Presentation on theme: "Knowledge Translation in BC Physiotherapy"— Presentation transcript:
1Knowledge Translation in BC Physiotherapy Alison M. HoensPhysical Therapy Knowledge Translation BrokerUBC Dept of PT, FOM; Physiotherapy Association of BC; BC RSRNet (VCH, PHC, BCC&W)Clinical Associate Professor, UBC Dept of PTClinical Coordinator, Physiotherapy, PHC
2Objectives To define & understand knowledge translation To appreciate why KT is importantTo provide a framework for knowledge translation in physical therapy in PTEnd of grant KTIntegrated KTTo outline the role of the KT BrokerTo identify possibilities for your involvement
3What is KT? Translational Knowledge Research (KT1) Translation (KT2) LabClinicalResearchHealthCareDoes it refer to translation from bench to bedside? From the ivy towers to the every day world?CIHR reserves to bench to bedside as TR, and KT as IT to EDW. Certainly not universalCIHR; Hulley et al, 2007
4Many terms, same basic idea … Applied health researchDiffusionDisseminationGetting knowledge into practiceImpactImplementationKnowledge communicationKnowledge cycleKnowledge exchangeKnowledge managementKnowledge translationKnowledge to actionKnowledge mobilizationKnowledge transferLinkage and exchangeParticipatory researchResearch into practiceResearch transferResearch translationTransmissionUtilizationIn fact there are zillions of terms used to mean essentially the same thing as KT
5Knowledge Translation CIHR definitionKnowledge translation is the exchange, synthesis and ethically-sound application of researcher findings within a complex system of relationships among researchers and knowledge users. CIHRHow does CIHR define KT
6KT “closing the know-do gap” As described in the CIHR Act, knowledge translation is a broad concept. It encompasses all steps between the creation of new knowledge and its application to yield beneficial outcomes for society. This includes knowledge dissemination, communication, technology transfer, ethical context, knowledge management, knowledge utilization, two-way exchange between researchers and those who apply knowledge, implementation research, technology assessment, synthesis of results within a global context, development of consensus guidelines, and more.
7But, fails to account for … AskAnswerAs described in the CIHR Act, knowledge translation is a broad concept. It encompasses all steps between the creation of new knowledge and its application to yield beneficial outcomes for society. This includes knowledge dissemination, communication, technology transfer, ethical context, knowledge management, knowledge utilization, two-way exchange between researchers and those who apply knowledge, implementation research, technology assessment, synthesis of results within a global context, development of consensus guidelines, and more.
8KT key concepts Ask Answer Know Do As described in the CIHR Act, knowledge translation is a broad concept. It encompasses all steps between the creation of new knowledge and its application to yield beneficial outcomes for society. This includes knowledge dissemination, communication, technology transfer, ethical context, knowledge management, knowledge utilization, two-way exchange between researchers and those who apply knowledge, implementation research, technology assessment, synthesis of results within a global context, development of consensus guidelines, and more.
9Knowledge translation is about ensuring that: ResearchersUsersKnowledge translation is about ensuring that:‘users’ are aware of and use research evidence to inform their decision makingResearch is informed by current available evidence and the experiences and information needs of ‘end users’
10WHY IS KT IMPORTANT IN PT? Mikhail et al, 2005: Physical Therapists’ use of interventions with high evidence of effectiveness in the management of a hypothetical typical patient with acute LBP68% of PTs used interventions with strong or mod evidence of effectiveness90% used interventions with limited evidence96% used interventions with absence of evidence of effectiveness
11WHY IS KT IMPORTANT IN PT? Stevenson, T et al. (2005). Influences on Treatment Choices in Stroke Rehabilitation: Survey of Canadian Physiotherapists. Physiotherapy Canada.Ranking of importance of factors influencing current practice:ExperienceContinuing education (practical)Colleague InfluenceContinuing Education (theory)Professional Literature * secondary sourcesEntry Level TrainingMost impt infuenceLeast impt infuence
12BARRIERSI had considerable freedom of clinical choice of therapy: my trouble was that I did not know which to use and when. I would gladly have sacrificed my freedom for a little knowledge.Sir Archie Cochrane. Effectiveness and Efficiency: Random Reflections on Health Services
13There seems to be little relation between the quality of the evidence and its diffusion into practice (Fitzgerald et al 2002)
14BARRIERSLack of time, computing resources, not enough evidence, lack of access; lack of skills for searching, appraising, and interpreting; lack of incentives (Bennett S. et al, Australian OT Journal, 50, )Relevant literature not compiled all in one place (Closs & Lewin, Br J of Therapy & Rehab, 5, ).Publication bias, indexing issues, language issues, assessing internal validity, access to electronic databases, access to full text, assessing applicability, drawing conclusions (Maher. C. et al. Phys Ther, 84: ).
