Knowledge Translation in BC Physiotherapy

1. Knowledge Translation in BC Physiotherapy Alison M. Hoens Physical Therapy Knowledge Translation Broker UBC Dept of PT, FOM; Physiotherapy Association of BC; BC RSRNet (VCH, PHC, BCC&W) Clinical Associate Professor, UBC Dept of PT Clinical Coordinator, Physiotherapy, PHC

2. Objectives • To define & understand knowledge translation • To appreciate why KT is important • To provide a framework for knowledge translation in physical therapy in PT • End of grant KT • Integrated KT • To outline the role of the KT Broker • To identify possibilities for your involvement

3. What is KT? Translational Research (KT1) Knowledge Translation (KT2) Lab Clinical Research Health Care CIHR; Hulley et al, 2007

4. Applied health research Diffusion Dissemination Getting knowledge into practice Impact Implementation Knowledge communication Knowledge cycle Knowledge exchange Knowledge management Knowledge translation Knowledge to action Knowledge mobilization Knowledge transfer Linkage and exchange Participatory research Research into practice Research transfer Research translation Transmission Utilization Many terms, same basic idea …

5. Knowledge Translation CIHR definition • Knowledge translation is the exchange, synthesis and ethically-sound application of researcher findings within a complex system of relationships among researchers and knowledge users.CIHR

6. KT “closing the know-do gap” Know Do

7. But, fails to account for … Ask Answer

8. KT key concepts Ask Answer Know Do

9. Researchers Users • Knowledge translation is about ensuring that: • ‘users’ are aware of and use research evidence to inform their decision making • Research is informed by current available evidence and the experiences and information needs of ‘end users’

10. WHY 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 LBP • 68% of PTs used interventions with strong or mod evidence of effectiveness • 90% used interventions with limited evidence • 96% used interventions with absence of evidence of effectiveness

11. WHY 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: • Experience • Continuing education (practical) • Colleague Influence • Continuing Education (theory) • Professional Literature * secondary sources • Entry Level Training Most impt infuence Least impt infuence

12. BARRIERS • I 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

13. There seems to be little relation between the quality of the evidence and its diffusion into practice (Fitzgerald et al 2002)

14. BARRIERS • Lack 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, 2003. Australian OT Journal, 50, 13-22.) • Relevant literature not compiled all in one place(Closs & Lewin, 1998. Br J of Therapy & Rehab, 5, 151-155). • 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: 645-654).

15. BARRIERS • Information overload • Rich with diversity yet highly chaotic • Need tools/processes that can reliably and sensibly address the info • Agency for Healthcare Research & Quality http://www.ahrq.gov/research/physprac.htm • xx

16. BARRIERS • 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. KT framework ‘Knowledge to Action’ Cycle Ian Graham, VP, KT, CIHR

18. End of grant Traditional approach Knowledge creation by researchers disseminated by publication & presentation Improvements: Targeted messages to key stakeholders More interactive strategies Eg. interactive material; e-classroom Opinion leader Integrated KT Clinician involved in research process from it’s inception Collaboration through research question, study & dissemination Types of KT

19. How effective are variousimplementation 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 interventions

20. What is effective? • Little to no effect • Educational materials • Didactic sessions • Sometimes effective • Audit & feedback • Local opinion leaders • Local consensus project • Patient mediated interventions • Consistently effective • Reminders • