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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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Lusardi MM. 2023 Carol B. Lewis Distinguished Lecture Address to the APTA Geriatrics Membership Combined Sections Meeting, February 23, 2023 Key Words & Challenges: Defining Our Role in Caring for Older Adults. J Geriatr Phys Ther 2023; 46:93-102. [PMID: 36935462 DOI: 10.1519/jpt.0000000000000378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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Tilson JK, Martinez CA, MacDowell S, D’Silva LJ, Howard R, Roth HR, Skop KM, Dannenbaum E, Farrell L. Use of the knowledge to action model improved physical therapist adherence to a common clinical practice guideline across multiple settings: a multisite case series. BMC Health Serv Res 2022; 22:1462. [PMID: 36456945 PMCID: PMC9714412 DOI: 10.1186/s12913-022-08796-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 11/05/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND When a new guideline is published there is a need to understand how its recommendations can best be implemented in real-world practice. Yet, guidelines are often published with little to no roadmap for organizations to follow to promote adherence to their recommendations. The purpose of this study was to evaluate the impact of using a common process model to implement a single clinical practice guideline across multiple physical therapy clinical settings. METHODS Five organizationally distinct sites with physical therapy services for patients with peripheral vestibular hypofunction participated. The Knowledge to Action model served as the foundation for implementation of a newly published guideline. Site leaders conducted preliminary gap surveys and face-to-face meetings to guide physical therapist stakeholders' identification of target-behaviors for improved guideline adherence. A 6-month multimodal implementation intervention included local opinion leaders, audit and feedback, fatigue-resistant reminders, and communities of practice. Therapist adherence to target-behaviors for the 6 months before and after the intervention was the primary outcome for behavior change. RESULTS Therapist participants at all sites indicated readiness for change and commitment to the project. Four sites with more experienced therapists selected similar target behaviors while the fifth, with more inexperienced therapists, identified different goals. Adherence to target behaviors was mixed. Among four sites with similar target behaviors, three had multiple areas of statistically significantly improved adherence and one site had limited improvement. Success was most common with behaviors related to documentation and offering patients low technology resources to support home exercise. A fifth site showed a trend toward improved therapist self-efficacy and therapist behavior change in one provider location. CONCLUSIONS The Knowledge to Action model provided a common process model for sites with diverse structures and needs to implement a guideline in practice. Multimodal, active interventions, with a focus on auditing adherence to therapist-selected target behaviors, feedback in collaborative monthly meetings, fatigue-resistant reminders, and developing communities of practice was associated with long-term improvement in adherence. Local rather than external opinion leaders, therapist availability for community building meetings, and rate of provider turnover likely impacted success in this model. TRIAL REGISTRATION This study does not report the results of a health care intervention on human participants.
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Affiliation(s)
- Julie K. Tilson
- grid.42505.360000 0001 2156 6853Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California USA
| | - Clarisa A. Martinez
- grid.42505.360000 0001 2156 6853Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California USA
| | - Sara MacDowell
- grid.417320.30000 0000 9612 8770Physical Therapy, Hearing and Balance Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana USA
| | - Linda J. D’Silva
- grid.412016.00000 0001 2177 6375Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas USA
| | - Robbin Howard
- grid.42505.360000 0001 2156 6853Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California USA
| | - Heidi R. Roth
- grid.16753.360000 0001 2299 3507Northwestern University School of Physical Therapy and Human Movement Sciences and Shirley Ryan AbilityLab, Chicago, IL USA
| | - Karen M. Skop
- grid.170693.a0000 0001 2353 285XPhysical Medicine and Rehabilitation Services, Department of Physical Therapy, James A. Haley Veterans’ Hospital, Morsani College of Medicine, University of South Florida, School of Physical Therapy, Tampa, FL USA
| | - Elizabeth Dannenbaum
- grid.414993.20000 0000 8928 6420Vestibular Program, Jewish Rehabilitation Hospital Foundation, Laval, Quebec Canada
| | - Lisa Farrell
- Symmetry Alliance, LLC, Fort Lauderdale, Florida USA
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A scoping review exploring the ‘grey area’ of suicide-related expression in later life: Developing a conceptual framework for professional engagement. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
As the body of research on suicide in later life has developed, so has its vocabulary. This has generated a high level of overlap in concepts and terminology used to articulate suicide and how it might present, as well as ‘grey area’ behavioural terms that are both specific to older adults and less well-defined (e.g. ‘hastening of death’ or ‘completed life’). A better understanding of individual experiences and pathways to suicide can help to inform assessment and interventions, and increase the potential to relate any theoretical concepts to the implementation of such. Here, we adopted a scoping review to search systematically literature on specific presentation, features, circumstances and outcomes of these grey areas of suicide in later life. Fifty-three articles (quantitative, qualitative and theoretical) were reviewed. A narrative approach was used to merge and translate this body of knowledge into a new conceptual framework based on four key themes: (a) a sense of completed life or existential loneliness; (b) death thoughts, wishes and ideation; (c) death-hastening behaviour and advanced directives; and (d) self-destructive or self-injurious behaviour. We discuss the importance of integrating this understanding into current knowledge and suicide prevention strategies for older adults. Recommendations are made for unifying research with policy themes on healthy ageing, person-centredness within service provision and citizen participation.
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Etheridge T, Bostick GP, Hoens AM, Holly J, Ippersiel P, Bobos P, Arumugam V, Woods S, Gielen S, Woznowski-Vu A, Campbell N. Barriers to Physiotherapists’ Use of Professional Development Tools for Chronic Pain: A Knowledge Translation Study. Physiother Can 2022. [DOI: 10.3138/ptc-2020-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The Pain Science Division (PSD) is a special interest group of the Canadian Physiotherapy Association that serves physiotherapists who have an interest in better understanding and managing patients’ pain. The PSD developed evidence-based resources for its members with the goal of improving patient care by supporting professional development. However, online metrics tracking access to these resources indicated that access was low. The purpose of this study was to identify the barriers PSD members encountered to the use of PSD resources and to recommend interventions to address these barriers guided by the Theory and Techniques Tool (TTT). Method: We distributed an online survey to PSD members across Canada. We used the TTT, a knowledge translation tool, to guide the design of the questionnaire and identify actionable findings. Results: Response rates from 621 non-student members and 1,470 student members were 26.9% and 1.4%, respectively. Based on the frequency of practicing physiotherapists’ ( N = 167) agreement with items in the TTT, the primary barriers to use of the PSD resources were forgetting that the resources were available and forgetting to use them. Conclusions: The TTT can be used to identify barriers to use of professional development tools.
