Characterizing research partnerships in child health research: A scoping review

Research partnerships between researchers and knowledge users (KUs) in child health are understudied. This study examined the scope of KU engagement reported in published child health research, inclusive of health research partnership approaches and KU groups. Search strategies were developed by a health research librarian. Studies had to be in English, published since 2007, and were not excluded based on design. A two-step, multiple-person hybrid screening approach was used for study inclusion. Data on study and engagement characteristics, barriers and facilitators, and effects were extracted by one reviewer, with 10% verified by a second reviewer. Three hundred fifteen articles were included, with 243 (77.1%) published between 2019 and 2021. Community-based participatory research was the most common approach used (n = 122, 38.3%). Most studies (n = 235, 74.6%) engaged multiple KU groups (range 1-11), with children/youth, healthcare professionals, and parents/families being most frequently engaged. Reporting of barriers and facilitators and effects were variable, reported in 170 (53.8%) and 197 (62.5%) studies, respectively. Publications have increased exponentially over time. There is ongoing need to optimize evaluation and reporting consistency to facilitate growth in the field. Additional studies are needed to further our understanding of research partnerships in child health.

A scoping review of the globally available tools for assessing health research partnership outcomes and impacts

BACKGROUND

Health research partnership approaches have grown in popularity over the past decade, but the systematic evaluation of their outcomes and impacts has not kept equal pace. Identifying partnership assessment tools and key partnership characteristics is needed to advance partnerships, partnership measurement, and the assessment of their outcomes and impacts through systematic study.

OBJECTIVE

To locate and identify globally available tools for assessing the outcomes and impacts of health research partnerships.

METHODS

We searched four electronic databases (Ovid MEDLINE, Embase, CINAHL + , PsychINFO) with an a priori strategy from inception to June 2021, without limits. We screened studies independently and in duplicate, keeping only those involving a health research partnership and the development, use and/or assessment of tools to evaluate partnership outcomes and impacts. Reviewer disagreements were resolved by consensus. Study, tool and partnership characteristics, and emerging research questions, gaps and key recommendations were synthesized using descriptive statistics and thematic analysis.

RESULTS

We screened 36 027 de-duplicated citations, reviewed 2784 papers in full text, and kept 166 studies and three companion reports. Most studies originated in North America and were published in English after 2015. Most of the 205 tools we identified were questionnaires and surveys targeting researchers, patients and public/community members. While tools were comprehensive and usable, most were designed for single use and lacked validity or reliability evidence. Challenges associated with the interchange and definition of terms (i.e., outcomes, impacts, tool type) were common and may obscure partnership measurement and comparison. Very few of the tools identified in this study overlapped with tools identified by other, similar reviews. Partnership tool development, refinement and evaluation, including tool measurement and optimization, are key areas for future tools-related research.

CONCLUSION

This large scoping review identified numerous, single-use tools that require further development and testing to improve their psychometric and scientific qualities. The review also confirmed that the health partnership research domain and its measurement tools are still nascent and actively evolving. Dedicated efforts and resources are required to better understand health research partnerships, partnership optimization and partnership measurement and evaluation using valid, reliable and practical tools that meet partners' needs.

Supporting meaningful research partnerships: an interview study applying behavior change theory to develop relevant recommendations for researchers

Research partnerships, while promising for ensuring translation of relevant and useable findings, are challenging and need support. This study aimed to apply behavior change theory to understand and support researchers' adoption of a research partnership approach and the Integrated Knowledge Translation (IKT) Guiding Principles for conducting and disseminating spinal cord injury (SCI) research in partnership. Using an IKT approach, SCI researchers across Canada and the USA completed a survey (n = 22) and were interviewed (n = 13) to discuss barriers and facilitators to deciding to partner and follow the IKT Guiding Principles. The Behaviour Change Wheel, Theoretical Domains Framework (TDF), and Mode of Delivery Ontology were used to develop the survey, interview questions, and guided analyses of interview data. COM-B and TDF factors were examined using descriptive statistics and abductive analyses of barriers and facilitators of decisions to partner and/or use the IKT Guiding Principles. TDF domains from the interview transcripts were then used to identify intervention, content, and implementation options. 142 factors (79 barriers, 63 facilitators) related to deciding to partner, and 292 factors (187 barriers, 105 facilitators) related to deciding to follow the IKT Guiding Principles were identified. Barriers to partnering or use the IKT Guiding Principles were primarily related to capability and opportunity and relevant intervention options were recommended. Interventions must support researchers in understanding how to partner and use the IKT Guiding Principles while navigating a research system, which is not always supportive of the necessary time and costs required for meaningful research partnerships.

Relational practices for meaningful inclusion in health research: Results of a deliberative dialogue study

INTRODUCTION

The importance of including people affected by research (e.g., community members, citizens or patient partners) is increasingly recognized across the breadth of institutions involved in connecting research with action. Yet, the increasing rhetoric of inclusion remains situated in research systems that tend to reward traditional dissemination and uphold power dynamics in ways that centre particular (privileged) voices over others. In research explicitly interested in doing research with those most affected by the issue or outcomes, research teams need to know how to advance meaningful inclusion. This study focused on listening to voices often excluded from research processes to understand what meaningful inclusion looks and feels like, and asked what contributes to being or feeling tokenized.

METHODS

In this deliberative dialogue study, 16 participants with experience of navigating social exclusions and contributing to research activities reflected on what makes for meaningful experiences of inclusion. Using a co-production approach, with a diversely representative research team of 15 that included patient and community partners, we used critically reflective dialogue to guide an inclusive process to study design and implementation, from conceptualization of research questions through to writing.

RESULTS

We heard that: research practices, partnerships and systems all contribute to experiences of inclusion or exclusion; the insufficiency or absence of standards for accountability amplifies the experience of exclusion; and inclusive practices require intention, planning, reflection and resources.

CONCLUSIONS

We offer evidence-informed recommendations for the deeply relational work and practices for inclusivity, focused on promising practices for cultivating welcoming systems, spaces and relationships.

PATIENT OR PUBLIC CONTRIBUTION

This work reflects a co-production approach, where people who use and are affected by research results actively partnered in the research process, including study design, data-generating activities, analysis and interpretation, and writing. Several of these partners are authors of this manuscript.

Characterizing Canadian funded partnered health research projects between 2011 and 2019: a retrospective analysis

BACKGROUND AND AIMS

Involving research users in collaborative research approaches may increase the relevance and utility of research findings. Our primary objectives were to (i) identify and describe characteristics of Canadian federally and provincially funded health research projects that included research users and were funded between 2011 and 2019; (ii) explore changes over time; and (iii) compare characteristics between funder required and optional partnerships.

METHODS

Retrospective analysis. Inclusion criteria were projects that included research users. We analyzed publicly available project variables, and coded field and type of research using established classification systems. We summarized data with descriptive statistics and compared variables across three funding year blocks and partnership requirement status.

RESULTS

We identified 1153 partnered health research projects, representing 137 fields of research and 37 types of research categories. Most projects included a required partnership (80%) and fell into health and social care services research (66%). Project length and funding amount increased from average of 24.8 months and $266 248 CAD in 2011-2013 to 31.6 months and $438 766 CAD in 2017-2019. There were significantly fewer required partnerships in 2017-2019.

CONCLUSIONS

Between 2011 and 2019 Canadian federally and provincially funded partnered health research reflected primarily care services research across many fields. The observed breadth suggests that partnered health research approaches are applicable in many fields of research. Additional work to support partnered research across all types of health research (especially biomedical research) is warranted. The administration of larger grants that are funded for longer time periods may address previously identified concerns among research teams engaging in partnered research but may mean that fewer teams receive funding and risk delaying responding to time-sensitive data needs for users. Our process and findings can be used as a starting point for international comparison.

IKT Guiding Principles: demonstration of diffusion and dissemination in partnership

INTRODUCTION

Integrated knowledge translation (IKT) is a partnered approach to research that aims to ensure research findings are applied in practice and policy. IKT can be used during diffusion and dissemination of research findings. However, there is a lack of understanding how an IKT approach can support the diffusion and dissemination of research findings. In this study, we documented and described the processes and outcomes of an IKT approach to diffusing and disseminating the findings of consensus recommendations for conducting spinal cord injury research.

METHODS

Communication of the IKT Guiding Principles in two phases: a diffusion phase during the first 102 days from the manuscript's publication, followed by a 1147 day active dissemination phase. A record of all inputs was kept and all activities were tracked by monitoring partnership communication, a partnership tracking survey, a project curriculum vitae, and team emails. Awareness outcomes were tracked through Google Analytics and a citation-forward search. Awareness includes the website accesses, the number of downloads, and the number of citations in the 29 month period following publication.

RESULTS

In the diffusion period, the recommendations were viewed 60 times from 4 different countries, and 4 new downloads. In the dissemination period, the recommendations were viewed 1109 times from 39 different countries, 386 new downloads, and 54 citations. Overall, during dissemination there was a 17.5% increase in new visitors to the website a month and a 95.5% increase in downloads compared to diffusion.

CONCLUSION

This project provides an overview of an IKT approach to diffusion and dissemination. Overall, IKT may be helpful for increasing awareness of research findings faster; however, more research is needed to understand best practices and the the impact of an IKT approach on the diffusion and dissemination versus a non-partnered approach.

A synthesis of the characteristics of dance interventions engaging adults with neurodevelopmental disabilities: a scoping review

PURPOSE

Dance can encourage physical activity and promote physical, cognitive, and social development for adults who have neurodevelopmental disabilities (NDD). Dance is defined as a form of expression that may be structured, exploratory, and/or cultural. Current literature supports the benefits of participation in dance for persons with NDD, however less is known about what characteristics support participation in dance.

