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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 2024; 40:1961-1973. [PMID: 37377094 DOI: 10.1080/09593985.2023.2229902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Romney WM, Wormley ME, Veneri D, Oberlander A, Catizone V, Grevelding P. Physical and occupational therapists' perceptions of sustainability of a knowledge translation intervention to improve the use of outcome measures in inpatient rehabilitation: a qualitative study. Qual Life Res 2024; 33:653-665. [PMID: 37966686 DOI: 10.1007/s11136-023-03550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE To assess the perceptions, barriers, and facilitators of sustaining the use of outcome measures of physical and occupational therapists following a three-year knowledge translation intervention. METHODS A phenomenological qualitative study was conducted at an inpatient rehabilitation hospital on 13 clinicians (6 physical therapists and 7 occupational therapists) participating in the knowledge translation intervention. Data collection used semi-structured interviewing during three focus groups to understand the lived experience of clinicians participating in the knowledge translation project. Data were analyzed using the Consolidated Framework for Implementation Research (CFIR) codebook. RESULTS Two investigators coded twelve CFIR constructs into barriers and facilitators for outcome measure use. Four key themes emerged as determinants for outcome measures use: (1) Organizational support and clinician engagement; (2) the knowledge translation intervention; (3) the outcome measures themselves; and (4) the patients. Clinicians reported using outcome measures for patient education, treatment planning, and goal setting, while they found other outcome measures lacked functional significance. Facilitators included organizational support, access to knowledge, ongoing training, and clinician engagement. Ongoing barriers included the need for more training and the need to select different tests. CONCLUSIONS This study found proper selection of outcomes measures is important and attributed the sustainability of the knowledge translation intervention to organizational support, clinician engagement and ongoing training. The clinicians wanted continued training to overcome new barriers. Barriers identified in this study were unique to the typical barriers identified for outcome measure use. Ongoing barrier assessments are needed for continued refinement of knowledge translation interventions to enhance sustainability.
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Affiliation(s)
- Wendy M Romney
- College of Health Professions, Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA.
- Inpatient Physical Therapy Department, Gaylord Specialty Healthcare, Wallingford, CT, USA.
| | - Michelle E Wormley
- College of Health Professions, Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
| | - Diana Veneri
- College of Health Professions, Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
- Inpatient Physical Therapy Department, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | - Andrea Oberlander
- College of Health Professions, Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
- Inpatient Physical Therapy Department, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | - Victoria Catizone
- College of Health Professions, Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
| | - Pete Grevelding
- Inpatient Physical Therapy Department, Gaylord Specialty Healthcare, Wallingford, CT, USA
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Scott HM, Braybrook D, Harðardóttir D, Ellis-Smith C, Harding R. Implementation of child-centred outcome measures in routine paediatric healthcare practice: a systematic review. Health Qual Life Outcomes 2023; 21:63. [PMID: 37394520 DOI: 10.1186/s12955-023-02143-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/04/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Person-centred outcome measures (PCOMs) are commonly used in routine adult healthcare to measure and improve outcomes, but less attention has been paid to PCOMs in children's services. The aim of this systematic review is to identify and synthesise existing evidence of the determinants, strategies, and mechanisms that influence the implementation of PCOMs into paediatric healthcare practice. METHODS The review was conducted and reported in accordance with PRISMA guidelines. Databased searched included CINAHL, Embase, Medline, and PsycInfo. Google scholar was also searched for grey literature on 25th March 2022. Studies were included if the setting was a children's healthcare service, investigating the implementation or use of an outcome measure or screening tool in healthcare practice, and reported outcomes relating to use of a measure. Data were tabulated and thematically analysed through deductive coding to the constructs of the adapted-Consolidated Framework for Implementation Research (CFIR). Results were presented as a narrative synthesis, and a logic model developed. RESULTS We retained 69 studies, conducted across primary (n = 14), secondary (n = 13), tertiary (n = 37), and community (n = 8) healthcare settings, including both child self-report (n = 46) and parent-proxy (n = 47) measures. The most frequently reported barriers to measure implementation included staff lack of knowledge about how the measure may improve care and outcomes; the complexity of using and implementing the measure; and a lack of resources to support implementation and its continued use including funding and staff. The most frequently reported facilitators of implementation and continued use include educating and training staff and families on: how to implement and use the measure; the advantages of using PCOMs over current practice; and the benefit their use has on patient care and outcomes. The resulting logic model presents the mechanisms through which strategies can reduce the barriers to implementation and support the use of PCOMs in practice. CONCLUSIONS These findings can be used to support the development of context-specific implementation plans through a combination of existing strategies. This will enable the implementation of PCOMs into routine paediatric healthcare practice to empower settings to better identify and improve child-centred outcomes. TRIAL REGISTRATION Prospero CRD 42022330013.