15BARRIERS Information overload xx Rich with diversity yet highly chaoticNeed tools/processes that can reliably and sensibly address the infoAgency for Healthcare Research & Qualityxx
16BARRIERS Structural (e.g. financial disincentives) Organisational (e.g. inappropriate skill mix, lack of facilities or equipment)Peer group (e.g. local standards of care not in line with desired practice)Individual (e.g. knowledge, attitudes, skills)Professional - patient interaction (e.g. problems with information processing)
17‘Knowledge to Action’ Cycle Ian Graham, VP, KT, CIHR KT framework‘Knowledge to Action’ CycleIan Graham, VP, KT, CIHR
18Types of KT Integrated KT End of grant Traditional approachKnowledge creation by researchers disseminated by publication & presentationImprovements:Targeted messages to key stakeholdersMore interactive strategiesEg. interactive material; e-classroomOpinion leaderIntegrated KTClinician involved in research process from it’s inceptionCollaboration through research question, study & dissemination
19How effective are various implementation strategies? Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay C, Vale L et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004.Single interventionsInterventionNumber of CRCTsRangeMedian effect sizeEducational materials4+3.6%, +17.0%+8.1%Audit and feedback5+1.3%, +16.0%+7.0%Reminders14–1.0%, +34.0%+14.1%
20What is effective? Little to no effect Sometimes effective Educational materialsDidactic sessionsSometimes effectiveAudit & feedbackLocal opinion leadersLocal consensus projectPatient mediated interventionsConsistently effectiveRemindersInteractive education (with discussion of practice)Social marketing(Bero et al., 1998, Grimshaw et al., 2001)
21An example: Inspiratory Muscle Training & COPD Knowledge to Action Cycle• Identify a problem that needs addressing Highly effective but greatly underutilized• Identify, review, and select knowledge relevant to the problemDemonstrate value• Adapt this knowledge to the local contextPT vs Nrsg vs RT led respiratory rehab programs• Assess the barriers to using the knowledgeKnowledge of how to do it? Accessibility to equipment? Time?
22An example: Inspiratory Muscle Training & COPD Knowledge to Action Cycle• Design transfer strategies to promote the use of this knowledge• Monitor how the knowledge diffuses throughout the user group• Evaluate the impact of the users’ application of the knowledge• Sustain the ongoing use of knowledge by users
24THE ROLE OF THE KT BROKER Knowledge BrokerDefinitions of ‘Broker”Business person who buys and sells for another in exchange for a commissionA party who mediates between buyer & sellerAn agent involved in the exchange of messages or transactionsDefinitions of ‘Knowledge Broker”:An intermediary who connects individuals to knowledge providersCore function is connecting people to share & exchange knowledgeDr. David Yetman - Knowledge Mobilization Manager, Harris Center
25THE ROLE OF THE KT BROKER Engage stakeholders; promote interactionInvolve partners in knowledge generation& disseminationIdentify championsBuild awarenessBuild relationshipsStrategic communicationFacilitate capacity for ‘evidence-informed’ decision makingIncorporate evaluation to ensure accountabilityDobbins et al (2009). Implementation ScienceDr. David Yetman - Knowledge Mobilization Manager, Harris Center
26THE ROLE OF THE KT BROKER 1. Needs evaluationIdentify knowledge gapsIdentify opportunitiesInventory of resources (current studies, areas of expertise, areas of interest); contact list of researchers & clinicians for specific areas of practice2. AcquireStrategies to acquire ‘best’ knowledgeTools to enhance acquiring knowledge (summary of adv/disadv of search engines, databases and key skills to enhance retrieval)E-alerts of publications*In conjunction with existing infrastructure eg. PABC librarian, UBC Rehab Sciences librarianDobbins et al. (2009). A description of a KTB role implemented as part of a RCTevaluating 3 KT strategies
27THE ROLE OF THE KT BROKER 3. AppraiseStrategies to enhance ability to critically appraise quality of evidenceTools for appraisal of RCTs, systematic reviews, Meta-analyses4. ApplyStrategies to enhance application of clinically relevant evidenceDevelopment of Clinical Practice GuidelinesDevelopment of on-line learning (pre-test, instructional video, e-classroom, post-test)Inclusion into policy (CPTBC)Developing targeted resources*Evidence-informed decision-making!Dobbins et al. (2009). A description of a KTB role implemented as part of a RCTevaluating 3 KT strategies