MATERIALS AND METHODS

A scoping review was conducted to synthesize the characteristics of dance interventions, teaching strategies, and outcome measures used to assess the efficacy of dance interventions. Searches were conducted across six databases and the results were screened according to: i) adults ≥18yrs of age with a diagnosed NDD, and ii) the program incorporated activities that fall within our definition of dance.

RESULTS

A range of dance forms and NDDs were represented across the fourteen studies reviewed. Few provided explicit details of the dance interventions, nor how instruction was adapted. All studies that measured fitness, mobility, balance, posture, and functional activity showed significant improvement. Studies that measured psychosocial and well-being focused on autistic characteristics and showed mixed results.

CONCLUSIONS

Details of interventions, instructions, measures of movement performance, and the relationship between outcomes and the interventions require further development and research.IMPLICATIONS FOR REHABILITATIONDance is a multimodal activity that can improve aerobic capacity, postural control, passive ROM, and strength in adults with neurodevelopmental disability at all levels of function.Participation in dance may be recommended as an option for recreational physical activity as current evidence supports dance as an effective physical activity, and/or supplement to therapeutic goals, with physiological as well as psychosocial benefits.When considering dance as a recreational activity it is important to consider the program and instructors approach, as well as the experience and training of the instructor, in order to best match the goals of the dancer with the goals of the specific program.

Standardized tools for assessing balance and mobility in stroke clinical practice guidelines worldwide: A scoping review

Background

Use of standardized tools to assess balance and mobility limitations is a recommended practice in stroke rehabilitation. The extent to which clinical practice guidelines (CPGs) for stroke rehabilitation recommend specific tools and provide resources to support their implementation is unknown.

Purpose

To identify and describe standardized, performance-based tools for assessing balance and/or mobility and describe postural control components challenged, the approach used to select tools, and resources provided for clinical implementation, in CPGs for stroke.

Methods

A scoping review was conducted. We included CPGs with recommendations on the delivery of stroke rehabilitation to address balance and mobility limitations. We searched seven electronic databases and grey literature. Pairs of reviewers reviewed abstracts and full texts in duplicate. We abstracted data about CPGs, standardized assessment tools, the approach for tool selection, and resources. Experts identified postural control components challenged by each tool.

Results

Of the 19 CPGs included in the review, 7 (37%) and 12 (63%) were from middle- and high-income countries, respectively. Ten CPGs (53%) recommended or suggested 27 unique tools. Across 10 CPGs, the most commonly cited tools were the Berg Balance Scale (BBS) (90%), 6-Minute Walk Test (6MWT) (80%), Timed Up and Go Test (80%) and 10-Meter Walk Test (70%). The tool most frequently cited in middle- and high-income countries was the BBS (3/3 CPGs), and 6MWT (7/7 CPGs), respectively. Across 27 tools, the three components of postural control most frequently challenged were underlying motor systems (100%), anticipatory postural control (96%), and dynamic stability (85%). Five CPGs provided information in varying detail on how tools were selected; only 1 CPG provided a level of recommendation. Seven CPGs provided resources to support clinical implementation; one CPG from a middle-income country included a resource available in a CPG from a high-income country.

Conclusion

CPGs for stroke rehabilitation do not consistently provide recommendations for standardized tools to assess balance and mobility or resources to facilitate clinical application. Reporting of processes for tool selection and recommendation is inadequate. Review findings can be used to inform global efforts to develop and translate recommendations and resources for using standardized tools to assess balance and mobility post-stroke.

Systematic Review Registration

https://osf.io/, identifier: 10.17605/OSF.IO/6RBDV.

How are health research partnerships assessed? A systematic review of outcomes, impacts, terminology and the use of theories, models and frameworks

Background

Accurate, consistent assessment of outcomes and impacts is challenging in the health research partnerships domain. Increased focus on tool quality, including conceptual, psychometric and pragmatic characteristics, could improve the quantification, measurement and reporting partnership outcomes and impacts. This cascading review was undertaken as part of a coordinated, multicentre effort to identify, synthesize and assess a vast body of health research partnership literature.

Objective

To systematically assess the outcomes and impacts of health research partnerships, relevant terminology and the type/use of theories, models and frameworks (TMF) arising from studies using partnership assessment tools with known conceptual, psychometric and pragmatic characteristics.

Methods

Four electronic databases were searched (MEDLINE, Embase, CINAHL Plus and PsycINFO) from inception to 2 June 2021. We retained studies containing partnership evaluation tools with (1) conceptual foundations (reference to TMF), (2) empirical, quantitative psychometric evidence (evidence of validity and reliability, at minimum) and (3) one or more pragmatic characteristics. Outcomes, impacts, terminology, definitions and TMF type/use were abstracted verbatim from eligible studies using a hybrid (independent abstraction–validation) approach and synthesized using summary statistics (quantitative), inductive thematic analysis and deductive categories (qualitative). Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD).

Results

Application of inclusion criteria yielded 37 eligible studies. Study quality scores were high (mean 80%, standard deviation 0.11%) but revealed needed improvements (i.e. methodological, reporting, user involvement in research design). Only 14 (38%) studies reported 48 partnership outcomes and 55 impacts; most were positive effects (43, 90% and 47, 89%, respectively). Most outcomes were positive personal, functional, structural and contextual effects; most impacts were personal, functional and contextual in nature. Most terms described outcomes (39, 89%), and 30 of 44 outcomes/impacts terms were unique, but few were explicitly defined (9, 20%). Terms were complex and mixed on one or more dimensions (e.g. type, temporality, stage, perspective). Most studies made explicit use of study-related TMF (34, 92%). There were 138 unique TMF sources, and these informed tool construct type/choice and hypothesis testing in almost all cases (36, 97%).

Conclusion

This study synthesized partnership outcomes and impacts, deconstructed term complexities and evolved our understanding of TMF use in tool development, testing and refinement studies. Renewed attention to basic concepts is necessary to advance partnership measurement and research innovation in the field.

Systematic review protocol registration: PROSPERO protocol registration: CRD42021137932 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=137932.

Connecting for Care: a protocol for a mixed-method social network analysis to advance knowledge translation in the field of child development and rehabilitation

BACKGROUND

Connections between individuals and organizations can impact knowledge translation (KT). This finding has led to growing interest in the study of social networks as drivers of KT. Social networks are formed by the patterns of relationships or connections generated through interactions. These connections can be studied using social network analysis (SNA) methodologies. The relatively small yet diverse community in the field of child development and rehabilitation (CD&R) in Canada offers an ideal case study for applying SNA. The purposes of this work are to (1) quantify and map the structure of Canadian CD&R KT networks among four groups: families, health care providers, KT support personnel, and researchers; (2) explore participant perspectives of the network structure and of KT barriers and facilitators within it; and (3) generate recommendations to improve KT capacity within and between groups. Aligning with the principles of integrated KT, we have assembled a national team whose members contribute throughout the research and KT process, with representation from the four participant groups.

METHODS

A sequential, explanatory mixed-method study, within the bounds of a national case study in the field of CD&R. Objective 1: A national SNA survey of family members with advocacy/partnership experience, health care providers, KT support personnel, and researchers, paired with an anonymous survey for family member without partnership experience, will gather data to describe the KT networks within and between groups and identify barriers and facilitators of network connections. Objective 2: Purposive sampling from Phase 1 will identify semi-structured interview participants with whom to examine conventional and network-driven KT barriers, facilitators, and mitigating strategies. Objective 3: Intervention mapping and a Delphi process will generate recommendations for network and conventional interventions to strengthen the network and facilitate KT.

DISCUSSION

This study will integrate network and KT theory in mapping the structure of the CD&R KT network, enhance our understanding of conventional and network-focused KT barriers and facilitators, and provide recommendations to strengthen KT networks. Recommendations can be applied and tested within the field of CD&R to improve KT, with the aim of ensuring children achieve the best health outcomes possible through timely access to effective healthcare.

Principles to guide spinal cord injury research partnerships: a Delphi consensus study

PURPOSE

To establish consensus regarding principles that should be used to guide spinal cord injury (SCI) research partnerships between researchers and research users.

MATERIALS AND METHODS

A three-round Delphi consensus exercise was carried out with researchers and/or research users involved in one or more SCI research partnerships. Participants considered a list of 125 partnership principles. In rounds 1 and 2, participants rated their agreement that a principle should guide SCI research partnerships on an 11-point Likert scale. After each round, principles that received a mean score of ≥8.0 or 70% of participants rated the principle ≥8.0 were retained. In round 3, participants categorized principles as essential, desirable, irrelevant, or unsure.

RESULTS

At least 20 individuals participated in each round. In round 1, 103 principles met consensus criteria and eight principles were added. In round 2, 93 principles met the criteria. In round 3, 29 principles were categorized as essential and eight as desirable. Recommended principles focused on the interpersonal, relational, and logistical aspects of partnerships. Principles that did not reach consensus related to social justice and actionable impact.

CONCLUSIONS

Findings provide insight into 37 principles that could be used to combat tokenism and inform future guidance to meaningfully engage partners in SCI research.Implications for RehabilitationConsensus-based research partnership principles (i.e., norms or beliefs) were identified and could be prioritized to help support spinal cord injury (SCI) researchers and research users combat tokenism and meaningfully engage research users as partners in the co-creation of knowledge.The resulting list of recommended research partnership principles was used to inform the development of guidance to support quality partnerships between SCI researchers and research users within and outside the rehabilitation context (www.IKTprinciples.com).Guidance supporting meaningful research partnerships may accelerate the time between discovery and use of research in practice.