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Affiliation(s)
- Hannah May Scott
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, Bessemer Rd, SE5 9RS, London, UK.
| | - Debbie Braybrook
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, Bessemer Rd, SE5 9RS, London, UK
| | - Daney Harðardóttir
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, Bessemer Rd, SE5 9RS, London, UK
| | - Clare Ellis-Smith
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, Bessemer Rd, SE5 9RS, London, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, Bessemer Rd, SE5 9RS, London, UK
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Curran JA, Gallant AJ, Wong H, Shin HD, Urquhart R, Kontak J, Wozney L, Boulos L, Bhutta Z, Langlois EV. Knowledge translation strategies for policy and action focused on sexual, reproductive, maternal, newborn, child and adolescent health and well-being: a rapid scoping review. BMJ Open 2022; 12:e053919. [PMID: 35039297 PMCID: PMC8765012 DOI: 10.1136/bmjopen-2021-053919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify knowledge translation (KT) strategies aimed at improving sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) and well-being. DESIGN Rapid scoping review. SEARCH STRATEGY A comprehensive and peer-reviewed search strategy was developed and applied to four electronic databases: MEDLINE ALL, Embase, CINAHL and Web of Science. Additional searches of grey literature were conducted to identify KT strategies aimed at supporting SRMNCAH. KT strategies and policies published in English from January 2000 to May 2020 onwards were eligible for inclusion. RESULTS Only 4% of included 90 studies were conducted in low-income countries with the majority (52%) conducted in high-income countries. Studies primarily focused on maternal newborn or child health and well-being. Education (81%), including staff workshops and education modules, was the most commonly identified intervention component from the KT interventions. Low-income and middle-income countries were more likely to include civil society organisations, government and policymakers as stakeholders compared with high-income countries. Reported barriers to KT strategies included limited resources and time constraints, while enablers included stakeholder involvement throughout the KT process. CONCLUSION We identified a number of gaps among KT strategies for SRMNCAH policy and action, including limited focus on adolescent, sexual and reproductive health and rights and SRMNCAH financing strategies. There is a need to support stakeholder engagement in KT interventions across the continuum of SRMNCAH services. Researchers and policymakers should consider enhancing efforts to work with multisectoral stakeholders to implement future KT strategies and policies to address SRMNCAH priorities. REGISTRATION The rapid scoping review protocol was registered on Open Science Framework on 16 June 2020 (https://osf.io/xpf2k).
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Affiliation(s)
- Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Allyson J Gallant
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia Kontak
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Etienne V Langlois
- The Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
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Boutcher F, Berta W, Urquhart R, Gagliardi AR. The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis. BMC Health Serv Res 2022; 22:11. [PMID: 34974827 PMCID: PMC8722036 DOI: 10.1186/s12913-021-07387-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/07/2021] [Indexed: 12/16/2022] Open
Abstract
Background Middle Managers (MMs) are thought to play a pivotal role as knowledge brokers (KBs) in healthcare organizations. However, the role of MMs who function as KBs (MM KBs) in health care is under-studied. Research is needed that contributes to our understanding of how MMs broker knowledge in health care and what factors influence their KB efforts. Methods We used a critical interpretive synthesis (CIS) approach to review both qualitative and quantitative studies to develop an organizing framework of how MMs enact the KB role in health care. We used compass questions to create a search strategy and electronic searches were conducted in MEDLINE, CINAHL, Social Sciences Abstracts, ABI/INFORM, EMBASE, PubMed, PsycINFO, ERIC and the Cochrane Library. Searching, sampling, and data analysis was an iterative process, using constant comparison, to synthesize the results. Results We included 41 articles (38 empirical studies and 3 conceptual papers) that met the eligibility criteria. No existing review was found on this topic. A synthesis of the studies revealed 12 MM KB roles and 63 associated activities beyond existing roles hypothesized by extant theory, and we elaborate on two MM KB roles: 1) convincing others of the need for, and benefit of an innovation or evidence-based practice; and 2) functioning as a strategic influencer. We identified organizational and individual factors that may influence the efforts of MM KBs in healthcare organizations. Additionally, we found that the MM KB role was associated with enhanced provider knowledge, and skills, as well as improved organizational outcomes. Conclusion Our findings suggest that MMs do enact KB roles in healthcare settings to implement innovations and practice change. Our organizing framework offers a novel conceptualization of MM KBs that advances understanding of the emerging KB role that MMs play in healthcare organizations. In addition to roles, this study contributes to the extant literature by revealing factors that may influence the efforts and impacts of MM KBs in healthcare organizations. Future studies are required to refine and strengthen this framework. Trial registration A protocol for this review was not registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07387-z.
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Affiliation(s)
- Faith Boutcher
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, Ontario, M6A 2E1, Canada.