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Affiliation(s)
- Tori Etheridge
- Centre for Neurology Studies, Surrey, British Columbia, Canada
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
| | - Geoff P. Bostick
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Alison M. Hoens
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Janet Holly
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Patrick Ippersiel
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Pavlos Bobos
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Vanitha Arumugam
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- Pain Management Program, St. Joseph Health Care, London, Ontario, Canada
| | | | | | - Arthur Woznowski-Vu
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Criss MG, Wingood M, Staples WH, Southard V, Miller KL, Norris TL, Avers D, Ciolek CH, Lewis CB, Strunk ER. APTA Geriatrics' Guiding Principles for Best Practices in Geriatric Physical Therapy. J Geriatr Phys Ther 2022; 45:70-75. [DOI: 10.1519/jpt.0000000000000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kelly G, Moys R, Burrough M, Hyde S, Randall S, Wales L. Rehabilitation in practice: improving delivery of upper limb rehabilitation for children and young people with acquired brain injuries through the development and implementation of a clinical pathway. Disabil Rehabil 2022; 44:158-165. [PMID: 32432940 DOI: 10.1080/09638288.2020.1761891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Decision making regarding upper limb assessment and management of children and young people (CYP) with acquired brain injury (ABI) is complex. This project aimed to standardise and improve upper limb provision in one residential rehabilitation unit for CYP with ABI. METHODS Plan-do-study-act (PDSA) methodology was used. Available evidence was synthesised and recommendations for assessment and intervention of CYP who present at different functional levels were made. A multi-modal knowledge translation process was used for pathway implementation, with regular review and updates in each PDSA cycle. Audit and staff survey at one year and two years post implementation were conducted. RESULTS A clinical pathway consisting of an assessment decision tree, intervention matrix and evidence based summaries was developed. Audit at one year demonstrated 70% of CYP had an appropriate assessment form, which increased to 82% at two years. Staff survey showed increased knowledge and use of the pathway, and decreased perceived training needs between years one and two. CONCLUSIONS Use of an upper limb pathway can standardise care in line with best available evidence, and increase staff confidence in this complex rehabilitation area. Several years of development and implementation were required to embed its use in practice.Implications for rehabilitationUpper limb rehabilitation for CYP with ABI is complex, with no "one size fits all" assessment or intervention techniques available.Developing a pathway in which the evidence for assessment and management interventions for CYP of different functional levels, and recommendations for clinical practice can improve the consistency of assessment and intervention, and staff confidence with upper limb management.A multimodal strategy for implementation planned from the outset of pathway development can facilitate the translation of the pathway into routine clinical practice.
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Affiliation(s)
- Gemma Kelly
- Research and Therapy Department, The Children's Trust, Tadworth Court, Tadworth, UK
| | - Ruth Moys
- Research and Therapy Department, The Children's Trust, Tadworth Court, Tadworth, UK
| | - Melanie Burrough
- Research and Therapy Department, The Children's Trust, Tadworth Court, Tadworth, UK
| | - Samantha Hyde
- Research and Therapy Department, The Children's Trust, Tadworth Court, Tadworth, UK
| | - Sammy Randall
- Research and Therapy Department, The Children's Trust, Tadworth Court, Tadworth, UK
| | - Lorna Wales
- Research and Therapy Department, The Children's Trust, Tadworth Court, Tadworth, UK
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Stander J, Grimmer K, Brink Y. How to contextualize training on guideline-uptake for your setting. J Eval Clin Pract 2021; 27:1164-1167. [PMID: 32926530 DOI: 10.1111/jep.13476] [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: 04/11/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
One knowledge translation method, of putting evidence into practice, is the use of clinical practice guidelines (CPG). The purpose of this brief report is to describe an 8-step process of "how to" contextualize a training programme to increase CPG-uptake for a targeted audience in a clearly defined setting. This process may assist implementation practitioners to fast-track the development of contextualized training to improve CPG-uptake.
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Affiliation(s)
- Jessica Stander
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karen Grimmer
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yolandi Brink
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Longtin C, Décary S, Cook CE, Tousignant-Laflamme Y. What does it take to facilitate the integration of clinical practice guidelines for the management of low back pain into practice? Part 2: A strategic plan to activate dissemination. Pain Pract 2021; 22:107-112. [PMID: 33998767 DOI: 10.1111/papr.13032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023]
Abstract
Low back pain (LBP) is the leading cause of disability worldwide among all musculoskeletal disorders despite an intense focus in research efforts. Researchers and decision makers have produced multiple clinical practice guidelines for the rehabilitation of LBP, which contain specific recommendations for clinicians. Adherence to these recommendations may have several benefits, such as improving the quality of care for patients living with LBP, by ensuring that the best evidence-based care is being delivered. However, clinicians' adherence to recommendations from these guidelines is low and numerous implementation barriers and challenges, such as complexity of information and sheer volume of guidelines have been documented. In a previous paper, we performed a systematic review of the literature to identify high-quality clinical practice guidelines on the management of LBP, and developed a concise yet comprehensive infographic that summarizes the recommendations from these guidelines. Considering the wealth of scientific evidence, passive dissemination alone of this research knowledge is likely to have limitations to help clinicians implement these recommendations into routine practice. Thus, an active and engaging dissemination strategy, aimed at improving the implementation and integration of specific recommendations into practice is warranted. In this paper, we argue that a conceptual framework, such as the theoretical domains framework, could facilitate the implementation of these recommendations into clinical practice. Specifically, we present a systematic approach that could serve to guide the development of a theory-informed knowledge translation intervention as a means to overcome implementation challenges in rehabilitation of LBP.
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Affiliation(s)
- Christian Longtin
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada
| | - Simon Décary
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada.,Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
| | - Chad E Cook
- Department of Orthopedics, Duke University, Durham, North Carolina, USA
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada.,Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, 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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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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13
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kafri M, Atun-Einy O. From Motor Learning Theory to Practice: A Scoping Review of Conceptual Frameworks for Applying Knowledge in Motor Learning to Physical Therapist Practice. Phys Ther 2019; 99:1628-1643. [PMID: 31407003 DOI: 10.1093/ptj/pzz118] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/13/2018] [Accepted: 05/05/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND The importance of motor learning knowledge for physical therapist practice is well known; however, its application is lacking. Conceptual frameworks that place motor learning knowledge within a clinical context are a potential mediator to overcome this gap. PURPOSE This study aimed to conduct a scoping review of the literature to identify and describe the content of such conceptual frameworks in physical therapy/rehabilitation, including the approaches taken in their development and the "elements" or building blocks of motor learning-based interventions within each conceptual framework. DATA SOURCES The data sources used were PubMed, CINAHL, and PsychInfo databases. STUDY SELECTION Articles that were selected had a primary focus on motor learning and its application in physical therapy/rehabilitation and were published between 2000 and 2017. DATA EXTRACTION Twelve of 62 relevant articles met the inclusion criteria. DATA SYNTHESIS Papers attempted to translate theoretical knowledge into a coherent, clinically accessible conceptual framework via 3 main approaches: synthesizing selected motor learning elements into original new conceptual frameworks, mapping motor learning elements in current clinical practices, and assembling selected motor learning elements. The elements of motor learning that were common across papers included theoretical concepts (such as "meaningful goal setting" and "active involvement"); practice variables (including the type, frequency, and timing of feedback; the focus of instructions; task breakdown; and the amount, variability, and order of practice); and intervention strategies (task specific and mental practice). Psychological aspects related to self-efficacy and motivation were also considered integral. LIMITATIONS Papers published before the year 2000 were excluded. CONCLUSION The scoping review revealed that the presentation of motor learning elements in a coherent framework encompassed very diverse approaches and used different categorization systems. In addition, to fully grasp the complexity of clinical practice, motor learning should be coupled with other fields of knowledge.