Exploring the delivery of community rehabilitation services for older people in an urban Canadian setting: Perspectives of service providers, managers and health system administrators

As the global population of older people increases, policies aimed at improving health care delivery for older people often include supports for ageing in place. Living in the community not only reduces institutionalisation but also improves quality of life and reduces health care costs. For older people, community rehabilitation offers the opportunity to preserve and maximise function while maintaining the ability to live in the community. However, limited research examines the delivery, coordination and integration of community rehabilitation services in health systems. Our case study explored the perspectives of service providers, managers and health system administrators on the strengths, limitations and gaps in community rehabilitation for older people in one Canadian urban health region. Using interpretive description and thematic analysis, we analysed interview data from: 16 service providers, eight managers and five health system administrators. Three themes were identified: (a) Limited Access to Programs and Services; (b) Need to Emphasise Promoting, Maintaining and Restoring Function; and (c) Lack of Flow Across the System. Participants highlighted that restrictive eligibility criteria limited access to services. Services were organised around health conditions that did not address the needs of older people. Long waitlists meant that services were delayed. Transportation costs limited participation of individuals from lower socioeconomic status (SES). Age restrictions did not reflect differences in the ageing process and the health inequities individuals from lower SES groups experienced. There was a lack of emphasis in community rehabilitation programs on maintaining or restoring function in older people, which is the primary focus of rehabilitation. Furthermore, key stakeholders stressed the need for strengthening the integration of service delivery across the continuum of care. The findings underscore the need to develop a conceptual framework for community rehabilitation to promote greater system integration, access and availability of services and to optimise functional outcomes for older people.

Factors associated with reporting of the Prevention of Falls Network Europe (ProFaNE) core outcome set domains in randomized trials on falls in older people: a citation analysis and correlational study

Background

Core outcome sets are advocated as a means to standardize outcome reporting across randomized controlled trials (RCTs) and reduce selective outcome reporting. In 2005, the Prevention of Falls Network Europe (ProFaNE) published a core outcome set identifying five domains that should be measured and reported, at a minimum, in RCTs or meta-analysis on falls in older people. As reporting of all five domains of the ProFaNE core outcome set has been minimal, we set out to investigate factors associated with reporting of the ProFaNE core outcome set domains in a purposeful sample of RCTs on falls in older people.

Methods

We conducted a systematic citation analysis to identify all reports of RCTs focused on falls in older people that cited the ProFaNE core outcome set between October 2005 and July 2021. We abstracted author-level, study-level, and manuscript-level data and whether each domain of the ProFaNE core outcome set was reported. We used penalized LASSO regression to identify factors associated with the mean percentage of ProFaNE core outcome set domains reported.

Results

We identified 85 eligible reports of RCTs. Articles were published between 2007 and 2021, described 75 unique RCTs, and were authored by 76 unique corresponding authors. The percentage of ProFaNE core outcome set domains reported ranged from 0 to 100%, with a median of 40% and mean (standard deviation, SD) of 52.2% (25.1). RCTs funded by a non-industry source reported a higher mean percentage of domains than RCTs without a non-industry funding source (estimated mean difference = 17.5%; 95% confidence interval (CI) 1.8–33.2). RCTs examining exercise (15.4%; 95% CI 1.9–28.9) or multi-component/factorial (17.4%; 95% CI 4.7–30.1) interventions each reported a higher mean percentage of domains than RCTs examining other intervention types.

Conclusions

We found that RCTs funded by at least one non-industry source, examining exercise or multi-component/factorial interventions, reported the highest percentages of ProFaNE core outcome set domains. Findings may help inform strategies to increase the impact of the ProFaNE core outcome set. Ultimately, this may lead to enhanced knowledge of the effectiveness and safety of interventions to prevent and/or manage falls in older people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06642-w.

Selecting implementation models, theories, and frameworks in which to integrate intersectional approaches

Background

Models, theories, and frameworks (MTFs) provide the foundation for a cumulative science of implementation, reflecting a shared, evolving understanding of various facets of implementation. One under-represented aspect in implementation MTFs is how intersecting social factors and systems of power and oppression can shape implementation. There is value in enhancing how MTFs in implementation research and practice account for these intersecting factors. Given the large number of MTFs, we sought to identify exemplar MTFs that represent key implementation phases within which to embed an intersectional perspective.

Methods

We used a five-step process to prioritize MTFs for enhancement with an intersectional lens. We mapped 160 MTFs to three previously prioritized phases of the Knowledge-to-Action (KTA) framework. Next, 17 implementation researchers/practitioners, MTF experts, and intersectionality experts agreed on criteria for prioritizing MTFs within each KTA phase. The experts used a modified Delphi process to agree on an exemplar MTF for each of the three prioritized KTA framework phases. Finally, we reached consensus on the final MTFs and contacted the original MTF developers to confirm MTF versions and explore additional insights.

Results

We agreed on three criteria when prioritizing MTFs: acceptability (mean = 3.20, SD = 0.75), applicability (mean = 3.82, SD = 0.72), and usability (median = 4.00, mean = 3.89, SD = 0.31) of the MTF. The top-rated MTFs were the Iowa Model of Evidence-Based Practice to Promote Quality Care for the ‘Identify the problem’ phase (mean = 4.57, SD = 2.31), the Consolidated Framework for Implementation Research for the ‘Assess barriers/facilitators to knowledge use’ phase (mean = 5.79, SD = 1.12), and the Behaviour Change Wheel for the ‘Select, tailor, implement interventions’ phase (mean = 6.36, SD = 1.08).

Conclusions

Our interdisciplinary team engaged in a rigorous process to reach consensus on MTFs reflecting specific phases of the implementation process and prioritized each to serve as an exemplar in which to embed intersectional approaches. The resulting MTFs correspond with specific phases of the KTA framework, which itself may be useful for those seeking particular MTFs for particular KTA phases. This approach also provides a template for how other implementation MTFs could be similarly considered in the future.

Trial registration

Open Science Framework Registration: osf.io/qgh64.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-022-01682-x.

Development and usability testing of tools to facilitate incorporating intersectionality in knowledge translation

Background

The field of knowledge translation (KT) has been criticized for neglecting contextual and social considerations that influence health equity. Intersectionality, a concept introduced by Black feminist scholars, emphasizes how human experience is shaped by combinations of social factors (e.g., ethnicity, gender) embedded in systemic power structures. Its use has the potential to advance equity considerations in KT. Our objective was to develop and conduct usability testing of tools to support integrating intersectionality in KT through three key phases of KT: identifying the gap; assessing barriers to knowledge use; and selecting, tailoring, and implementing interventions.

Methods

We used an integrated KT approach and assembled an interdisciplinary development committee who drafted tools. We used a mixed methods approach for usability testing with KT intervention developers that included semi-structured interviews and the System Usability Scale (SUS). We calculated an average SUS score for each tool. We coded interview data using the framework method focusing on actionable feedback. The development committee used the feedback to revise tools, which were formatted by a graphic designer.

Results

Nine people working in Canada joined the development committee. They drafted an intersectionality primer and one tool that included recommendations, activities, reflection prompts, and resources for each of the three implementation phases. Thirty-one KT intervention developers from three countries participated in usability testing. They suggested the tools to be shorter, contain more visualizations, and use less jargon. Average SUS scores of the draft tools ranged between 60 and 78/100. The development committee revised and shortened all tools, and added two, one-page summary documents. The final toolkit included six documents.

Conclusions

We developed and evaluated tools to help embed intersectionality considerations in KT. These tools go beyond recommending the use of intersectionality to providing practical guidance on how to do this. Future work should develop guidance for enhancing social justice in intersectionality-enhanced KT.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08181-1.

A scoping review to identify and describe the characteristics of theories, models and frameworks of health research partnerships

Background

Engaging users of health research, namely knowledge users, as partners in the research process may to lead to evidence that is more relevant to the users. This may optimize the uptake of evidence in healthcare practice, resulting in improved health outcomes or more efficient healthcare systems. However, barriers to involving knowledge users in the research process exist. Theories, models and frameworks may help guide the process of involving knowledge users and address barriers to engaging with knowledge users in research; however, there is little evidence identifying or describing the theories, models and frameworks of health research partnerships.

Objectives

Identify and describe theories, models and frameworks of health research partnerships. Report on concepts of knowledge user engagement represented in identified theories, models and frameworks.

Methods

We conducted a scoping review. Database (MEDLINE, Embase, CINAHL, PCORI) and ancestry and snowball searches were utilized. Included articles were written in English, published between January 2005 and June 2021, specific to health, a research partnership, and referred to a theory, model or framework. No critical appraisal was conducted. We developed a coding framework to extract details related to the publication (e.g. country, year) and theory, model or framework (e.g. intended users, theoretical underpinning, methodology, methods of development, purpose, concepts of knowledge user engagement). One reviewer conducted data extraction. Descriptive statistics and narrative synthesis were utilized to report the results.

Results

We identified 21 874 articles in screening. Thirty-nine models or frameworks were included in data analysis, but no theory. Two models or frameworks (5%) were underpinned by theory. Literature review was the method (n = 11, 28%) most frequently used to develop a model or framework. Guiding or managing a partnership was the most frequently reported purpose of the model/framework (n = 14, 36%). The most represented concept of knowledge user engagement was principles/values (n = 36, 92%).