28PT KTB Deliverables 1. Establish a web presence 2. Facilitate PT clinician / researcher partnerships3. Enhance access to evidence-based learning resources & knowledge products4. Identify & facilitate 1 KT initiative for each funding partner5. 1 joint PT & OT KB activity and share outcomes from all PT KB & OT KB activities6. Provide progress reports & year-end report
29Goals & Deliverables Establish a web presence UBC Dept of Physical Therapy – Knowledge Broker, under ‘Research’PABC – members portion of websiteLinks to other partners
30Goals & Deliverables Facilitate PT clinician / researcher partnerships Identify clinicians for potential partnershipsLink clinicians & researchers for integrated KT and end-of-grant KT collaboration opportunitiesIdentify PT clinicians and researchers for potential clinician / researcher partnershipsLink PT clinicians and researchers for integrated KT and end-of-grant KT collaboration opportunities
31Goals & DeliverablesEnhance access to evidence-based learning resources & knowledge productsIdentify existing & develop new learning resources & online guides to assist clinicians in acquiring, appraising, synthesizing & applying knowledge into practiceProvide on-line access to the learning resources, guides & other knowledge productsIdentify existing and develop new learning resources and on-line guides to assist clinicians in acquiring, appraising, synthesizing and applying knowledge into practiceProvide on-line access to the learning resources, guides and other knowledge products
32Goals & DeliverablesIdentify & facilitate 1 KT initiative for each funding partnerBest practice for arthroplasty patientsUse of outcome measurementBest practice for skin & wound managementGuidelines on when it is safe to mobilize the acute medical or post-surgical client
34Greatest Need- Article alerts - based on area of practice (ortho, neuro, cardioresp)Training on EBP skills- More interest in on-line resources than written resources on how to acquire, appraise and apply evidenceOther needs:- Directory of researchers external to BC for specific areas of practice- Have alerts focus on systematic reviews and CPGs- Access to EBP resources that are clinician friendly- Journal clubs/discussion groups (accessed by videoconferencing) which are specific to practice areas.- Guidance on acquiring, appraising and applying evidence- Directory of resources for assistance with grant writing and statistical analysis- Alerts re upcoming courses- Organizational support: funding for clinician research, allocated time
35Greatest Need- Directory of clinician collaboratorsOther Needs- KT template for grant applications- Linkage to collaborators- Forums to identify research priorities
36Greatest NeedDirectory of clinician collaboratorsOther Needs- Inventory of current research projects- Inventory of effective organizational strategies for increasing EBP- Directory of funding sources- More KB positions
37Best Practice for Joint Arthroplasty Baseline: VCHRI Program Evaluation CourseRegional Orthopaedic Working GroupPRAG Outcome Measures SubCommitteeMSc: evaluationPABCPractice Guideline Advisors GroupCommunications DirectorUBC Faculty sponsor: Dr. Elizabeth DeanCADTH? - Canadian Agency for Drugs and Technologies in Health (CADTH)CESEI? – Center for Excellence in Simulated Education and Innovation
38Best Practice in Skin & Wound Care VCH/PHC Skin & Wound Care PT CommitteeVCH/PHC OT Pressure Ulcer Guidelines – in conjunction with OT KBVCH/PHC Interdisciplinary Skin & Wound Care CommitteePABCPractice Guideline Advisors GroupCommunications DirectorUBC Faculty sponsor – Alison HoensCADTH? - Canadian Agency for Drugs and Technologies in Health (CADTH)CESEI? – Center for Excellence in Simulated Education and Innovation
39Best Practice in Skin & Wound Care 1. To increase the awareness of the role of PTs in prevention & management of skin & wound issues2. To increase the number of PTs who undertake a basic risk assessment & utilize basic interventions3. To increase the number of PTs who know where to find guidance & information on more advanced assessment & interventions
40When is it safe to mobilize the acute medical / post surgical pt? PABCPractice Guideline Advisors GroupCommunications DirectorUBC Faculty sponsor: Dr. Darlene ReidCADTH? - Canadian Agency for Drugs and Technologies in Health (CADTH)CESEI? – Center for Excellence in Simulated Education and Innovation
44Acknowledgements The content of the preceding slides was derived from: Dr. David Johnson “Developing a KT Plan in Grant Applications”CIHR websiteCEBM websiteMcMaster KT+ websiteDr. DP Ryan, Director of Education & Knowledge Translation, Torontorgps.on.ca/slides/knowledgetopracticeprocess.pdf