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building Suite 425, 155 College Street, Toronto, Ontario, M5T 3M6, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Room 413, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Anna R Gagliardi
- University Health Network, 13EN-228, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
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Sweet SN, Michalovic E, Baxter K, Baron J, Gainforth HL. RE-AIMing conferences: a reach, effectiveness, and maintenance evaluation of the Rick Hansen Institute's Praxis 2016. Transl Behav Med 2021; 10:123-135. [PMID: 30753657 DOI: 10.1093/tbm/ibz002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article reported on the reach, effectiveness, and maintenance dimensions of a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) analysis to evaluate Praxis 2016, a conference aimed to develop solutions to overcome challenges to translating research into practice in the spinal cord injury (SCI) community. Reach indicators were collected from the Praxis 2016 organizing committee. For effectiveness and maintenance, attendees (n = 106) completed a questionnaire pre-, post-, and 9-month post-Praxis 2016 assessing (a) capability (e.g., knowledge), (b) motivation, (c) opportunities, and (d) the groups they currently, need to, and/or plan to work with to develop solutions to overcome the challenges of translating SCI research into practice. They also reported their satisfaction with Praxis 2016. Qualitative interviews with attendees and organizers post-Praxis 2016 were conducted. Praxis 2016 reached 28% of their intended audience. For effectiveness, attendees' knowledge significantly increased (t(59)= 3.83, p < .001), they reported a greater need to work with members within the SCI community from pre- to post-Praxis 2016, and were generally satisfied with Praxis 2016. Regarding maintenance, more attendees reported needing to work with researchers, clinicians and SCI community organizations at 9-month post-Praxis 2016. The interviewees reported increased knowledge and capacity to network with the SCI community, but highlighted concerns for the long-term impact of Praxis 2016. Praxis 2016 was an effective approach to create short-term change in knowledge, and to expand knowledge translation networks. Further efforts could build on Praxis 2016 to foster long-term success in overcoming the challenges in translating SCI research into practice.
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Affiliation(s)
- Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Emilie Michalovic
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Kristy Baxter
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
| | | | - Heather L Gainforth
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
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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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9
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Moore JL, Mbalilaki JA, Graham ID. Knowledge Translation in Physical Medicine and Rehabilitation: A Citation Analysis of the Knowledge-to-Action Literature. Arch Phys Med Rehabil 2021; 103:S256-S275. [PMID: 33556348 DOI: 10.1016/j.apmr.2020.12.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To (1) provide an overview of the use of the Knowledge-to-Action Cycle (KTA) to guide a clinical implementation project; (2) identify activities performed in each phase of the KTA; and (3) provide suggestions to improve KTA activities in physical medicine and rehabilitation. DATA SOURCES Google Scholar and PubMed were searched through December 31, 2019. STUDY SELECTION Two reviewers screened titles, abstracts, and full-text articles to identify published studies that used the KTA to implement a project. DATA EXTRACTION Two reviewers examined full-text articles. Data extraction included activities performed in each phase of the KTA, including measurements used to evaluate the project's effectiveness. DATA SYNTHESIS Commonly performed KTA activities were identified and country of study, area of rehabilitation, and other factors related to the use of the KTA in rehabilitation were described. A total of 46 articles that met the study's inclusion criteria provided an overview of the use of the KTA in rehabilitation. Strengths and weaknesses of the articles are discussed and recommendations for improved KTA use are provided. CONCLUSIONS Implementation of evidence-based practice requires focused engineering and efforts. This review provides an overview of the knowledge translation activities occurring in physical medicine and rehabilitation and considerations to improve knowledge translation research and practice.
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Affiliation(s)
- Jennifer L Moore
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway; Institute for Knowledge Translation, Carmel, IN, United States.
| | - Julia A Mbalilaki
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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10
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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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Moore JL, Virva R, Henderson C, Lenca L, Butzer JF, Lovell L, Roth E, Graham ID, Hornby TG. Applying the Knowledge-to-Action Framework to Implement Gait and Balance Assessments in Inpatient Stroke Rehabilitation. Arch Phys Med Rehabil 2020; 103:S230-S245. [PMID: 33253695 DOI: 10.1016/j.apmr.2020.10.133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/01/2020] [Accepted: 10/06/2020] [Indexed: 11/02/2022]
Abstract
OBJECTIVES The overall objectives of this project were to implement and sustain use of a gait assessment battery (GAB) that included the Berg Balance Scale, 10-meter walk test, and 6-minute walk test during inpatient stroke rehabilitation. The study objective was to assess the effect of the study intervention on clinician adherence to the recommendations and its effect on clinician perceptions and the organization. DESIGN Pre- and post-training intervention study. SETTING Subacute inpatient rehabilitation facility. PARTICIPANTS Physical therapists (N=6) and physical therapist assistants (N=2). INTERVENTION The intervention comprised a bundle of activities, including codeveloping and executing the plan with clinicians and leaders. The multicomponent implementation plan was based on the Knowledge-to-Action Framework and included implementation facilitation, implementation leadership, and a bundle of knowledge translation interventions that targeted barriers. Implementation was an iterative process in which results from one implementation phase informed planning of the next phase. MAIN OUTCOME MEASURES Clinician administration adherence, surveys of perceptions, and organizational outcomes. RESULTS Initial adherence to the GAB was 46% and increased to more than 85% after 6 months. These adherence levels remained consistent 48 months after implementation. Clinician perceptions of measure use were initially high (>63%), with significant improvements in knowledge and use of one measure after implementation. CONCLUSIONS We successfully implemented the assessment battery with high levels of adherence to recommendations, likely because of using the bundle of knowledge translation activities, facilitation, and use of a framework to codevelop the plan. These changes in practice were sustainable, as determined by a 4-year follow-up.
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Affiliation(s)
- Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN; South Eastern Norway Regional Center of Knowledge Translation in Rehabilitation, Oslo, Norway.
| | - Roberta Virva
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI
| | - Chris Henderson
- Institute for Knowledge Translation, Carmel, IN; Indiana University School of Medicine, Indianapolis, IN
| | - Lauren Lenca
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI
| | - John F Butzer
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI
| | | | - Elliot Roth
- Shirley Ryan AbilityLab, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - T George Hornby
- Institute for Knowledge Translation, Carmel, IN; Indiana University School of Medicine, Indianapolis, IN
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12
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Abstract
PURPOSE To determine how physical therapy utilization varies with Congenital Muscular Torticollis (CMT) Severity Grading Scale, considering episode of care and clinical practice guidelines. METHODS A 3-year retrospective medical record review was conducted. Data were collected for 81 infants receiving physical therapy for CMT. Sample and service characteristics are described; 46 complete records (infants 6 months or younger) were analyzed to determine how physical therapy utilization varied across severity grades. RESULTS AND CONCLUSIONS Of the 46 infants with complete care episodes, half had fully resolved all asymmetries. Units billed, episode duration, and total visits each increased across CMT severity grades 1 to 3. Cervical rotation restrictions correlated with total units billed, indicating a positive relationship between CMT severity and service utilization. WHAT THIS ADDS TO THE EVIDENCE This study supports that as CMT severity increases, physical therapy utilization increases for grades 1 to 3 of the 2018 CMT Severity Grading Scale.
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13
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Rafferty MR, MacDonald J, Byskosh A, Sloan L, Toledo S, Marciniak C, Simuni T. Using Implementation Frameworks to Provide Proactive Physical Therapy for People With Parkinson Disease: Case Report. Phys Ther 2019; 99:1644-1655. [PMID: 31508801 PMCID: PMC7372734 DOI: 10.1093/ptj/pzz129] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/15/2019] [Accepted: 04/12/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND PURPOSE European clinical practice guidelines recommend physical therapy for people with Parkinson disease (PD) soon after diagnosis to provide education, physical activity advice, and individualized interventions when needed. However, therapy is frequently not used until after gait and balance problems occur. The purpose of this administrative case study is to present the application of a proactive physical therapy (PAPT) approach at 1 rehabilitation center using implementation frameworks to support the (1) implementation process, (2) determinants of implementation success, and (3) implementation evaluation. CASE DESCRIPTION The PAPT program targeted people with PD before the onset of significant mobility dysfunction. It was initiated in 1 outpatient neurological rehabilitation center. The program used shared decision-making to promote long-term maintenance of independent exercise. The Knowledge-to-Action Framework was used by champions to plan implementation processes. Implementation barriers were addressed using the Consolidated Framework for Implementation Research. The program was evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework with mixed methods. OUTCOMES In the program's first year, 38 people were referred, 28 were evaluated, and 20 participated in the 6-month program evaluation. Following PAPT, the number of participants reporting regular participation in aerobic, strengthening, and flexibility exercise approximately doubled, while those engaging in balance activities increased from 1 to 8. They reported a median of 140 minutes of aerobic exercise per week. Implementation barriers included location, insurance coverage, and difficulty scheduling long-term follow-up visits. Participants reported physical and emotional benefits of the program. DISCUSSION Implementation frameworks assisted with the implementation and evaluation of a PAPT delivery model that helped people with PD to increase and maintain independent exercise participation.
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Affiliation(s)
- Miriam R Rafferty
- Shirley Ryan AbilityLab Illinois; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 E Erie St, 19th Floor Strength and Endurance Lab, Chicago, IL 60611 (USA); and Department of Psychiatry and Behavioral Science, Feinberg School of Medicine, Northwestern University
| | - Jillian MacDonald
- Shirley Ryan AbilityLab. Dr MacDonald is a board-certified clinical specialist in neurologic physical therapy
| | | | | | - Santiago Toledo
- Shirley Ryan AbilityLab; and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
| | - Christina Marciniak
- AbilityLab; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University; and Department of Neurology, Feinberg School of Medicine, Northwestern University
| | - Tanya Simuni
- Department of Neurology, Feinberg School of Medicine, Northwestern University
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14
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Worum H, Lillekroken D, Ahlsen B, Roaldsen KS, Bergland A. Bridging the gap between research-based knowledge and clinical practice: a qualitative examination of patients and physiotherapists' views on the Otago exercise Programme. BMC Geriatr 2019; 19:278. [PMID: 31638912 PMCID: PMC6805671 DOI: 10.1186/s12877-019-1309-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Falls and fall-related injuries exacerbate the health problems of older adults, and they are a public health concern. Despite an abundance of research, the implementation of evidence-based fall prevention programs has been slow and limited, additionally and these programs have not reduced the incidence of falling. Therefore, the primary objective of the present study was to examine patients and physiotherapists' views on the factors that influence the implementation of the community- and evidence-based Otago Exercise Programme for fall prevention. METHODS We conducted eight in-depth interviews with physiotherapists and patients, and a focus group interview with 12 physiotherapists and authority figures who represented local hospitals and municipalities. The resultant qualitative data were subjected to thematic analysis. RESULTS The analysis yielded two main themes: the researcher's role and position in the implementation process and the tension between research-based knowledge and clinical practice. The participants believed that research-based knowledge can address the challenges of clinical practice. Further, the patients reported that the fall prevention program made them feel safe and enhanced their ability to cope with daily life. The physiotherapists also observed that research findings do not readily translate into clinical practice. Further, they contended that research-based knowledge is not universal and that it cannot be generalized across different contexts; instead, it must be adapted and translated into a user-friendly language. The findings suggest that the application of research-based knowledge does equate to filling up empty jars and that research-based knowledge does not flow from the expert to the non-expert as water through a tube. Indeed, physiotherapists and patients are not tabula rasa. Additionally, the participants believed that researchers and stakeholders must think critically about who has the power and voice to create a common understanding. CONCLUSIONS Our findings delineate the means by which the gap between research and practice regarding the Otago fall prevention program can bridged. The program can guide clinical work and provide important information that can be used to improve the quality of other fall prevention programs. However, the research-based knowledge that it confers must be adapted for use in clinical contexts.
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Affiliation(s)
- Hilde Worum
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Birgitte Ahlsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kirsti Skavberg Roaldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neurobiology, Health Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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15
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Pediatric Physical Therapists' Use of the Congenital Muscular Torticollis Clinical Practice Guidelines: A Qualitative Implementation Study. Pediatr Phys Ther 2019; 31:331-336. [PMID: 31568376 DOI: 10.1097/pep.0000000000000639] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE This study is a follow-up to the quantitative survey to examine the perceptions of pediatric physical therapists (PTs) on the application of the 2013 Congenital Muscular Torticollis Clinical Practice Guideline (CMT CPG). METHOD Qualitative semi-structured telephone interviews were completed. Interview questions focused on how the guidelines influenced practice, facilitators and barriers to implementation, and knowledge translation activities. RESULTS Thirteen pediatric PTs from a variety of practice settings participated. Positive perceptions about the CMT CPG included the use of flow charts, synthesized literature in one place, and validation of examination and intervention approaches. Negative perceptions included its length and that approaches without published evidence were not addressed. Three major themes were identified: knowledge and evidence for practice, education of clinicians, and the CPG structure and components that influenced practice. CONCLUSIONS The CMT CPG provided a number of benefits. Recommendations for future enhancement and development are provided.
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16
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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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17
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Huang MH, Hile E, Croarkin E, Wampler-Kuhn M, Blackwood J, Colon G, Pfalzer LA. Academy of Oncologic Physical Therapy EDGE Task Force: A Systematic Review of Measures of Balance in Adult Cancer Survivors. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000177] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Knox V, Vuoskoski P, Mandy A. Use of outcome measures in children with severe cerebral palsy: A survey of U.K. physiotherapists. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1786. [PMID: 31172663 DOI: 10.1002/pri.1786] [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: 11/13/2018] [Revised: 02/18/2019] [Accepted: 04/07/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate the use of outcome measures for children with cerebral palsy (CP) by paediatric physiotherapists (PTs) who are based in the United Kingdom, as limited research exists regarding their use in this population, and to explore therapists' use of measures within different Gross Motor Function Classification System (GMFCS) levels and for different types of CP. METHODS A six-item online survey was advertised through two paediatric therapy special interest groups inviting physiotherapists to participate. Descriptive statistics (range, frequencies, and percentages) were used to analyse survey data. RESULTS Two hundred and seven physiotherapists returned completed survey questionnaires. One hundred and seventy-six (85%) therapists reported using a wide variety of outcome measures (57). Eighty-one per cent of therapists' responses for having "most difficulty" in identifying responsive outcome measures were for children with impaired mobility at GMFCS Levels IV-V and children with more significant body involvement (76%), for example, spastic quadriplegia or dyskinesia. Eighty-six per cent of therapists' responses for having "greatest ease" of identifying responsive outcome measures were for children within GMFCS Levels I-III and for children with less significant body involvement (72%), for example, hemiplegia. The variety of outcome measures used by therapists with children within GMFCS IV-V was less (16). CONCLUSIONS The majority (85%) of the PTs surveyed used outcome measures with children with CP, but 81% perceived a difficulty in identifying responsive measures for children with more severe impairments who are classified as GMFCS IV-V. The reasons for this perceived difficulty warrant investigation and may suggest a need for training regarding relevant measures and/or a need to develop new measures for this group of children.