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Affiliation(s)
- Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
| | - Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
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15
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A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation: A CLINICAL PRACTICE GUIDELINE. J Neurol Phys Ther 2019; 42:174-220. [PMID: 29901487 PMCID: PMC6023606 DOI: 10.1097/npt.0000000000000229] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Use of outcome measures (OMs) in adult neurologic physical therapy is essential for monitoring changes in a patient's status over time, quantifying observations and patient-reported function, enhancing communication, and increasing the efficiency of patient care. OMs also provide a mechanism to compare patient and organizational outcomes, examine intervention effectiveness, and generate new knowledge. This clinical practice guideline (CPG) examined the literature related to OMs of balance, gait, transfers, and patient-stated goals to identify a core set of OMs for use across adults with neurologic conditions and practice settings. Methods: To determine the scope of this CPG, surveys were conducted to assess the needs and priorities of consumers and physical therapists. OMs were identified through recommendations of the Academy of Neurologic Physical Therapy's Evidence Database to Guide Effectiveness task forces. A systematic review of the literature on the OMs was conducted and additional OMs were identified; the literature search was repeated on these measures. Articles meeting the inclusion criteria were critically appraised by 2 reviewers using a modified version of the COnsensus-based Standards for the selection of health Measurement INstruments. (COSMIN) checklist. Methodological quality and the strength of statistical results were determined. To be recommended for the core set, the OMs needed to demonstrate excellent psychometric properties in high-quality studies across neurologic conditions. Results/Discussion: Based on survey results, the CPG focuses on OMs that have acceptable clinical utility and can be used to assess change over time in a patient's balance, gait, transfers, and patient-stated goals. Strong, level I evidence supports the use of the Berg Balance Scale to assess changes in static and dynamic sitting and standing balance and the Activities-specific Balance Confidence Scale to assess changes in balance confidence. Strong to moderate evidence supports the use of the Functional Gait Assessment to assess changes in dynamic balance while walking, the 10 meter Walk Test to assess changes in gait speed, and the 6-Minute Walk Test to assess changes in walking distance. Best practice evidence supports the use of the 5 Times Sit-to-Stand to assess sit to standing transfers. Evidence was insufficient to support use of a specific OM to assess patient-stated goals across adult neurologic conditions. Physical therapists should discuss the OM results with patients and collaboratively decide how the results should inform the plan of care. Disclaimer: The recommendations included in this CPG are intended as a guide for clinicians, patients, educators, and researchers to improve rehabilitation care and its impact on adults with neurologic conditions. The contents of this CPG were developed with support from the APTA and the Academy of Neurologic Physical Therapy (ANPT). The Guideline Development Group (GDG) used a rigorous review process and was able to freely express its findings and recommendations without influence from the APTA or the ANPT. The authors declare no competing interest. Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A214.
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16
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Beyond efficacy: a qualitative organizational perspective on key implementation science constructs important to physical activity intervention translation to rural community cancer care sites. J Cancer Surviv 2019; 13:537-546. [PMID: 31250353 DOI: 10.1007/s11764-019-00773-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To identify constructs relevant to implementation of evidence-based physical activity (PA) behavior change interventions for rural women cancer survivors from an organizational perspective. METHODS During the development of a PA intervention implementation toolkit, 11 potential interventionists and 19 community and organizational stakeholders completed focus groups stratified by role. Narratives were audio recorded, transcribed, and coded for Consolidated Framework for Implementation Research (CFIR) constructs. RESULTS Multiple CFIR constructs were identified: Implementation Process (i.e., Engaging, Reflecting and Evaluating), Intervention Characteristics (i.e., Design Quality and Packaging, Cost, Evidence Strength and Quality, Adaptability, Complexity), Inner Setting (i.e., Implementation Readiness, Implementation Climate, Structural Characteristics), Outer Setting (i.e., Patient Needs and Resources, Cosmopolitanism), and Characteristics of Individuals (i.e., Knowledge and Beliefs, Stage of Change). Narratives identified rural implementation barriers (e.g., transportation) and facilitators (e.g., community-oriented). Unique needs of the cancer survivor (e.g., coping during cancer treatment and long-term effects on physical abilities) were emphasized as important barriers potentially addressed through Adaptability and Readiness implementation strategies. Narratives identified multi-level (i.e., individual-, organizational-, and community-level) strategies for targeting the identified constructs. CONCLUSIONS Fourteen CFIR constructs emerged as potentially important for organizations to consider when implementing PA interventions. Constructs were integrated into our implementation toolkit and research testing their potential mechanisms of action when implementing PA interventions in rural settings is warranted. IMPLICATIONS Strategies that target the identified constructs may enhance the implementation of PA programs for rural cancer survivors. Cancer survivors can facilitate these efforts by partnering with their health care providers and community organizations. IMPLICATIONS FOR CANCER SURVIVORS Organizations promoting physical activity programs for cancer survivors must overcome implementation barriers including but not limited to cost, necessary expertise, and lack of awareness. Cancer survivors can facilitate these efforts by partnering with their health care providers, cancer center, and local community organizations to raise awareness and champion these efforts. It will "take a village", with cancer survivors being their own best advocate, to bring physical activity promotion to a broad range of cancer survivors.
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Morris JH, Bernhardsson S, Bird ML, Connell L, Lynch E, Jarvis K, Kayes NM, Miller K, Mudge S, Fisher R. Implementation in rehabilitation: a roadmap for practitioners and researchers. Disabil Rehabil 2019; 42:3265-3274. [PMID: 30978129 DOI: 10.1080/09638288.2019.1587013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Despite growth in rehabilitation research, implementing research findings into rehabilitation practice has been slow. This creates inequities for patients and is an ethical issue. However, methods to investigate and facilitate evidence implementation are being developed. This paper aims to make these methods relevant and accessible for rehabilitation researchers and practitioners.Methods: Rehabilitation practice is varied and complex and occurs within multilevel healthcare systems. Using a "road map" analogy, we describe how implementation concepts and theories can inform implementation strategies in rehabilitation. The roadmap involves a staged journey that considers: the nature of evidence; context for implementation; navigation tools for implementation; strategies to facilitate implementation; evaluation of implementation outcomes; and sustainability of implementation. We have developed a model to illustrate the journey, and four case studies exemplify implementation stages in rehabilitation settings.Results and Conclusions: Effective implementation strategies for the complex world of rehabilitation are urgently required. The journey we describe unpacks that complexity to provide a template for effective implementation, to facilitate translation of the growing evidence base in rehabilitation into improved patient outcomes. It emphasizes the importance of understanding context and application of relevant theory, and highlights areas which should be targeted in new implementation research in rehabilitation.Implications for rehabilitationEffective implementation of research evidence into rehabilitation practice has many interconnected steps and a roadmap analogy is helpful in defining them.Understanding context for implementation is critically important and using theory can facilitate development of understanding.Research methods for implementation in rehabilitation should be carefully selected and outcomes should evaluate implementation success as well as clinical change.Sustainability requires regular revisiting of the interconnected steps.