Conclusions

The models and frameworks identified could be utilized by researchers and knowledge users to inform aspects of a health research partnership, such as guidance or implementation of a partnership. Future research evaluating the quality and applicability of the models and frameworks is necessary to help partners decide which model or framework to implement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-022-00877-4.

Patient-Reported Outcomes Measurement in Radiation Oncology: Interpretation of Individual Scores and Change over Time in Clinical Practice

Tools for measuring patients’ perceived health and quality of life, such as patient-reported outcome measures (PROMs), inform clinical decisions for patients requiring radiation therapy. However, there may be inconsistencies in how patients interpret and respond to PROMs due to cultural, environmental, personal, or experiential factors. Differential item functioning (DIF) and response shift (RS) refer to differences in the meaning of PROMs between patients or over time (respectively). DIF and RS can threaten the accurate interpretation and use of PROMs, potentially resulting in erroneous conclusions about effectiveness, and flawed individual-level clinical decision-making. Given the empirical evidence of DIF and RS, we aim to review clinical implications and solutions for addressing DIF and RS by providing vignettes from collaborative examinations with workshop participants, as well as the literature. By making these methodological concepts accessible and relevant, for practice, clinicians may feel more confident to ask clarifying questions of patients when PROM scores and the contextual patient information do not align. PROM scores need to be interpreted via dialogue with the patient to avoid misinterpretation due to DIF and RS, which could diminish patient–clinician communication and impede shared decision-making. This work is part of an interdisciplinary knowledge translation initiative focused on the interpretation of PROM scores by clinically-oriented audiences.

Systematic overviews of partnership principles and strategies identified from health research about spinal cord injury and related health conditions: A scoping review

STUDY DESIGN

Scoping review.

OBJECTIVE

To identify and provide systematic overviews of partnership principles and strategies identified from health research about spinal cord injury (SCI) and related health conditions.

METHODS

Four health electronic databases (Medline, Embase, CINAHL, PsycINFO) were searched from inception to March 2019. We included articles that described, reflected, and/or evaluated one or more collaborative research activities in health research about SCI, stroke, multiple sclerosis, Parkinson's disease, amputation, cerebral palsy, spina bifida, amyotrophic lateral sclerosis, acquired brain injury, or wheelchair-users. Partnership principles (i.e. norms or values) and strategies (i.e. observable actions) were extracted and analyzed using directed qualitative content analysis.

RESULTS

We included 39 articles about SCI (n = 13), stroke (n = 15), multiple sclerosis (n = 5), amputation (n = 2), cerebral palsy (n = 2), Parkinson's disease (n = 1), and wheelchair users (n = 1). We extracted 110 principles and synthesized them into 13 overarching principles. Principles related to building and maintaining relationships between researchers and research users were most frequently reported. We identified 32 strategies that could be applied at various phases of the research process and 26 strategies that were specific to a research phase (planning, conduct, or dissemination).

CONCLUSION

We provided systematic overviews of principles and strategies for research partnerships. These could be used by researchers and research users who want to work in partnership to plan, conduct and/or disseminate their SCI research. The findings informed the development of the new SCI Integrated Knowledge Translation Guiding Principles (www.iktprinciples.com) and will support the implementation of these Principles within the SCI research system.

'Doing' or 'using' intersectionality? Opportunities and challenges in incorporating intersectionality into knowledge translation theory and practice

Intersectionality is a widely adopted theoretical orientation in the field of women and gender studies. Intersectionality comes from the work of black feminist scholars and activists. Intersectionality argues identities such as gender, race, sexuality, and other markers of difference intersect and reflect large social structures of oppression and privilege, such as sexism, racism, and heteronormativity. The reach of intersectionality now extends to the fields of public health and knowledge translation. Knowledge translation (KT) is a field of study and practice that aims to synthesize and evaluate research into an evidence base and move that evidence into health care practice. There have been increasing calls to bring gender and other social issues into the field of KT. Yet, as scholars outline, there are few guidelines for incorporating the principles of intersectionality into empirical research. An interdisciplinary, team-based, national health research project in Canada aimed to bring an intersectional lens to the field of knowledge translation. This paper reports on key moments and resulting tensions we experienced through the project, which reflect debates in intersectionality: discomfort with social justice, disciplinary divides, and tokenism. We consider how our project advances intersectionality practice and suggests recommendations for using intersectionality in health research contexts. We argue that while we encountered many challenges, our process and the resulting co-created tools can serve as a valuable starting point and example of how intersectionality can transform fields and practices.

Exploring factors influencing physiotherapists' perceptions of measuring reactive balance following a theory-based multi-component intervention: a qualitative descriptive study

Purpose: Reactive balance is a critical consideration for mobility and fall avoidance, but is under-assessed among physiotherapists. The objective of this study was to explore factors influencing physiotherapist perceptions about measuring reactive balance upon completion of a 12-month theory-based, multi-component intervention to increase use of a measure of reactive balance.Methods: A qualitative descriptive approach was used. Semi-structured interviews were conducted with 28 physiotherapists treating adults with balance impairment in three urban Canadian rehabilitation hospitals that participated in the intervention. Interviews explored perceptions of reactive balance measurement and perceived changes in clinical behavior. Thematic analysis involved multiple rounds of coding, review and discussion, theme generation, and interpretation of findings through individual analysis and team meetings.Findings: Participants expressed contrasting views about integrating reactive balance measurement in their practice, despite consistent acknowledgement of the importance of reactive balance for function. Three themes were identified highlighting factors that mediated perceptions about measuring reactive balance: patient characteristics; trust between physiotherapist and patient; and the role of physiotherapist fear.Conclusions: The findings highlight that decision making for measuring reactive balance in rehabilitation settings is complex. There is a need for additional work to facilitate long-term implementation of clinical reactive balance measurement, such as refining patient criteria for administration, ensuring sufficient time to establish a trusting relationship, and developing and testing strategies to address physiotherapist fear.IMPLICATIONS FOR REHABILITATIONReactive balance is important for falls prevention and mobility, but is under-assessed among physiotherapists.This study identified three factors that influenced uptake of reactive balance measurement among physiotherapists in rehabilitation settings: patient characteristics; trust between physiotherapist and patient; and the role of physiotherapist fear.Knowledge of the identified factors may assist with design and use of reactive and other balance measurements.Strategies aimed at developing trusting relationships between physiotherapist and patient along with addressing physiotherapist fear could facilitate the uptake of clinical reactive balance measurement.

A prospective study to establish the minimal clinically important difference of the Mini-BESTest in individuals with stroke

OBJECTIVE

To determine the minimal clinically important difference of the Mini-BESTest in individuals' post-stroke.

DESIGN

Prospective cohort study.

SETTING

Outpatient stroke rehabilitation.

SUBJECTS

Fifty outpatients with stroke with a mean (SD) age of 60.8 (9.4).

INTERVENTION

Outpatients with stroke were assessed with the Mini-BESTest before and after a course of conventional rehabilitation. Rehabilitation sessions occurred one to two times/week for one hour and treatment duration was 1.3-42 weeks (mean (SD) = 17.4(10.6)).

MAIN MEASURES

We used a combination of anchor- and distribution-based approaches including a global rating of change in balance scale completed by physiotherapists and patients, the minimal detectable change with 95% confidence, and the optimal cut-point from receiver operating characteristic curves.

RESULTS

The average (SD) Mini-BESTest score at admission was 18.2 (6.5) and 22.4 (5.2) at discharge (effect size: 0.7) (P = 0.001). Mean change scores on the Mini-BESTest for patient and physiotherapist ratings of small change were 4.2 and 4.3 points, and 4.7 and 5.3 points for substantial change, respectively. The minimal detectable change with 95% confidence for the Mini-BESTest was 3.2 points. The minimally clinical importance difference was determined to be 4 points for detecting small changes and 5 points for detecting substantial changes.

CONCLUSIONS

A change of 4-5 points on the Mini-BEST is required to be perceptible to clinicians and patients, and beyond measurement error. These values can be used to interpret changes in balance in stroke rehabilitation research and practice.

Exploring University Age-Friendliness Using Collaborative Citizen Science

Background and Objectives

Since the launch of Dublin City University’s Age-Friendly University (AFU) Initiative in 2012, relatively little empirical research has been published on its feasibility or implementation by institutions of higher learning. This article describes how collaborative citizen science—a research method where professional researchers and community members work together across multiple stages of the research process (e.g., data collection, analysis, and/or knowledge mobilization) to investigate an issue—was used to identify barriers and supports to university age-friendliness at the University of Manitoba (UofM) in Canada.

Research Design and Methods

Ten citizen scientists each completed 1 data collection walk around the UofM campus and used a tablet application to document AFU barriers and supports via photographs and accompanying audio commentaries. The citizen scientists and university researchers then worked together in 2 analysis sessions to identify AFU priority areas and brainstorm recommendations for institutional change. These were then presented to a group of interested university stakeholders.

Results

The citizen scientists collected 157 photos documenting AFU barriers and supports on campus. Accessibility, signage, and transportation were identified as being the most pressing issues for the university to address to improve overall age-friendliness.

Discussion and Implications

We suggest that academic institutions looking to complete assessments of their age-friendliness, particularly those exploring physical barriers and supports, could benefit from incorporating older citizen scientists into the process of collecting, analyzing, and mobilizing findings.

Design of an mHealth application for winter mobility for mobility device users

BACKGROUND

There is limited evidence on the strategies, resources, and tools shown to improve winter mobility and community participation.