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Affiliation(s)
- Virginia Knox
- Community Paediatric Physiotherapy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Pirjo Vuoskoski
- Department of Health Sciences, Karelia University of Applied Sciences, Karelia, Finland
| | - Anne Mandy
- Centre for Health Research, University of Brighton, Brighton, UK
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19
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Bailes AF, Gannotti M, Bellows DM, Shusterman M, Lyman J, Horn SD. Caregiver knowledge and preferences for gross motor function information in cerebral palsy. Dev Med Child Neurol 2018; 60:1264-1270. [PMID: 30132848 DOI: 10.1111/dmcn.13994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/28/2022]
Abstract
AIM To determine caregiver knowledge and preferences for gross motor information and examine differences across Gross Motor Function Classification System (GMFCS) levels. METHOD A questionnaire was developed. Respondents reported GMFCS knowledge, preference for knowledge, and experience with GMFCS and motor curve information. RESULTS In total, 303 caregivers of children with cerebral palsy (CP) (GMFCS level I: 22%; GMFCS level II: 16%; GMFCS level III: 15%; GMFCS level IV: 23%; GMFCS level V: 24%) completed the questionnaire. Forty-five per cent of caregivers knew the GMFCS level at survey, and only 31% knew how their child's motor development compared with others of similar age and level. Caregiver education level was associated with knowledge (p<0.001). Most prefer discussing motor development with a therapist. Of caregivers who knew their child's GMFCS level at survey, 83% reported it would be helpful to revisit the topic over time. Compared with GMFCS level IV and V, caregivers of children in GMFCS levels I to III preferred to learn at the same time as CP diagnosis, (p=0.04) and were more likely to report having received visual aids (p=0.04). Caregivers of children in GMFCS levels IV and V found it more difficult to learn their child's level (p<0.001) versus those caring for children of GMFCS levels I to III, and reported seeing pictures with descriptions more informative (p=0.03). INTERPRETATION Caregivers of children with CP may not know GMFCS and motor curve information, and vary in experience and preferences for this information. WHAT THIS PAPER ADDS Fewer than half of caregivers of children with cerebral palsy (CP) know their child's Gross Motor Function Classification System level. Most want to know how their child's function compares to other children with CP. The majority of caregivers would like to revisit the topic over time. Caregivers want to discuss gross motor information with the therapist and doctor.
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Affiliation(s)
- Amy F Bailes
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mary Gannotti
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Danielle M Bellows
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA.,Connecticut Children's Medical Center, Hartford, CT, USA
| | | | | | - Susan D Horn
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
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20
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Auld ML, Johnston LM. Getting inTOUCH: outcomes of a knowledge translation intervention for tactile assessment knowledge, barriers, and practice in paediatric therapists working with children with cerebral palsy. Disabil Rehabil 2018; 41:2350-2358. [PMID: 29693473 DOI: 10.1080/09638288.2018.1466202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Tactile impairments are common in children with cerebral palsy (CP), however assessment is not routinely carried out by therapists. We investigated a multi-faceted Knowledge Translation intervention to improve Knowledge, remove Barriers and enhance Practice of tactile assessments by paediatric therapists. Method: Twelve therapists from a state-wide service for children with CP (seven physiotherapists, five occupational therapists; 12 female) received: written information, demonstration videos, a face-to-face workshop, equipment provision, and on-call mentoring. Therapists completed pre-post-intervention questionnaires reporting their perceived tactile assessment Knowledge, current Practices and implementation Barriers. Results: Following intervention, therapists improved Knowledge of correct (1) tactile impairment prevalence in children with CP (pre 3/12; post 9/12), (2) tactile assessment items (e.g. Registration - pre 1/12; post 9/12; Localisation - pre 2/12; post 10/12), and (3) equipment choice (e.g. Monofilaments - pre 1/12; post 10/12). Tactile assessment Practice improved slightly. All major clinician-level implementation Barriers were resolved and less obvious organisational-level Barriers were identified for follow-up. Conclusion: A 12-month multi-faceted Knowledge Translation intervention can improve tactile assessment Knowledge, resolve major clinician-level implementation Barriers, and identify less obvious organisational-level Barriers to be addressed to achieve maximum Practice improvement. Ongoing multi-faceted knowledge translation processes are essential for high-performing organisations. Implications for rehabilitation A multi-faceted knowledge translation intervention significantly improved paediatric therapists' knowledge of the items and equipment necessary for tactile assessment. A 12-month intervention can address clinician-level barriers of knowledge, confidence, and access to equipment and assist in the identification of less obvious organisational-level barriers. Consideration of motivational readiness for change, intervention timelines, monitoring of emergent barriers, and fitting tactile assessment into a broader assessment framework are critical for improving uptake of tactile assessment in practice.
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Affiliation(s)
- Megan L Auld
- a School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia.,b CPL - Choice, Passion, Life , Brisbane , Australia
| | - Leanne M Johnston
- a School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Australia
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21
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Romney W, Salbach N, Parrott JS, Deutsch JE. A knowledge translation intervention designed using audit and feedback and the Theoretical Domains Framework for physical therapists working in inpatient rehabilitation: A case report. Physiother Theory Pract 2018; 35:686-702. [DOI: 10.1080/09593985.2018.1457113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Wendy Romney
- Department of Physical Therapy, Sacred Heart University, Fairfield, CT, USA
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ, USA
| | - Nancy Salbach
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - James Scott Parrott
- Department of Interdisciplinary Studies, Rutgers University, Newark, NJ, USA
| | - Judith E Deutsch
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ, USA
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22
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Abstract
PURPOSE This study describes survey responses about implementation of the congenital muscular torticollis clinical practice guideline (CMT-CPG) by pediatric physical therapists (PT) and successes and challenges with knowledge-brokering activities. METHODS An online survey was distributed to pediatric PTs who self-identified with practice experience with congenital muscular torticollis. Data were analyzed for implementation frequency of guideline recommendations and differences pre and postpublication of the CMT-CPG. RESULTS After publication, guideline recommendation implementation improved such that no recommendation was being implemented by less than 50% of respondents, and most were implemented by greater than 90%. The majority of respondents participated in knowledge brokering; however, many indicated minimal effectiveness of those activities. CONCLUSIONS The CMT-CPG has successfully aided in changing practice. Participants identified areas of challenge and success in translating recommendations into practice and in knowledge brokering that may be helpful for the development of future CPGs.
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23
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Moore JL, Carpenter J, Doyle AM, Doyle L, Hansen P, Hahn B, Hornby TG, Roth HR, Spoeri S, Tappan R, Van Der Laan K. Development, Implementation, and Use of a Process to Promote Knowledge Translation in Rehabilitation. Arch Phys Med Rehabil 2017; 99:82-90. [PMID: 28928025 DOI: 10.1016/j.apmr.2017.08.476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the use and effect of the Battery of Rehabilitation Assessments and Interventions on evidence-based practice (EBP) over 6 years. DESIGN Successive independent samples study. SETTING Large rehabilitation system. PARTICIPANTS Successive samples of allied health clinicians (N=372) in 2009 (n=136), 2012 (n=115), and 2015 (n=121). INTERVENTIONS The Battery of Rehabilitation Assessments and Interventions includes 2 components: (1) a process to synthesize, adapt, and make recommendations about the application of evidence; and (2) a process to implement the recommended practices in 3 levels of care. MAIN OUTCOME MEASURES To assess the effect of the project, surveys on EBP perspectives, use, and barriers were conducted before Battery of Rehabilitation Assessments and Interventions implementation and 3 and 6 years after implementation. Questions about effect of the project on clinical practice were included 3 and 6 years postimplementation. RESULTS Survey data indicate the Battery of Rehabilitation Assessments and Interventions resulted in a significant increase in use of EBPs to make clinical decisions and justify care. As a result of the project, survey participants reported a substantial increase in use of outcome measures in 2012 (74%) and 2015 (91%) and evidence-based interventions in 2012 (62%) and 2015 (82%). In 2012, significant differences (P≤.01) in effect of the Battery of Rehabilitation Assessments and Interventions on practice were identified between therapists who were directly involved in the project and Interventions compared with uninvolved therapists. In 2015, no significant differences existed between involved and uninvolved therapists. CONCLUSIONS After 6 years of sustained implementation efforts, the Battery of Rehabilitation Assessments and Interventions expedited the adoption of EBPs throughout a large system of care in rehabilitation.
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Affiliation(s)
- Jennifer L Moore
- Regional Center of Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo/Nesodden, Norway; Institute for Knowledge Translation, Carmel, IN.
| | | | | | | | | | | | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University, Indianapolis, IN
| | - Heidi R Roth
- Shirley Ryan AbilityLab, Chicago, IL; Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL
| | | | - Rachel Tappan
- Shirley Ryan AbilityLab, Chicago, IL; Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL
| | - Krista Van Der Laan
- Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL
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24
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Käll I, Larsson ME, Bernhardsson S. Use of outcome measures improved after a tailored implementation in primary care physiotherapy: a prospective, controlled study. J Eval Clin Pract 2016; 22:668-76. [PMID: 26853076 DOI: 10.1111/jep.12513] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 12/25/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES It is important that physiotherapists routinely use outcome measures to evaluate treatment results. There is limited knowledge about effective ways to increase use of outcome measures. The objectives were to investigate the effect of a tailored implementation of guidelines for evaluation of physiotherapy treatment and to explore differences in outcome subgrouped by demographic variables. METHODS A prospective, controlled study was conducted in primary care physiotherapy in western Sweden. 448 publicly employed physiotherapists participated. The intervention comprised a tailored, multi-component implementation of guidelines for treatment and evaluation of musculoskeletal disorders. The core component was a 3-hour implementation seminar. The control group received no intervention. Self-reported attitudes towards, access to and use of outcome measures were assessed with a web-based questionnaire before and after the implementation. RESULTS After the implementation, a significantly higher proportion of physiotherapists in the intervention group than in the control group reported using outcome measures frequently, 54.8% vs. 35.6%, a 19.2% difference. The proportion of physiotherapists who reported that they considered outcome measures important to use and that they had easy access to outcome measures at their workplace, were similar in both groups at follow-up, 92.8% vs. 93.1%, and 95.2% vs. 90.8%, respectively. At follow-up, no differences related to demographic variables were found in the subgroup analyses. CONCLUSIONS The findings suggest that a tailored, multi-component implementation can be effective in increasing use of outcome measures. Although most physiotherapists considered outcome measures important and reported having easy access to them at their workplace, only a little more than half reported using outcome measures after the intervention.