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Affiliation(s)
- Jacqui H Morris
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Susanne Bernhardsson
- Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden.,The Sahlgrenska Academy Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Marie-Louise Bird
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Louise Connell
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - Elizabeth Lynch
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Victoria, Australia
| | - Kathryn Jarvis
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - Nicola M Kayes
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Kim Miller
- Evidence Centre, Sunny Hill Health Centre for Children, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Suzie Mudge
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Rebecca Fisher
- School of Medicine, University of Nottingham, Nottingham, UK
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18
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van Rhyn B, Barwick A. Health Practitioners' Perceptions of Falls and Fall Prevention in Older People: A Metasynthesis. QUALITATIVE HEALTH RESEARCH 2019; 29:69-79. [PMID: 30311840 DOI: 10.1177/1049732318805753] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Fall prevention has received a great deal of consideration and funding, however fall rates have not reduced accordingly. Health practitioners are key stakeholders in the process of implementing fall prevention evidence into their clinical assessment and management of older people at risk of falling. Investigating health practitioners' clinical experiences and perceptions has been identified as a means to enhance the translation of knowledge. Four databases were searched for studies exploring health practitioners' perceptions of falls and fall prevention. A metasynthesis of eight qualitative studies was conducted. The findings suggest that health practitioners face substantial barriers in the implementation of fall prevention practices. These include personal, interpersonal, and clinical barriers in addition to limitations of the research evidence. This knowledge hopes to enhance targeted dissemination of knowledge, reducing the research-practice gap and improving clinical outcomes for older people at risk of falls.
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Affiliation(s)
| | - Alex Barwick
- 1 Southern Cross University, Bilinga, Queensland, Australia
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19
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Initial perceptions of, and intention to use, an online guideline adaptation framework: a descriptive survey. INT J EVID-BASED HEA 2018; 16:214-226. [PMID: 30045056 DOI: 10.1097/xeb.0000000000000147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM The aim of this research was to evaluate CAN-Implement.Pro as a structured and systematic process for planning local evidence implementation, to develop a contextual and demographic profile of potential users and assess their initial perceptions and intention to use CAN-Implement.Pro. METHODS Ethics approval was obtained from the University of Adelaide Human Research Ethics Committee (Approval number: H-2016-157). A descriptive cross-sectional study was undertaken to capture the demographic characteristics of participants, as well as their initial perceptions of, and intention to use, the software for guideline adaptation projects. RESULTS A total of 21 individuals representing guideline groups completed the survey. Only 43% had taken part in at least one previous implementation project. Thirty-three percent reported embarking on their first implementation project; 24% had yet to participate in an evidence implementation project. Nursing was the most highly referenced profession at 75%, followed by medical specialties (40%); two respondents indicated allied health professions were included in their implementation group. Respondents represented countries or regions of high and upper middle income as classified by the WHO Regional Office for the Eastern Mediterranean. The majority (67%) found CAN-Implement.Pro to be well-organized, easy to navigate and reliable. Most (80%) also indicated they were more likely to return to the software than not; 20% were neutral. In terms of overall satisfaction, more than half (60%) were very satisfied or satisfied, a third (33%) was neutral and 7% were dissatisfied. Over 66% of the respondents considered their group to be familiar with the knowledge-to-action model. A slightly higher percentage (74%) reported software based upon the knowledge-to-action model had a strong conceptual framework. In terms of evidence informed functionality, 75% of the respondents concluded that the software could assist guideline groups to provide structure for their implementation planning; a similar proportion (75%) indicated that the software would also enhance or improve coordination, communication and logistics management in guideline-related implementation projects. Participants were familiar with a range of resources, models, theories and frameworks for implementation, implementation planning and guideline adaptation. The most common frameworks were related to behavioural theories or variations of the Promoting Action on Research Implementation in Health Services framework. CONCLUSION Eighty percent of the respondents indicated that their group would be likely to use the software to guide implementation planning in future projects, whereas 20% were neutral. In terms of expectations for contemporary software, multimedia resources rated highly, as did interactive components within the knowledge-to-action model.
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McDonnell B, Stillwell S, Hart S, Davis RB. Breaking Down Barriers to the Utilization of Standardized Tests and Outcome Measures in Acute Care Physical Therapist Practice: An Observational Longitudinal Study. Phys Ther 2018; 98:528-538. [PMID: 29471539 PMCID: PMC6692648 DOI: 10.1093/ptj/pzy032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 02/16/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Standardized tests and outcome measures (STOM) have not been consistently implemented as part of most physical therapists' practice. Incidence of STOM use among physical therapists at Beth Israel Deaconess Medical Center was similar to low levels cited nationally among acute care physical therapists. Targeted knowledge translation (KT) strategies have been suggested to promote the application of research evidence into clinical decision making. PURPOSE The purpose of this quality improvement (QI) effort was to implement a series of interventions aimed at increasing both use and interpretation of STOM by physical therapists practicing in acute care. DESIGN This study used an observational longitudinal design. METHODS A literature review identified current barriers and facilitators to the use of STOM by physical therapists. KT strategies were tailored to the practice setting in order to target barriers and promote facilitators to the use of STOM. Data were collected through retrospective chart review at baseline and then subsequently at 4 periods following the implementation of the QI project. RESULTS A statistically significant increase in both the use (primary outcome) and interpretation (secondary outcome) of STOM was observed following the implementation of KT strategies. The increase was sustained at all subsequent measurement periods. LIMITATIONS Limitations include the lack of a control group and the small number of setting- and diagnosis-specific STOM available for use by physical therapists practicing in acute care. CONCLUSIONS Implementation of KT strategies was associated with an increase in the frequency of use and interpretation of STOM. Similar QI efforts are feasible in any acute care physical therapy department and potentially other settings.
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Affiliation(s)
- Brian McDonnell
- Rehabilitation Services, Beth Israel Deaconess Medical Center, 30 Brookline Ave, Boston, MA 02215,Address all correspondence to Dr McDonnell at: bmcdonn1@-bidmc.harvard.edu. Dr McDonnell is a board-certified geriatric clinical specialist
| | - Shannon Stillwell
- Rehabilitation Services, Beth Israel Deaconess Medical Center. Dr Stillwell is a board-certified geriatric clinical specialist
| | - Shelby Hart
- Rehabilitation Services, Beth Israel Deaconess Medical Center
| | - Roger B Davis
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center
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21
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VanderKaay S, Letts L, Jung B, Moll SE. On-line ethics education for occupational therapy clinician–educators: a single-group pre-/post-test study. Disabil Rehabil 2018; 41:2841-2853. [DOI: 10.1080/09638288.2018.1473510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Sandra VanderKaay
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Bonny Jung
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Sandra E. Moll
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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22
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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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Pavol MA, Bassile CC, Lehman JR, Harmon E, Ferreira N, Shinn B, St James N, Callender J, Stein J. Modified Approach to Stroke Rehabilitation (MAStR): feasibility study of a method to apply procedural memory concepts to transfer training. Top Stroke Rehabil 2018; 25:351-358. [PMID: 29609504 DOI: 10.1080/10749357.2018.1458462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Training and implementation for a multidisciplinary stroke rehabilitation method emphasizing procedural memory. BACKGROUND Current practice in stroke rehabilitation relies on explicit memory, often compromised by stroke, failing to capitalize on better-preserved procedural memory skills. Recruitment of procedural memory requires consistency and practice, characteristics difficulty to promote on inpatient rehabilitation units. We designed a method Modified Approach to Stroke Rehabilitation (MAStR) to maximize consistency and practice for transfer training with stroke patients. DESIGN Phase I, single-group study. MAStR has two innovations: (1) simplification of instructions to only three words, other direction provided non-verbally; (2) having all rehabilitation staff apply the same approach for transfers. Staff training in MAStR included review of written material describing the rationale for MAStR and demonstration of a transfer using MAStR. Enrolled patients completed each transfer with MAStR in addition to standard rehabilitation therapy. RESULTS The MAStR method was taught to a large, multidisciplinary rehabilitation staff (n = 31). Training and certification required 15 min per staff member. Five stroke patients were enrolled. No transfers with MAStR resulted in injury, no negative feedback was received from staff or patients. Staff reported satisfaction with the brief MAStR training and reported transfers were easier to complete with the MAStR method. CONCLUSIONS Feasibility was demonstrated for an innovative application of procedural memory concepts to stroke rehabilitation. All rehabilitation disciplines were successfully trained. MAStR was well-tolerated and liked by rehabilitation staff and patients. These results support pursuit of a Phase II pilot study.
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Affiliation(s)
- Marykay A Pavol
- a Cerebral Localization Lab, Stroke Division, Department of Neurology, Neurological Institute, Columbia University Medical Center , Columbia University College of Physicians & Surgeons , New York , NY , USA
| | - Clare C Bassile
- b Department of Rehabilitation and Regenerative Medicine , Columbia University College of Physicians & Surgeons , New York , NY , USA
| | - Jennifer R Lehman
- c Department of Rehabilitation Medicine (Physical Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Emma Harmon
- d Department of Rehabilitation Medicine (Occupational Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Nancy Ferreira
- c Department of Rehabilitation Medicine (Physical Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Brittany Shinn
- d Department of Rehabilitation Medicine (Occupational Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Nancy St James
- e Department of Nursing (Inpatient Rehabilitation Unit) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Jacqueline Callender
- f Department of Rehabilitation Medicine (Recreation Therapy) , New York Presbyterian Hospital-Columbia University , New York , NY , USA
| | - Joel Stein
- b Department of Rehabilitation and Regenerative Medicine , Columbia University College of Physicians & Surgeons , New York , NY , USA
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Hudon A, Blackburn É, Laliberté M, Perreault K, Mazer B, Ehrmann Feldman D, Williams-Jones B, Hunt M. Supporting ethics educators in Canadian occupational therapy and physical therapy programs: A national interprofessional knowledge exchange project. J Interprof Care 2018; 32:452-462. [PMID: 29469598 DOI: 10.1080/13561820.2018.1435514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Ethics education is the cornerstone of professional practice, fostering knowledge and respect for core ethical values among healthcare professionals. Ethics is also a subject well-suited for interprofessional education and collaboration. However, there are few initiatives to gather experiences and share resources among ethics educators in rehabilitation. We thus undertook a knowledge exchange project to: 1) share knowledge about ethics training across Canadian occupational and physical therapy programs, and 2) build a community of educators dedicated to improving ethics education. The objectives of this paper are to describe this interprofessional knowledge exchange project involving ethics educators (with a diversity of professional and disciplinary backgrounds) from Canadian occupational and physical therapy programs as well as analyze its outcomes based on participants' experiences/perceptions. Two knowledge exchange strategies were employed: an interactive one-day workshop and a wiki platform. An immediate post-workshop questionnaire evaluated the degree to which participants' expectations were met. Structured telephone interviews 9-10 months after the workshop collected participants' perceptions on whether (and if so, how) the project influenced their teaching or led to further interprofessional collaborations. Open-ended questions from the post-workshop questionnaires and individual interviews were analyzed using qualitative methods. Of 40 ethics educators contacted, 23 participated in the workshop and 17 in the follow-up interview. Only 6 participants logged into the wiki from its launch to the end of data collection. Five themes emerged from the qualitative analysis: 1) belonging and networking; 2) sharing and collaborating; 3) changing (or not) ways of teaching ethics; 4) sustaining the network; and 5) envisioning the future of ethics education. The project attained many of its goals, despite encountering some challenges. While the wiki platform proved to be of limited benefit in advancing the project goals, the interactive format and collaborative nature of the one-day workshop were described as rewarding and effective in bringing together occupational therapy and physical therapy educators to meet, network, and share knowledge.
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Affiliation(s)
- Anne Hudon
- a Department of Physical Therapy, School of Rehabilitation , Faculty of Medicine, University of Montreal , Montréal , Québec , Canada.,b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montréal , Québec , Canada.,c Institut de recherche en santé publique de l'Université de Montréal , Montréal , Québec , Canada
| | - Émilie Blackburn
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montréal , Québec , Canada.,d School of Physical and Occupational Therapy , McGill University , Montréal , Québec , Canada
| | - Maude Laliberté
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montréal , Québec , Canada.,c Institut de recherche en santé publique de l'Université de Montréal , Montréal , Québec , Canada.,e Department of Social and Preventive Medicine, School of Public Health , University of Montreal , Montréal , Québec , Canada
| | - Kadija Perreault
- f Department of Rehabilitation, Faculty of Medicine , Université Laval , Québec City , Québec , Canada.,g Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Montréal , Québec , Canada
| | - Barbara Mazer
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montréal , Québec , Canada.,d School of Physical and Occupational Therapy , McGill University , Montréal , Québec , Canada
| | - Debbie Ehrmann Feldman
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montréal , Québec , Canada.,c Institut de recherche en santé publique de l'Université de Montréal , Montréal , Québec , Canada
| | - Bryn Williams-Jones
- c Institut de recherche en santé publique de l'Université de Montréal , Montréal , Québec , Canada.,e Department of Social and Preventive Medicine, School of Public Health , University of Montreal , Montréal , Québec , Canada
| | - Matthew Hunt
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal , Montréal , Québec , Canada.,d School of Physical and Occupational Therapy , McGill University , Montréal , Québec , Canada
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Thapa S, Hannes K, Buve A, Bhattarai S, Mathei C. Theorizing the complexity of HIV disclosure in vulnerable populations: a grounded theory study. BMC Public Health 2018; 18:162. [PMID: 29351785 PMCID: PMC5775526 DOI: 10.1186/s12889-018-5073-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 01/11/2018] [Indexed: 12/04/2022] Open
Abstract
Background HIV disclosure is an important step in delivering the right care to people. However, many people with an HIV positive status choose not to disclose. This considerably complicates the delivery of adequate health care. Methods We conducted a grounded theory study to develop a theoretical model explaining how local contexts impact on HIV disclosure and what the mechanisms are that determine whether people choose to disclose or not. We conducted in-depth interviews among 23 people living with HIV, 8 health workers and 5 family and community members, and 1 community development worker in Achham, Nepal. Data were analysed using constant-comparative method, performing three levels of open, axial, and selective coding. Results Our theoretical model illustrates how two dominant systems to control HIV, namely a community self-coping and a public health system, independently or jointly, shape contexts, mechanisms and outcomes for HIV disclosure. Conclusion This theoretical model can be used in understanding processes of HIV disclosure in a community where HIV is concentrated in vulnerable populations and is highly stigmatized, and in determining how public health approaches would lead to reduced stigma levels and increased HIV disclosure rates.
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Affiliation(s)
- Subash Thapa
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium. .,Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Karin Hannes
- Centre for Sociological Research, Faculty of Social Sciences, KU Leuven, Parkstraat 45, 3000, Leuven, Belgium
| | - Anne Buve
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Shivani Bhattarai
- Department of Public Health, Nobel College Pokhara University, Kathmandu, 44601, Nepal
| | - Catharina Mathei
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
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Stander J, Grimmer K, Brink Y. Training programmes to improve evidence uptake and utilisation by physiotherapists: a systematic scoping review. BMC MEDICAL EDUCATION 2018; 18:14. [PMID: 29334943 PMCID: PMC5769325 DOI: 10.1186/s12909-018-1121-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/09/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND Research training programmes are a knowledge translation (KT) intervention which aim to improve research evidence uptake by clinicians. Whilst KT training programmes have been reported to significantly improve evidence uptake by physiotherapists, it is unclear which aspects of training optimally assist KT into physiotherapy practice. The purpose of the review was to establish the body of evidence regarding KT training programmes to improve physiotherapists' use of evidence-based practice (EBP) and clinical practice guidelines (CPG). METHODS A systematic scoping review was undertaken in line with the adapted Arksey and O'Malley framework. Nine electronic databases (CINAHL, BIOMED CENTRAL, Cochrane, Web of Science, PROQUEST, PUBMED, OTseeker, Scopus, ERIC) were searched. Targeted keywords identified primary research articles of any hierarchy, that described the nature and impact of KT training programmes for physiotherapists. Where systematic reviews were identified, the component primary studies were considered individually for relevance. Critical appraisal was not undertaken due to the nature of a scoping review, and data was reported descriptively. RESULTS Ten systematic reviews were identified (yielding four relevant primary studies). Five additional primary studies were identified (two randomised controlled trials, two non-randomised controlled trials and one pre-post study) which were not included in the original systematic reviews. This provided nine eligible primary research studies for review. The KT strategies were all multi-faceted. Interactive sessions, didactic sessions, printed material and discussion and feedback were consistently associated with effective outcomes. When KT strategies addressed local barriers to EBP utilisation, there were better success rates for EBP and CPG uptake, irrespective of the outcome measures used. There were no consistent ways of measuring outcome. CONCLUSION Multi-faceted KT strategies designed to address local barriers to knowledge translation were most effective in improving EBP/ CPG uptake among physiotherapists.
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Affiliation(s)
- Jessica Stander
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
| | - Karen Grimmer
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
- International Centre for Allied Health Evidence (iCAHE), City East Campus, P4-18 North Terrace, University of South Australia, Adelaide, 5000 Australia
| | - Yolandi Brink
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
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Abstract
The objective of this article is to introduce the Clinical Framework for Quality Improvement of Cancer Cachexia (Cachexia Care Framework) as a tool to demonstrate the relevance of integrating the clinical components of cancer cachexia and the organizational strategies of a cancer institution on the quality of patient care and delivery of services throughout the cancer cachexia continuum. The data sources included peer-reviewed literature relevant to cancer cachexia and quality cancer care, and the authors’ expertise. The Cachexia Care Framework results from a combination of the international consensus definition of cancer cachexia, the Institute of Medicine report Ensuring Quality Cancer Care, and the authors’ experience with a cancer cachexia clinic. This framework is proposed as a guidance for oncology nurses and other healthcare providers to improve the quality of care of cancer cachexia patients. Specifically, the framework can be used by oncology nurses involved in the care of patients diagnosed with cancer cachexia either in direct patient care, administration, research, or education. Nurses can use the framework in clinical practice to identify specific assessments and interventions based on the cachexia stage of the patient; in nursing administration, the framework offers a wide view of potential errors that can happen and the opportunity to prevent them; in nursing research, the framework illustrates the several factors and processes that can impact patient outcomes; and in nursing education, the framework outlines the elements necessary to develop and implement a continuum education curriculum to educate the workforce of oncology nurses, and in the academic setting, an interprofessional curriculum to educate nurses and many other healthcare disciplines.
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Affiliation(s)
- Clara Granda-Cameron
- Undergraduate Program, College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mary Pat Lynch
- Abramson Cancer Center, Pennsylvania Hospital, Philadelphia, PA, USA
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Mącznik AK, Schneiders AG, Athens J, Sullivan SJ. The development of an instructional video for the teaching of acupressure for pain management in acute musculoskeletal injuries: A knowledge translation study. Phys Ther Sport 2017; 29:34-42. [PMID: 29175595 DOI: 10.1016/j.ptsp.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/28/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To survey potential stakeholders to obtain information relevant to the production of a video on teaching acupressure for sports injury management, and gain feedback from potential users on the prototype video. DESIGN Focus groups and online survey methods nested within a knowledge translation framework. PARTICIPANTS Four focus groups (n = 24) were conducted, two with sports medics and two with sports physiotherapists as a part of the development of a prototype video. Nineteen stakeholders viewed the prototype video and participated in the subsequent online survey. MAIN OUTCOME MEASURES Focus groups' transcripts were analysed to develop themes using a general inductive approach. Survey data analysis incorporated quantitative and qualitative analysis. RESULTS Three key themes concerning the design of the video emerged from the focus groups: 1) the recommendation for both demonstration and verbal instructions on the acupressure technique; 2) keeping the content of the video to a minimum; and 3) the need for professionalism in the production of the video, and highlighting the presenter's expertise and qualifications. The survey participants found the video to be clear and professional. CONCLUSIONS Collectively these studies described the development and assessment of a user-oriented instructional video on teaching of acupressure for the management of sports injuries.
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Affiliation(s)
- Aleksandra Katarzyna Mącznik
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand.
| | | | - Josie Athens
- Department of Preventive and Social Medicine, University of Otago, New Zealand
| | - Stephen John Sullivan
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
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The Rest of the Story! REHABILITATION ONCOLOGY 2017. [DOI: 10.1097/01.reo.0000000000000084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Thapa S, Hannes K, Cargo M, Buve A, Aro AR, Mathei C. Building a Conceptual Framework to Study the Effect of HIV Stigma-Reduction Intervention Strategies on HIV Test Uptake: A Scoping Review. J Assoc Nurses AIDS Care 2017; 28:545-560. [PMID: 28473183 DOI: 10.1016/j.jana.2017.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/10/2017] [Indexed: 11/25/2022]
Abstract
A scoping review of grey and peer-reviewed literature was conducted to develop a conceptual framework to illustrate mechanisms involved in reducing HIV stigma and increasing HIV test uptake. We followed a three-step approach to exploring the literature: developing concepts, organizing and categorizing concepts, and synthesizing concepts into a framework. The framework contains four types of intervention strategies: awareness creation, influencing normative behavior, providing support, and developing regulatory laws. The awareness creation strategy generally improves knowledge and the influencing normative behavior strategy changes stigmatizing attitudes and behaviors, and subsequently, increases HIV test uptake. Providing support and development of regulatory law strategies changes actual stigmatizing behaviors of the people, and subsequently, increases HIV test uptake. The framework further outlines that the mechanisms described are influenced by the interaction of various social-contextual and individual factors. The framework sheds new light on the effects of HIV stigma-reduction intervention strategies and HIV test uptake.
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Lee M, Heo HH, Oh S, Kim E, Yoon B. Patient-centered evaluation of home-based rehabilitation developed using community-based participatory research approach for people with disabilities: a case series. Disabil Rehabil 2016; 40:238-248. [PMID: 27848248 DOI: 10.1080/09638288.2016.1250121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of the locally tailored and individualized home-based rehabilitation (HBR) program developed using the community-based participatory research (CBPR) approach, in terms of perceived health in patients with different levels of social engagement, and to explore the perceived facilitators and barriers to rehabilitation. METHOD A concurrent mixed-method design was employed. Four patients participated in the combined therapist- and self-delivered HBR program for 5 months. The perceived health outcomes were quantitatively assessed at baseline, after the therapist-delivered intervention period, and at 1 and 3 months after the self-delivered intervention period. Then, in-depth individual interviews were conducted to explore the facilitators and barriers to rehabilitation. RESULTS The perceived health of patients who were fully or partially engaged in society was increased during the therapist-delivered intervention period, and maintained the increased level during the self-delivered intervention period, whereas that of patients who were rarely or not engaged dropped again to lower than the baseline. These results were caused by differentiated facilitators and barriers to rehabilitation depending on the level of social engagement. CONCLUSIONS Applying tailored strategies to patients with differing levels of social engagement is recommended to further optimize the local relevance of the HBR program. Implications for rehabilitation A community-based participatory research approach can provide an opportunity to enhance local relevance through community-academic partnerships, in developing a home-based rehabilitation (HBR) program for the people with disabilities. For community therapists, enhancing the local relevance of the HBR program, applying tailored strategies to patients with differing levels of social engagement is recommended because the perceived health of the HBR program can be different owing to differing perceived facilitators and barriers to rehabilitation, depending on the level of social engagement. For patients with rare or no engagement in society, satisfying their need for interaction with the therapists and helping them cope with their wrong belief about the possibility of their recovery is important to encourage behavioral change and perceived physical improvements.
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Affiliation(s)
- Minyoung Lee
- a Department of Physical Therapy, College of Health Sciences , Korea University , Seoul , South Korea
| | - Hyun-Hee Heo
- b Department of Public Health Sciences , Graduate School, Korea University , Seoul , South Korea
| | - Sejun Oh
- a Department of Physical Therapy, College of Health Sciences , Korea University , Seoul , South Korea
| | - Eunseung Kim
- c Department of Physical Therapy, Jung-gu Public Health Center , Seoul , South Korea
| | - BumChul Yoon
- a Department of Physical Therapy, College of Health Sciences , Korea University , Seoul , South Korea
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Bennett S, Whitehead M, Eames S, Fleming J, Low S, Caldwell E. Building capacity for knowledge translation in occupational therapy: learning through participatory action research. BMC MEDICAL EDUCATION 2016; 16:257. [PMID: 27716230 PMCID: PMC5045617 DOI: 10.1186/s12909-016-0771-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/20/2016] [Indexed: 06/02/2023]
Abstract
BACKGROUND There has been widespread acknowledgement of the need to build capacity in knowledge translation however much of the existing work focuses on building capacity amongst researchers rather than with clinicians directly. This paper's aim is to describe a research project for developing a knowledge translation capacity building program for occupational therapy clinicians. METHODS Participatory action research methods were used to both develop and evaluate the knowledge translation capacity-building program. Participants were occupational therapists from a large metropolitan hospital in Australia. Researchers and clinicians worked together to use the action cycle of the Knowledge to Action Framework to increase use of knowledge translation itself within the department in general, within their clinical teams, and to facilitate knowledge translation becoming part of the department's culture. Barriers and enablers to using knowledge translation were identified through a survey based on the Theoretical Domains Framework and through focus groups. Multiple interventions were used to develop a knowledge translation capacity-building program. RESULTS Fifty-two occupational therapists participated initially, but only 20 across the first 18 months of the project. Barriers and enablers were identified across all domains of the Theoretical Domains Framework. Interventions selected to address these barriers or facilitate enablers were categorised into ten different categories: educational outreach; teams working on clinical knowledge translation case studies; identifying time blocks for knowledge translation; mentoring; leadership strategies; communication strategies; documentation and resources to support knowledge translation; funding a knowledge translation champion one day per week; setting goals for knowledge translation; and knowledge translation reporting strategies. Use of these strategies was, and continues to be monitored. Participants continue to be actively involved in learning and shaping the knowledge translation program across the department and within their specific clinical areas. CONCLUSION To build capacity for knowledge translation, it is important to involve clinicians. The action cycle of the Knowledge to Action framework is a useful guide to introduce the knowledge translation process to clinicians. It may be used to engage the department as a whole, and facilitate the learning and application of knowledge translation within specific clinical areas. Research evaluating this knowledge translation program is being conducted.
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Affiliation(s)
- Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, Therapies Annexe, Chancellors Place, Brisbane, 4072 Australia
| | - Mary Whitehead
- Occupational Therapy Department, Princess Alexandra Hospital (Metro South Hospital and Health Service), 199 Ipswich Road, Woolloongabba, Australia
| | - Sally Eames
- School of Health and Rehabilitation Sciences, The University of Queensland, Therapies Annexe, Chancellors Place, Brisbane, 4072 Australia
- Occupational Therapy Department, Princess Alexandra Hospital (Metro South Hospital and Health Service), 199 Ipswich Road, Woolloongabba, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Therapies Annexe, Chancellors Place, Brisbane, 4072 Australia
- Occupational Therapy Department, Princess Alexandra Hospital (Metro South Hospital and Health Service), 199 Ipswich Road, Woolloongabba, Australia
| | - Shanling Low
- School of Health and Rehabilitation Sciences, The University of Queensland, Therapies Annexe, Chancellors Place, Brisbane, 4072 Australia
| | - Elizabeth Caldwell
- Occupational Therapy Department, Princess Alexandra Hospital (Metro South Hospital and Health Service), 199 Ipswich Road, Woolloongabba, Australia
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Peek K, Carey M, Sanson-Fisher R, Mackenzie L. Aiding patient adherence to physiotherapist-prescribed self-management strategies: an evidence-based behavioural model in practice. PHYSICAL THERAPY REVIEWS 2016. [DOI: 10.1080/10833196.2016.1226537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dziedzic KS, French S, Davis AM, Geelhoed E, Porcheret M. Implementation of musculoskeletal Models of Care in primary care settings: Theory, practice, evaluation and outcomes for musculoskeletal health in high-income economies. Best Pract Res Clin Rheumatol 2016; 30:375-397. [DOI: 10.1016/j.berh.2016.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022]
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Tilson JK, Mickan S, Howard R, Sum JC, Zibell M, Cleary L, Mody B, Michener LA. Promoting physical therapists' use of research evidence to inform clinical practice: part 3--long term feasibility assessment of the PEAK program. BMC MEDICAL EDUCATION 2016; 16:144. [PMID: 27176726 PMCID: PMC4866278 DOI: 10.1186/s12909-016-0654-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 04/26/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND Evidence is needed to develop effective educational programs for promoting evidence based practice (EBP) and knowledge translation (KT) in physical therapy. This study reports long-term outcomes from a feasibility assessment of an educational program designed to promote the integration of research evidence into physical therapist practice. METHODS Eighteen physical therapists participated in the 6-month Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program. The participant-driven active learning program consisted of four consecutive, interdependent components: 1) acquiring managerial leadership support and electronic resources in three clinical practices, 2) a 2-day learner-centered EBP training workshop, 3) 5 months of guided small group work synthesizing research evidence into a locally relevant list of, actionable, evidence-based clinical behaviors for therapists treating persons with musculoskeletal lumbar conditions--the Best Practices List, and 4) review and revision of the Best Practices List, culminating in participant agreement to implement the behaviors in practice. Therapists' EBP learning was assessed with standardized measures of EBP-related attitudes, self-efficacy, knowledge and skills, and self-reported behavior at baseline, immediately-post, and 6 months following conclusion of the program (long-term follow-up). Therapist adherence to the Best Practice List before and after the PEAK program was assessed through chart review. RESULTS Sixteen therapists completed the long-term follow-up assessment. EBP self-efficacy and self-reported behaviors increased from baseline to long-term follow-up (p < 0.001 and p = 0.002, respectively). EBP-related knowledge and skills showed a trend for improvement from baseline to long-term follow-up (p = 0.05) and a significant increase from immediate-post to long-term follow-up (p = 0.02). Positive attitudes at baseline were sustained throughout (p = 0.208). Eighty-nine charts were analyzed for therapist adherence to the Best Practices List. Six clinical behaviors had sufficient pre- and post-PEAK charts to justify analysis. Of those, one behavior showed a statistically significant increase in adherence, one had high pre- and post-PEAK adherence, and four were change resistant, starting with low adherence and showing no meaningful improvement. CONCLUSIONS This study supports the feasibility of the PEAK program to produce long-term improvements in physical therapists' EBP-related self-efficacy and self-reported behavior. EBP knowledge and skills showed improvement from post-intervention to long-term follow-up and a trend toward long-term improvements. However, chart review of therapists' adherence to the participant generated Best Practices List in day-to-day patient care indicates a need for additional support to facilitate behavior change. Future versions of the PEAK program and comparable multi-faceted EBP and KT educational programs should provide ongoing monitoring, feedback, and problem-solving to successfully promote behavior change for knowledge translation.
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Affiliation(s)
- Julie K Tilson
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St., CHP 155, Los Angeles, CA, 90089, USA.
| | - Sharon Mickan
- Gold Coast Health and Griffith University, Southport, 4215, QLD, Australia
| | - Robbin Howard
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
| | - Jonathan C Sum
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
| | - Maria Zibell
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
| | - Lyssa Cleary
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
| | - Bella Mody
- Agile Physical Therapy, 3825 El Camino Real, Palo Alto, CA, 94306, USA
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
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Use of Tablet Computers to Promote Physical Therapy Students' Engagement in Knowledge Translation During Clinical Experiences. J Neurol Phys Ther 2016; 40:81-9. [PMID: 26945431 PMCID: PMC4795099 DOI: 10.1097/npt.0000000000000123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background and Purpose: Physical therapists strive to integrate research into daily practice. The tablet computer is a potentially transformational tool for accessing information within the clinical practice environment. The purpose of this study was to measure and describe patterns of tablet computer use among physical therapy students during clinical rotation experiences. Methods: Doctor of physical therapy students (n = 13 users) tracked their use of tablet computers (iPad), loaded with commercially available apps, during 16 clinical experiences (6-16 weeks in duration). Results: The tablets were used on 70% of 691 clinic days, averaging 1.3 uses per day. Information seeking represented 48% of uses; 33% of those were foreground searches for research articles and syntheses and 66% were for background medical information. Other common uses included patient education (19%), medical record documentation (13%), and professional communication (9%). The most frequently used app was Safari, the preloaded web browser (representing 281 [36.5%] incidents of use). Users accessed 56 total apps to support clinical practice. Discussion and Conclusions: Physical therapy students successfully integrated use of a tablet computer into their clinical experiences including regular activities of information seeking. Our findings suggest that the tablet computer represents a potentially transformational tool for promoting knowledge translation in the clinical practice environment. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A127).
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