OBJECTIVE

This paper describes a multifaceted approach taken to develop an mHealth application that provides information, resources, and strategies to facilitate winter mobility for mobility device users, service providers, community organisations, and researchers.

METHODS

The study was conducted in three phases: (1) A scoping review of peer-reviewed and grey literature was completed to identify literature that reported on tools, strategies, resources, and recommendations used to promote winter mobility; (2) Online asynchronous focus groups were conducted to identify the type of content that mobility device users wanted to include in the web-based application; and (3) A prototype mHealth application was developed based on the findings from the previous phases. Using a rapid prototyping process that included stakeholder review through an online survey, four cycles of application design and development were undertaken.

RESULTS

The scoping review identified 23 peer-reviewed studies and limited grey literature on winter mobility strategies, resources and recommendations. Twenty-four participants from across Canada engaged in one of five focus groups. Focus group analysis led to the development of the content categories for the mHealth application. The initial prototype application developed was reviewed by; 27 mobility device users, 16 health care providers, and seven consumer organisation representatives identified areas of strength and further refinement in regard to application design.

CONCLUSIONS

The approach used in this study provided a method to develop an application based on the ideas, needs, and interests of a variety of stakeholders. Once fully developed, the application has the potential to fill the gaps related to the lack of a unified collection of winter mobility strategies and resources, and open the dialogue on methods to improve winter participation among mobility device users.IMPLICATIONS FOR REHABILITATIONDespite winter conditions being a common challenge among mobility device users, there is an absence of an organised approach towards helping individuals manage their winter mobility needs.As the development and usage of mHealth applications continues to increase, it is valuable to use methods of designing applications based on the ideas, needs, and interests of a variety of stakeholders.Development of a framework for collating information on winter mobility strategies and resources is the first step towards launching an mHealth application.

Design characteristics and inclusion of evidence-based exercise recommendation in fall prevention community exercise programs for older adults in Canada: a national descriptive self-report study

BACKGROUND

Training balance through exercise is an effective strategy to reduce falls in community-dwelling older adults. Evidence-based fall prevention exercise recommendations have been proposed, specifying that exercise programs should: (1) provide a high challenge to balance, (2) be offered for a least three hours per week, (3) be provided on an ongoing basis. Community exercise programs have the potential to deliver effective fall prevention exercise; however, current design characteristics and whether they include the recommendations is not known. This study described design characteristics of fall prevention community exercise programs for older adults (50 years and older) across Canada, and explored whether these programs included the three evidence-based exercise recommendations.

METHODS

Instructors of fall prevention community exercise programs completed electronic self-report questionnaires following a modified Dillman recruitment approach. Questions explored program characteristics, exercise content, target population, and program and instructor demographic information. Using a previously developed coding scheme based on recommendations, exercises were coded for balance challenge.

RESULTS

One hundred fourty completed eligible questionnaires were analyzed (74% response rate). One hundred thirty-three programs (95%) included the challenge recommendation by prescribing mostly moderate or high challenge balance exercises, 16 programs (11%) included at least three hours of exercise a week, and 59 programs (42%) were offered on an ongoing basis. Eight programs (6%) included all three recommendations.

CONCLUSIONS

Most programs included at least one recommendation for effective fall prevention exercise. Future studies should examine organizational barriers and facilitators to incorporating evidence-based exercise recommendations and explore the use of mixed home/in-class strategies to include the recommendations.

Comparative effectiveness of exercise interventions for preventing falls in older adults: A secondary analysis of a systematic review with network meta-analysis

BACKGROUND

Systematic reviews have established that exercise reduces falls in older adults, however the most effective types of exercise are not known. This secondary analysis determined the comparative effectiveness of fall prevention exercise approaches.

METHOD

All fall prevention exercise interventions for older adults were identified from an existing search from inception until April 2017. Interventions were coded using a framework of 25 exercise types. Two reviewers independently screened studies, extracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis (NMA) were conducted. P-scores were used to rank exercise combinations.

RESULTS

One hundred and sixty-nine studies were included. NMA was conducted on 73 studies (30,697 participants) for the outcome of number of fallers. The exercise combination ranked with the greatest likelihood of being most effective relative to no exercise was: anticipatory control, dynamic stability, functional stability limits, reactive control and flexibility (p-score = 0.95). This exercise combination also significantly reduced number of fallers compared to 16 other combinations. No exercise combination had a significantly greater effect on reducing number of fallers more than this combination.

CONCLUSION

This analysis identified components of effective fall prevention exercise. The results can inform evidence-informed exercise recommendations and be used to design effective programs.

Integrated Knowledge Translation Guiding Principles for Conducting and Disseminating Spinal Cord Injury Research in Partnership

OBJECTIVE

To address a gap between spinal cord injury (SCI) research and practice by rigorously and systematically co-developing integrated knowledge translation (IKT) guiding principles for conducting and disseminating SCI research in partnership with research users.

DESIGN

The process was guided by the internationally accepted The Appraisal of Guidelines for REsearch & Evaluation (AGREE) II Instrument for evaluating the development of clinical practice guidelines.

SETTING

North American SCI research system (ie, SCI researchers, research users, funders).

PARTICIPANTS

The multidisciplinary expert panel (n=17) and end users (n=35) included individuals from a North American partnership of SCI researchers, research users, and funders who have expertise in research partnerships.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Clarity, usefulness, and appropriateness of the principles.

RESULTS

Data regarding 125 principles of partnered research were systematically collected from 4 sources (review of reviews, scoping review, interviews, Delphi consensus exercise). A multidisciplinary expert panel held a 2-day meeting to establish consensus, select guiding principles, and draft the guidance. The panel reached 100% consensus on the principles and guidance document. The final document includes a preamble, 8 guiding principles, and a glossary. Survey data showed that the principles and guidance document were perceived by potential end users as clear, useful, and appropriate.

CONCLUSIONS

The IKT Guiding Principles represent the first rigorously co-developed, consensus-based guidance to support meaningful SCI research partnerships. The principles are a foundational tool with the potential to improve the relevance and impact of SCI research, mitigate tokenism, and advance the science of IKT.

An external focus of attention compared to an internal focus of attention improves anticipatory postural adjustments among people post-stroke

BACKGROUND

People after stroke often have postural impairments that can increase their risk of falling. Anticipatory postural adjustments (APAs) are changes in the activity of postural muscles prior to a voluntary movement in order to maintain vertical equilibrium. Previous research suggests that improving APAs leads to better postural control and reduces the risk of falls. Despite the importance of APAs and their impairment among people post-stroke, studies that aim to investigate methods for improving APAs are limited. Consistent evidence supports that an external focus of attention compared to an internal focus of attention, yields superior performance of motor skills that include postural control.

RESEARCH QUESTION

What are the effects of adopting different foci of attention on measures of APAs and movement parameters when performing a lower extremity Fitts' task among people post-stroke?

METHODS

Twelve individuals post-stroke performed a lower extremity stepping movement (Fitts' task) while adopting an external focus or an internal focus of attention in a within-subject design. A motion capture system was used to record participants' movement data. Custom software derived movement time (MT), peak velocity (PV), time to peak velocity (ttPV) and variability at endpoint (SD_T). Electromyography was used to measure muscle activity and determine APAs onset and magnitude. For all dependent variables separate repeated measures ANOVAs were conducted to compare performance between foci of attention.

RESULTS

The results showed that an external focus of attention yielded significantly better performance on all outcome measures. The improvement in performance was seen in shorter MT, higher PV, shorter ttPV, smaller SD_T, earlier APAs onset and more efficient APAs magnitude.

SIGNIFICANCE

The changes in outcome measures suggest that adopting an external focus of attention during postural tasks could be an effective strategy for improving balance control among people post-stroke.

Applying an intersectionality lens to the theoretical domains framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

Background

A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers.

Methods

An interdisciplinary Framework Committee (n = 17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the TDF and its domains. An iterative approach aimed at building consensus was used to finalize recommendations.

Results

Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality alongside the TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation.

Conclusions

Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.

Disseminating the Foundations of Knowledge Translation and Patient Engagement Science Through the KnowledgeNudge Blog and Twitter Profile: Quantitative Descriptive Evaluation

BACKGROUND

There is a documented need to build capacity for theory- and evidence-informed knowledge translation (KT) and patient engagement (PE) practice in health research. Dissemination of foundational content online coupled with social media promotion may build capacity by increasing awareness, knowledge, and positive attitudes.

OBJECTIVE

This retrospective study sought to (1) describe exposure and engagement of the KnowledgeNudge KT and PE dissemination strategy (online blog and Twitter profile) over 2 years and (2) identify and compare characteristics of individual posts with the most and least exposure and reach.

METHODS

Exposure was assessed by blog site views per month and Twitter profile impressions per month. Engagement was assessed by Twitter profile interactions per month. Descriptive statistics were calculated for 6-month blocks and compared using one-way analysis of variance or Student t test. Individual post exposure was assessed by average post views per week. Individual post reach was assessed by average post reads per week. High- and low-profile blog posts with the highest and lowest 10th percentile for exposure and reach were identified.

RESULTS

A total of 99 posts and 755 tweets were published during the study period. There was a significant increase in exposure (P=.004) and reach (P<.001) during the final 6 months. Seven high-profile and 6 low-profile posts were identified. High-profile posts had a significantly greater average word count than low-profile posts (P=.003). There were no other significant differences between posts.

