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 12/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines are a common strategy for implementing research findings into practice and facilitating evidence-based practice in health care settings. There is a paucity of knowledge about the impact of different guideline implementation strategies on clinical practice in a physiotherapy context. The study aimed to assess the impact of a guideline implementation intervention on clinical physiotherapy practice. METHODS A tailored, multicomponent guideline implementation was compared with usual practice. Clinical practice was evaluated in physiotherapy treatment methods used for 3 common musculoskeletal disorders. Data were collected with a validated web-based questionnaire. RESULTS Postimplementation data were collected from 168 physiotherapists in the intervention group and 88 in the control group. The most frequently reported treatment methods for low back pain were advice on posture (reported by 95% in the intervention group vs 90% in the control group), advice to stay active (93% vs 90%), and stabilization exercise (88% vs 80%). Differences between groups were not significant. Reported use of body awareness training (23% vs 6%, P = .023) and spinal manipulation (9% vs 23%, P = .044) differed between the groups. The most frequently used treatment methods for neck pain were advice on posture (95% vs 92%), advice to stay active (89% vs 87%), and ROM exercise (85% vs 71%) (no significant differences between groups). Reported use of body awareness training (24% vs 7%, P = .023) differed between the groups. The most frequently used treatment methods for subacromial pain were range of motion exercises (reported by 93% in both groups), advice on posture (90% vs 87%), home exercise (77% vs 74%), and stabilization exercise (69% vs 66%) (no significant difference between groups). CONCLUSIONS Treatment methods used were largely in line with evidence already before the guideline implementation, which may explain why the guideline implementation had only little impact on clinical practice.
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Affiliation(s)
- Susanne Bernhardsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Maria E H Larsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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13
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Romney W, Salbach N, Parrott JS, Deutsch JE. A Knowledge Translation Intervention Designed and Implemented by a Knowledge Broker Improved Documented Use of Gait Speed: A Mixed-Methods Study. J Geriatr Phys Ther 2019; 43:E1-E10. [DOI: 10.1519/jpt.0000000000000239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Kotte EMW, de Groot JF, Winkler AMF, Veenhof C, Takken T. Fitkids Treadmill Test: Clinical Utility and Factors Associated With Its Use Among Physical Therapists. Phys Ther 2019; 99:428-439. [PMID: 30690630 DOI: 10.1093/ptj/pzy142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 09/04/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although the Fitkids Treadmill Test (FTT) has been validated and normative values are available for healthy 6- to 18-year-old children and adolescents, these facts do not automatically imply uptake of the test in routine practice of physical therapists. OBJECTIVE The objectives of this study were to evaluate the utility of the FTT in different diagnostic groups and to explore potential factors affecting the use of the FTT in clinical practice. DESIGN Mixed methods with both quantitative and qualitative data were used in this study. METHODS Outcome parameters from the FTT were retrieved from the Fitkids database. For evaluation of the utility of the FTT, 2 indicators, exercise duration and maximal effort, were used. An online survey was sent to physical therapists in Fitkids practices to identify factors affecting the use of the FTT in clinical practice. RESULTS The proportion of children and adolescents in each of the diagnostic groups who reached the minimal duration of a maximal exercise test ranged from 94% to 100%. The proportion of participants who reached a peak heart rate ≥180 beats/min ranged from 46% for participants with cognitive, psychological, or sensory disorders to 92% for participants with metabolic diseases. The most important facilitator for use of the FTT was the fact that most physical therapists were convinced of the additional value of the FTT. The main barriers were therapists' attitudes (resistance to change/lack of experience) and, on the environmental level, the absence of a treadmill ergometer in physical therapist practice. LIMITATIONS Structured interviews would have provided more information on potential factors affecting the use of the FTT in clinical practice. CONCLUSIONS This study has shown the clinical utility of the FTT in different diagnostic groups in pediatric physical therapist practice. Responding to the factors identified in this study should enable improved uptake of the FTT in clinical practice.
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Affiliation(s)
- Elles M W Kotte
- Fitkids Foundation, Box 75751, 1070 AT Amsterdam, the Netherlands
| | - Janke F de Groot
- University of Applied Science, Utrecht, the Netherlands; Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands; and Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Cindy Veenhof
- University of Applied Science; and University Medical Center Utrecht
| | - Tim Takken
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht
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15
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Östhols S, Boström C, Rasmussen-Barr E. Clinical assessment and patient-reported outcome measures in low-back pain – a survey among primary health care physiotherapists. Disabil Rehabil 2018; 41:2459-2467. [DOI: 10.1080/09638288.2018.1467503] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Sara Östhols
- Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
- Capio St Göran Hospital, Multidisciplinary Pain Unit, Stockholm, Sweden
| | - Carina Boström
- Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
- Karolinska University Hospital, Department of Allied Health Professionals, Stockholm, Sweden
| | - Eva Rasmussen-Barr
- Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
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16
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O’Connor B, Kerr C, Shields N, Imms C. Understanding allied health practitioners’ use of evidence-based assessments for children with cerebral palsy: a mixed methods study. Disabil Rehabil 2017; 41:53-65. [DOI: 10.1080/09638288.2017.1373376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bridget O’Connor
- School of Allied Health, Australian Catholic University, Melbourne, Australia
| | - Claire Kerr
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Nora Shields
- School of Allied Health, La Trobe University, Melbourne, Australia
- Northern Health, Melbourne, Australia
| | - Christine Imms
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, Australia
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17
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Colquhoun HL, Lamontagne ME, Duncan EA, Fiander M, Champagne C, Grimshaw JM. A systematic review of interventions to increase the use of standardized outcome measures by rehabilitation professionals. Clin Rehabil 2016; 31:299-309. [PMID: 27090265 DOI: 10.1177/0269215516644309] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the types and effectiveness of interventions to increase the knowledge about, attitudes towards, and use of standardized outcome measures in rehabilitation professionals. DATA SOURCES An electronic search using Medline, EMBASE, PsycINFO, CINAHL, Ergonomics Abstracts, Sports Discus. The search is current to February 2016. STUDY SELECTION All study designs testing interventions were included as were all provider and patient types. Two reviewers independently conducted a title and abstract review, followed by a full-text review. DATA EXTRACTION Two reviewers independently extracted a priori variables and used consensus for disagreements. Quality assessment was conducted using the Assessment of Quantitative Studies published by the Effective Public Health Practice Group. DATA SYNTHESIS We identified 11 studies involving at least 1200 providers. Nine of the studies showed improvements in outcome measure use rates but only three of these studies used an experimental or quasi-experimental design. Eight of the studies used an educational approach in the intervention and three used audit and feedback. Poor intervention description and quality of studies limited recommendations. CONCLUSIONS Increased attention to testing interventions focused on known barriers, matched to behavior change techniques, and with stronger designs is warranted.
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Affiliation(s)
- Heather L Colquhoun
- 1 Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | | | - Edward As Duncan
- 3 Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
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