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Affiliation(s)
- Ingela Käll
- Närhälsan Stenungsund Rehabilitation, Stenungsund, Sweden. .,Umeå University, Department of Community Medicine and Rehabilitation & Physiotherapy, UMEÅ, Sweden.
| | - Maria Eh Larsson
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Research and Development, Primary Health Care, Närhälsan Primary Care Research and Development Centre, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden.,Närhälsan Rehabilitation Hönö/Öckerö, Region Västra Götaland, Hönö, Sweden
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25
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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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26
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O'Connor B, Kerr C, Shields N, Imms C. A systematic review of evidence-based assessment practices by allied health practitioners for children with cerebral palsy. Dev Med Child Neurol 2016; 58:332-47. [PMID: 26645152 DOI: 10.1111/dmcn.12973] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 12/16/2022]
Abstract
AIM The routine use of psychometrically robust assessment tools is integral to best practice. This systematic review aims to determine the extent to which evidence-based assessment tools were used by allied health practitioners for children with cerebral palsy (CP). METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols 2015 was employed. A search strategy applied the free text terms: 'allied health practitioner', 'assessment', and 'cerebral palsy', and related subject headings to seven databases. Included articles reported assessment practices of occupational therapists, physiotherapists, or speech pathologists working with children with CP aged 0 to 18 years, published from the year 2000. RESULTS Fourteen articles met the inclusion criteria. Eighty-eight assessment tools were reported, of which 23 were in high use. Of these, three tools focused on gross motor function and had acceptable validity for use with children with CP: Gross Motor Function Measure, Gross Motor Function Classification System, and goniometry. Validated tools to assess other activity components, participation, quality of life, and pain were used infrequently or not at all. INTERPRETATION Allied health practitioners used only a few of the available evidence-based assessment tools. Assessment findings in many areas considered important by children and families were rarely documented using validated assessment tools.
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Affiliation(s)
- Bridget O'Connor
- School of Allied Health, Australian Catholic University, Fitzroy, Vic., Australia
| | - Claire Kerr
- Centre for Disability and Development Research, Australian Catholic University, Fitzroy, Vic., Australia.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Nora Shields
- School of Allied Health, La Trobe University, Bundoora, Vic., Australia.,Northern Centre for Health Education and Research, Epping, Vic., Australia
| | - Christine Imms
- Centre for Disability and Development Research, Australian Catholic University, Fitzroy, Vic., Australia
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27
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Aligning Documentation With Congenital Muscular Torticollis Clinical Practice Guidelines: Administrative Case Report. Phys Ther 2016; 96:111-20. [PMID: 26381809 DOI: 10.2522/ptj.20150012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 09/09/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE A hospital-based pediatric outpatient center, wanting to weave evidence into practice, initiated an update of knowledge, skills, and documentation patterns with its staff physical therapists and occupational therapists who treat people with congenital muscular torticollis (CMT). This case report describes 2 cycles of implementation: (1) the facilitators and barriers to implementation and (2) selected quality improvement outcomes aligned with published clinical practice guidelines (CPGs). CASE DESCRIPTION The Pediatric Therapy Services of St Joseph's Regional Medical Center in New Jersey has 4 full-time, 1 part-time, and 3 per diem staff. Chart audits in 2012 revealed variations in measurement, interventions, and documentation that led to quality improvement initiatives. An iterative process, loosely following the knowledge-to-action cycle, included a series of in-service training sessions to review the basic anatomy, pathokinesiology, and treatment strategies for CMT; reading assignments of the available CPGs; journal review; documentation revisions; and training on the recommended measurements to implement 2 published CPGs and measure outcomes. OUTCOMES A previous 1-page generic narrative became a 3-page CMT-specific form aligned with the American Physical Therapy Association Section on Pediatrics CMT CPG recommendations. Staff training on the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, classification of severity, type of CMT, prognostication, measures of cervical range of motion, and developmental progression improved documentation consistency from 0% to 81.9% to 100%. Clinicians responded positively to using the longer initial evaluation form. DISCUSSION Successful implementation of both clinical and documentation practices were facilitated by a multifaceted approach to knowledge translation that included a culture supportive of evidence-based practice, administrative support for training and documentation redesign, commitment by clinicians to embrace changes aimed at improved care, and clinical guidelines that provide implementable recommendations.
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