CONCLUSIONS

The increases in KnowledgeNudge exposure and engagement offer preliminary evidence in support of this dissemination strategy for the practice of KT and PE. Variation in individual post exposure and reach warrants further exploration to tailor content to user needs. Future work will include a prospective evaluation strategy to explore the effect of KnowledgeNudge on awareness, knowledge, attitudes, and behavior.

A review of reviews on principles, strategies, outcomes and impacts of research partnerships approaches: a first step in synthesising the research partnership literature

Background

Conducting research in partnership with stakeholders (e.g. policy-makers, practitioners, organisations, patients) is a promising and popular approach to improving the implementation of research findings in policy and practice. This study aimed to identify the principles, strategies, outcomes and impacts reported in different types of reviews of research partnerships in order to obtain a better understanding of the scope of the research partnership literature.

Methods

This review of reviews is part of a Coordinated Multicenter Team approach to synthesise the research partnership literature with five conceptually linked literature reviews. The main research question was ‘What principles, strategies, outcomes and impacts are reported in different types of research partnership approaches?’. We included articles describing a literature review of research partnerships using a systematic search strategy. We used an adapted version of the Revised Assessment of Multiple Systematic Reviews tool to assess quality. Nine electronic databases were searched from inception to April 2018. Principles, strategies, outcomes and impacts were extracted from the included reviews and analysed using direct content analysis.

Results

We included 86 reviews using terms describing several research partnership approaches (e.g. community-based participatory research, participatory research, integrated knowledge translation). After the analyses, we synthesised 17 overarching principles and 11 overarching strategies and grouped them into one of the following subcategories: relationship between partners; co-production of knowledge; meaningful stakeholder engagement; capacity-building, support and resources; communication process; and ethical issues related to the collaborative research activities. Similarly, we synthesised 20 overarching outcomes and impacts on researchers, stakeholders, the community or society, and the research process.

Conclusions

This review of reviews is the first that presents overarching principles, strategies, outcomes and impacts of research partnerships. This review is unique in scope as we synthesised literature across multiple research areas, involving different stakeholder groups. Our findings can be used as a first step to guide the initiation and maintenance of research partnerships and to create a classification system of the key domains of research partnerships, which may improve reporting consistency in the research partnership literature.

Trial registration

This study is registered via Open Science Framework: 10.17605/OSF.IO/GVR7Y.

Implementation strategies in emergency management of children: a scoping review protocol

BACKGROUND

Behavior change is not simple, and the introduction of guidelines or protocols does not mean that they will be followed. As such, implementation strategies are vital for the uptake and sustainability of changes in medical protocols. Medical or mental emergencies may be life-threatening, especially in children due to their unique physiological needs. In emergency departments (EDs), where timely decisions are often made, practice change requires thoughtful considerations regarding the best approaches to implementation. As there are many studies reporting on a wide variety of implementation strategies in the emergency management of children in EDs, we aim to identify and map the characteristics of these studies.

METHODS

We will conduct a scoping review to identify various implementation strategies in the emergency management of children using the Arksey and O'Malley framework. We will search MEDLINE (Ovid), Embase (Ovid), Cochrane Central (Wiley), and CINAHL (Ebsco), from inception to May 29, 2019, for implementation studies among the pediatric population (≤ 21 years) in a pediatric emergency setting. Two pairs of reviewers will independently select studies for inclusion and extract the data. We will perform a descriptive, narrative analysis of the characteristics of the identified implementation strategies.

DISCUSSION

We will present specific characteristics and outcome measures of all included studies in a tabular form. The results of this review are expected to help identify and characterize successful implementation strategies in the emergency management of children in EDs.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework https://osf.io/h6jv2.

Winter Mobility and Community Participation Among People Who Use Mobility Devices: A Scoping Review

OBJECTIVE

To identify the knowledge, products, and strategies for individuals with mobility-related disabilities used to address challenging winter conditions.

DATA SOURCES

AgeLine, OVID, Scopus, and CIHAHL were searched for studies that met the inclusion criteria, from inception to April 2018. Sources for gray literature, or information outside commercial publishing, included ProQUEST, government websites, and manufacturers, vendors, and consumer organization websites.

SOURCE SELECTION

Population of people with limited or reduced mobility or mobility device users involved in winter-related environmental conditions; aim was to increase activity, participation, or safety.

DATA EXTRACTION

Two reviewers independently applied the inclusion criteria to select eligible sources. Two reviewers independently extracted the data from each source.

DATA SYNTHESIS

Twenty-three published peer-reviewed papers were located. Study populations were predominantly those who used wheelchairs (mixed wheelchair type, n=7; power, n=4; manual, n=2), canes (n=3), or specialized winter footwear (n=2). The primary focus of these papers was determined to be tool or device (n=10), recommendations (n=9), strategy (n=2), or resource (n=2). Civic policy documents were variable in citizen responsibility for snow clearing. Limited winter-related supports were identified on consumer organization websites. Although some winter-specific products exist, very few studies have examined the effectiveness of any of these products.

CONCLUSIONS

Despite the common experience of challenging winter conditions, a paucity of winter-specific research and innovation relevant for individuals who use mobility devices exists. Researchers, consumers, and industry need to partner to develop novel tools, strategies, resources, and evidence-based recommendations.

Filling gaps in type 1 diabetes and exercise research: a scoping review and priority-setting project

Our team examined the characteristics of patient engagement (PE) practices in exercise-based randomized trials in type 1 diabetes (T1D), and facilitated T1D stakeholders in determining the top 10 list of priorities for exercise research. Two methodological approaches were employed: a scoping review and a modified James Lind Alliance priority-setting partnership. Published (Medline, Embase, CINAHL and Central databases) and grey literature (www.clinicaltrials.gov) were searched to identify randomized controlled trials of exercise interventions lasting minimum 4 weeks and available in English. We extracted information on PE and patient-reported outcomes (PROs) to identify if patient perspectives had been implemented. Based on results, we set out to determine exercise research priorities as a first step towards a patient-engaged research agenda. An online survey was distributed across Canada to collect research questions from patients, caregivers and healthcare providers. We qualitatively analyzed submitted questions and compiled a long list that a 12-person stakeholder steering committee used to identify the top 10 priority research questions. Of 9962 identified sources, 19 published trials and 4 trial registrations fulfilled inclusion criteria. No evidence of PE existed in any included study. Most commonly measured PROs were frequency of hypoglycemia (n=7) and quality of life (n=4). The priority-setting survey yielded 194 submitted research questions. Steering committee rankings identified 10 priorities focused on lifestyle factors and exercise modifications to maintain short-term glycemic control. Recent exercise-based randomized trials in T1D have not included PE and PROs. Patient priorities for exercise research have yet to be addressed with adequately designed clinical trials.

Access to Multidisciplinary Care for Pediatric Weight Management: Exploring Perspectives of the Health Care Team within Canada and the United States

Background: In Canada and the United States, most families referred for pediatric weight management services do not start treatment. Of families who initiate care, many discontinue before the program ends. Parents and youth have reported difficulties in accessing services as an important barrier to starting or completing programming. The purpose of this study was to understand barriers and identify potential solutions related to access to care from the perspective of health care team members from Canada and the United States. Methods: Qualitative description method guided the study design. Participants were health care team members, purposefully recruited through Canadian and US-based pediatric weight management program registries. Telephone interviews were conducted with participants between February and May 2017. Interviews were transcribed verbatim and analyzed using content analysis. Results: Eighteen individuals from 16 sites participated (n = 8 Canada, n = 8 United States). Access barriers and potential solutions were related to: (1) referral and eligibility, (2) wait lists and program capacity, (3) logistics and costs, and (4) stigma and weight bias. Barriers were similar between Canadian and US sites, with the exception of cost-related barriers. Conclusions: Health care providers from Canada and the United States reported multiple societal, organizational, service, and family-level barriers to accessing multidisciplinary pediatric weight management care. Proposed solutions suggest that service providers can play a key role alongside families to improve access to appropriate care. Further research is needed to demonstrate the feasibility and effectiveness of proposed solutions.

To what extent do older adult community exercise programs in Winnipeg, Canada address balance and include effective fall prevention exercise? A descriptive self-report study

Background

Effective fall prevention exercise for community-dwelling older adults requires (i) challenging balance exercise, (ii) offered at least 3 hrs/ week, and (iii) on an ongoing basis, to reduce falls. Community exercise programs are a potential implementation strategy for fall prevention exercise; however, the extent to which they address balance and include effective fall prevention exercise is unknown. Study objectives were to describe program delivery, exercise design, and assessment characteristics of older adult community exercise programs in Winnipeg, Canada; determine if they included effective fall prevention exercise; determine the balance challenge and components of postural control addressed in the most- and least-frequently reported exercises.

Methods

A public inventory of older adult community exercise programs served as the sampling frame for cross-sectional telephone questionnaires exploring program, exercise, and assessment characteristics. Exercises were coded independently by two investigators for balance challenge level and components of postural control. Programs were categorized by number of effective fall prevention exercise components established by evidence-based recommendations. Descriptive statistics were calculated.

Results

Thirty-three eligible programs were identified and nine individuals participated. Most programs (n = 5, 56%) identified as general exercise, and two (22%) as fall prevention exercise. Most programs (n = 5, 56%) were offered two or more times/ week and reported exercise intensity as somewhat challenging. Exercise time offered ranged between 1 and 3 h/ week. Assessments were conducted in two programs (22%). Only one program (general exercise) included all components of effective fall prevention exercise. Two programs (22%) included the component of being offered at least 3 hrs/ week. Three programs (33%) included the component of being offered on an ongoing basis. Seven programs (78%) prescribed mostly moderate challenge balance exercise, and one program (11%) prescribed mostly high challenge exercise. Most of the 19 most-frequently prescribed exercises (n = 17, 89%) targeted static stability and none targeted reactive postural control.

Conclusions

Most of the older adult community exercise programs participating in this study did not focus on fall prevention, and did not include all components of effective fall prevention exercise. Future studies should focus on fall prevention programs and explore factors influencing implementation of effective fall prevention exercise components to facilitate planning.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1224-x) contains supplementary material, which is available to authorized users.

Quality improvement strategies to prevent falls in older adults: a systematic review and network meta-analysis

BACKGROUND

Falls are a common occurrence and the most effective quality improvement (QI) strategies remain unclear.

METHODS

We conducted a systematic review and network meta-analysis (NMA) to elucidate effective quality improvement (QI) strategies for falls prevention. Multiple databases were searched (inception-April 2017). We included randomised controlled trials (RCTs) of falls prevention QI strategies for participants aged ≥65 years. Two investigators screened titles and abstracts, full-text articles, conducted data abstraction and appraised risk of bias independently.

RESULTS

A total of 126 RCTs including 84,307 participants were included after screening 10,650 titles and abstracts and 1210 full-text articles. NMA including 29 RCTs and 26,326 patients found that team changes was statistically superior in reducing the risk of injurious falls relative to usual care (odds ratio [OR] 0.57 [0.33 to 0.99]; absolute risk difference [ARD] -0.11 [95% CI, -0.18 to -0.002]). NMA for the outcome of number of fallers including 61 RCTs and 40 128 patients found that combined case management, patient reminders and staff education (OR 0.18 [0.07 to 0.47]; ARD -0.27 [95% CI, -0.33 to -0.15]) and combined case management and patient reminders (OR, 0.36 [0.13 to 0.97]; ARD -0.19 [95% CI, -0.30 to -0.01]) were both statistically superior compared to usual care.

CONCLUSIONS

Team changes may reduce risk of injurious falls and a combination of case management, patient reminders, and staff education, as well as case management and patient reminders may reduce risk of falls. Our results can be tailored to decision-maker preferences and availability of resources.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42013004151).

Motor Behavior Concepts in the Study of Balance: A Scoping Review

Previous research suggests that using Fitts' law; attentional focus or challenge point framework (CPF) is beneficial in balance control studies. A scoping review was conducted to examine studies that utilized these motor behavior concepts during balance control tasks. An extensive literature search was performed up to January 2018. Two independent reviewers conducted a study selection process followed by data extraction of the search results. Forty-six studies were identified, with 2 studies related to CPF, 12 studies related to Fitts' law and 32 studies related to focus of attention. The CPF appears to be a useful method for designing a progressive therapeutic program. Fitts' law can be used as a tool for controlling the difficulty of motor tasks. Focus of attention studies indicate that adopting an external focus of attention improves task performance. Overall, studies included in this review report benefit when using the selected motor behavior concepts. However, the majority (>80%) of studies included in the review involved healthy populations, with only three clinical trials. In order to ascertain the benefits of the selected motor behavior concepts in clinical settings, future research should focus on using these concepts for clinical trials to examine balance control among people with balance impairments.

Engaging patients and the public in Health Research: experiences, perceptions and training needs among Manitoba health researchers

BACKGROUND

The significance of patient and public engagement is increasingly recognized in health research, demonstrated by explicit requirements for patient and public engagement by funding agencies and journals. Such requirements have charged health researchers with leading patient and public engagement efforts, but evidence suggests that this practice is still evolving. Little research has explored the experiences and training needs of health researchers. This study aimed to establish a baseline understanding of the experiences, perceptions and training needs of health researchers in engaging patients and the public in health research in the context of Manitoba.

METHODS

A cross-sectional 50-item questionnaire was distributed using a multi-phase purposive sampling strategy targeting health researchers in Manitoba, Canada. Data was summarized using frequencies, percentages and analyzed using chi-square testing. A local patient engagement advisory group was consulted at the interpretation stage of the study to obtain feedback and input on the findings and their implications.

RESULTS

Responses from 53 health researchers were included. Most participants had engaged patients and the public in their own research (n = 43, 81.1%). Those who had engaged reported having some (n = 19, 44.2%), extensive (n = 14, 32.6%) or a little (n = 10, 23.3%) experience with this process. Most engaged at the levels of inform, consult or involve (81.3, 64.6 and 54.2% respectively), while fewer engaged at the collaborate (37.5%) or patient-directed levels (12.5%). Recruitment occurred using a number of approaches and engagement occurred at various phases of the research process, while main groups engaged were patients (n = 38, 82.6%) and families/caregivers (n = 25, 54.4%). Barriers to engaging patients and the public in health research included funding, time, compensation, logistics, recruitment, motivation at both the patient and researcher level, and skills of researchers to engage. Researchers reported an overwhelming need and interest for supports, funding and training to effectively engage patients and the public in health research. Consultation with the patient advisory group provided further insight on study findings and areas for future research.

CONCLUSIONS

Participating Manitoba health researchers engaged patients and the public in health research at multiple, but typically lower levels of involvement. Findings highlight the barriers to effective, authentic and meaningful patient and public engagement and support the need for targeted training, supports, funding and time for health researchers.

A review protocol on research partnerships: a Coordinated Multicenter Team approach

BACKGROUND

Research partnership approaches, in which researchers and stakeholders work together collaboratively on a research project, are an important component of research, knowledge translation, and implementation. Despite their growing use, a comprehensive understanding of the principles, strategies, outcomes, and impacts of different types of research partnerships is lacking. Generating high-quality evidence in this area is challenging due to the breadth and diversity of relevant literature. We established a Coordinated Multicenter Team approach to identify and synthesize the partnership literature and better understand the evidence base. This review protocol outlines an innovative approach to locating, reviewing, and synthesizing the literature on research partnerships.

METHODS

Five reviews pertaining to research partnerships are proposed. The Coordinated Multicenter Team developed a consensus-driven conceptual framework to guide the reviews. First, a review of reviews will comparatively describe and synthesize key domains (principles, strategies, outcomes, and impacts) for different research partnership approaches, within and beyond health (e.g., integrated knowledge translation, participatory action research). After identifying commonly used search terminology, three complementary scoping reviews will describe and synthesize these domains in the health research partnership literature. Finally, an umbrella review will amalgamate and reflect on the collective findings and identify research gaps and future directions. We will develop a collaborative review methodology, comprising search strategy efficiencies, terminology standardization, and the division of screening, extraction, and synthesis to optimize feasibility and literature capture. A series of synthesis and scoping manuscripts will emerge from this Coordinated Multicenter Team approach.

DISCUSSION

Comprehensively describing and differentiating research partnership terminology and its domains will address well-documented gaps in the literature. These efforts will contribute to and improve the quality, conduct, and reporting of research partnership literature. The collaborative review methodology will help identify and establish common terms, leverage efficiencies (e.g., expertise, experience, search and protocol design, resources) and optimize research feasibility and quality. Our approach allows for enhanced scope and inclusivity of all research user groups and domains, thereby contributing uniquely to the literature. This multicenter, efficiency and quality-focused approach may serve to inspire researchers across the globe in addressing similar domain challenges, as exist in this rapidly expanding field.

A theory-based multi-component intervention to increase reactive balance measurement by physiotherapists in three rehabilitation hospitals: an uncontrolled single group study

BACKGROUND

Most implementation interventions in rehabilitation, including physiotherapy, have used passive, non-theoretical approaches without demonstrated effectiveness. The goal of this study was to improve an important domain of physiotherapy practice - reactive balance measurement - with a targeted theory-based multi-component intervention developed using the Theoretical Domains Framework. The primary objective was to determine documented reactive balance measure use in a 12-month baseline, during, and for three months post- intervention.

METHODS

An uncontrolled before-and-after study was completed with physiotherapists at three urban adult rehabilitation hospitals in Ontario, Canada. The 12-month intervention included group meetings, local champions, and health record modifications for a validated reactive balance measure. The primary outcome was the proportion of records with a documented reactive balance measure when balance was assessed pre-, during- and post-intervention. Secondary outcomes were changes in use, knowledge, and confidence post-intervention, differences across sites, and intervention satisfaction.

RESULTS

Reactive balance was not measured in any of 211 eligible pre-intervention records. Thirty-three physiotherapists enrolled and 28 completed the study. Reactive balance was measured in 31% of 300 eligible records during-intervention, and in 19% of 90 eligible records post-intervention (p < 0.04). Knowledge and confidence significantly increased post-intervention (all p < 0.05). There were significant site differences in use during- and post-intervention (all p < 0.05). Most participants reported satisfaction with intervention content (71%) and delivery (68%).

CONCLUSIONS

Reactive balance measurement was greater among participants during-intervention relative to the baseline, and use was partially sustained post-intervention. Continued study of intervention influences on clinical reasoning and exploration of site differences is warranted.

Comparisons of Interventions for Preventing Falls in Older Adults: A Systematic Review and Meta-analysis

IMPORTANCE

Falls result in substantial burden for patients and health care systems, and given the aging of the population worldwide, the incidence of falls continues to rise.

OBJECTIVE

To assess the potential effectiveness of interventions for preventing falls.

DATA SOURCES

MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Ageline databases from inception until April 2017. Reference lists of included studies were scanned.

STUDY SELECTION

Randomized clinical trials (RCTs) of fall-prevention interventions for participants aged 65 years and older.

DATA EXTRACTION AND SYNTHESIS

Pairs of reviewers independently screened the studies, abstracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis were conducted.

MAIN OUTCOMES AND MEASURES

Injurious falls and fall-related hospitalizations.

RESULTS

A total of 283 RCTs (159 910 participants; mean age, 78.1 years; 74% women) were included after screening of 10 650 titles and abstracts and 1210 full-text articles. Network meta-analysis (including 54 RCTs, 41 596 participants, 39 interventions plus usual care) suggested that the following interventions, when compared with usual care, were associated with reductions in injurious falls: exercise (odds ratio [OR], 0.51 [95% CI, 0.33 to 0.79]; absolute risk difference [ARD], -0.67 [95% CI, -1.10 to -0.24]); combined exercise and vision assessment and treatment (OR, 0.17 [95% CI, 0.07 to 0.38]; ARD, -1.79 [95% CI, -2.63 to -0.96]); combined exercise, vision assessment and treatment, and environmental assessment and modification (OR, 0.30 [95% CI, 0.13 to 0.70]; ARD, -1.19 [95% CI, -2.04 to -0.35]); and combined clinic-level quality improvement strategies (eg, case management), multifactorial assessment and treatment (eg, comprehensive geriatric assessment), calcium supplementation, and vitamin D supplementation (OR, 0.12 [95% CI, 0.03 to 0.55]; ARD, -2.08 [95% CI, -3.56 to -0.60]). Pairwise meta-analyses for fall-related hospitalizations (2 RCTs; 516 participants) showed no significant association between combined clinic- and patient-level quality improvement strategies and multifactorial assessment and treatment relative to usual care (OR, 0.78 [95% CI, 0.33 to 1.81]).

CONCLUSIONS AND RELEVANCE

Exercise alone and various combinations of interventions were associated with lower risk of injurious falls compared with usual care. Choice of fall-prevention intervention may depend on patient and caregiver values and preferences.

A descriptive qualitative examination of knowledge translation practice among health researchers in Manitoba, Canada

BACKGROUND

The importance of effective translation of health research findings into action has been well recognized, but there is evidence to suggest that the practice of knowledge translation (KT) among health researchers is still evolving. Compared to research user stakeholders, researchers (knowledge producers) have been under-studied in this context. The goals of this study were to understand the experiences of health researchers in practicing KT in Manitoba, Canada, and identify their support needs to sustain and increase their participation in KT.

METHODS

Qualitative semi-structured interviews were conducted with 26 researchers studying in biomedical; clinical; health systems and services; and social, cultural, environmental and population health research. Interview questions were open-ended and probed participants' understanding of KT, their experiences in practicing KT, barriers and facilitators to practicing KT, and their needs for KT practice support.

RESULTS

KT was broadly conceptualized across participants. Participants described a range of KT practice experiences, most of which related to dissemination. Participants also expressed a number of negative emotions associated with the practice of KT. Many individual, logistical, and systemic or organizational barriers to practicing KT were identified, which included a lack of institutional support for KT in both academic and non-academic systems. Participants described the presence of good relationships with stakeholders as a critical facilitator for practicing KT. The most commonly identified needs for supporting KT practice were access to education and training, and access to resources to increase awareness and promotion of KT. While there were few major variations in response trends across most areas of health research, the responses of biomedical researchers suggested a unique KT context, reflected by distinct conceptualizations of KT (such as commercialization as a core component), experiences (including frustration and lack of support), and barriers to practicing KT (for example, intellectual property concerns).

CONCLUSIONS

The major findings of this study were the continued variations in conceptualization of KT, and persisting support needs that span basic individual to comprehensive systemic change. Expanding the study to additional regions of Canada will present opportunities to compare and contrast the state of KT practice and its influencing factors.

Moving towards a more inclusive patient and public involvement in health research paradigm: the incorporation of a trauma-informed intersectional analysis

BACKGROUND

The concept of patient engagement in health research has received growing international recognition over recent years. Yet despite some critical advancements, we argue that the concept remains problematic as it negates the very real complexities and context of people's lives. Though patient engagement conceptually begins to disrupt the identity of "researcher," and complicate our assumptions and understandings around expertise and knowledge, it continues to essentialize the identity of "patient" as a homogenous group, denying the reality that individuals' economic, political, cultural, subjective and experiential lives intersect in intricate and multifarious ways.

DISCUSSION

Patient engagement approaches that do not consider the simultaneous interactions between different social categories (e.g. race, ethnicity, Indigeneity, gender, class, sexuality, geography, age, ability, immigration status, religion) that make up social identity, as well as the impact of systems and processes of oppression and domination (e.g. racism, colonialism, classism, sexism, ableism, homophobia) exclude the involvement of individuals who often carry the greatest burden of illness - the very voices traditionally less heard in health research. We contend that in order to be a more inclusive and meaningful approach that does not simply reiterate existing health inequities, it is important to reconceptualize patient engagement through a health equity and social justice lens by incorporating a trauma-informed intersectional analysis. This article provides key concepts to the incorporation of a trauma-informed intersectional analysis and important questions to consider when developing a patient engagement strategy in health research training, practice and evaluation. In redefining the identity of both "patient" and "researcher," spaces and opportunities to resist and renegotiate power within the intersubjective relations can be recognized and addressed, in turn helping to build trust, transparency and resiliency - integral to the advancement of the science of patient engagement in health research.

Balance Assessment Practices of Saskatchewan Physiotherapists: A Brief Report of Survey Findings

Purpose: This study was conducted to determine the balance assessment practices of physiotherapists in Saskatchewan. Methods: Practising physiotherapists who assess and treat adults with balance and mobility impairments were eligible to participate in this cross-sectional, online survey. The questions investigated the use of balance assessment measures, the balance components assessed, and practice area. Results: Of the 72 respondents, most reported regularly assessing five or more of the nine balance components listed. Movement observation was the most commonly reported measure used, followed by the Berg Balance Scale, single-leg stance test, and tandem standing/walking. Conclusions: Most physiotherapists in Saskatchewan use a variety of tools to assess balance. Gaps in practices related to fall prevention were noted in the mismatch between the tools used and the components reportedly assessed.

Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews

BACKGROUND

There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers.

METHODS

Study design: overview of reviews.

DATA SOURCE

MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015).

STUDY SELECTION

two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language.

DATA EXTRACTION AND SYNTHESIS

two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors' conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.).

RESULTS

Of 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change.

CONCLUSIONS

Behavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.

Arthritis and associated limitations in community-dwelling Canadians living with stroke

BACKGROUND

Residual impairments and gait deviations post-stroke may lead to secondary musculoskeletal complications such as arthritis. This study explored the prevalence of arthritis and associated functional limitations in community-dwelling Canadians with and without stroke.

METHODS

Secondary analysis of the Canadian Community Health Survey; a population-based, cross-sectional survey conducted by Statistics Canada in 2011 and 2012. Respondents >50 years old who reported a stroke diagnosis (n = 1892) were age- and gender-matched with controls randomly selected from survey respondents who did not report a stroke (n = 1892). Stroke and control groups were compared on presence of arthritis (yes/no) and secondary variables including pain, perceived health and assistance required (5 point scales) using the Rao-Scott X(2) test. Within the stroke group, logistic regression was used to investigate the effect of arthritis on life satisfaction, pain limiting activities and perceived health with age, gender, BMI, comorbidities and socioeconomic status used as covariates in the model.

RESULTS

A greater proportion of the stroke group (53%) reported arthritis compared to controls (43%). These groups also differed in reports of perceived health and pain. Within the stroke group, those with arthritis were significantly more likely to report pain limiting activities (OR 3.89) and less likely to report satisfaction with life (OR 0.59).

CONCLUSIONS

This preliminary work suggests that arthritis is more prevalent in individuals with stroke compared to individuals without stroke and that this co-morbidity is associated with worse reports of pain and perceived health. A limitation is that it is not possible to determine if the arthritis pre-dated or followed the stroke. This work provides support for a longitudinal investigation of the development of secondary musculoskeletal issues post-stroke.

Applying knowledge translation theory to physical therapy research and practice in balance and gait assessment: case report

BACKGROUND AND PURPOSE

Knowledge translation (KT) is an emerging discipline with a focus on implementing health evidence in decision making and clinical practice. Knowledge translation theories provide conceptual frameworks that can direct research focused on optimizing best practice. The objective of this case report is to describe one prominent KT theory--the knowledge-to-action (KTA) framework--and how it was applied to research on balance and gait assessment in physical therapist practice.

CASE DESCRIPTION

Valid and reliable assessment tools are recommended to evaluate balance and gait function, but gaps in physical therapy practices are known. The KTA framework's 2-pronged approach (knowledge creation phase and action cycle) guided research questions exploring current practices in balance and gait assessment and factors influencing practice in Ontario, Canada, with the goal of developing and evaluating targeted KT interventions.

OUTCOMES

Results showed the rate at which therapists use standardized balance and gait tools was less than optimal and identified both knowledge-to-practice gaps and individual and organizational barriers to implementing best assessment practices. These findings highlighted the need for synthesis of evidence to address those gaps prior to the development of potential intervention strategies.

DISCUSSION

The comprehensive KTA framework was useful in guiding the direction of these ongoing research programs. In both cases, the sequence of the individual KTA steps was modified to improve the efficiency of intervention development, there was a need to go back and forth between the 2 phases of the KTA framework, and additional behavior change and barrier assessment theories were consulted. Continued research is needed to explicitly evaluate the efficacy of applying KT theory to best practice in health care.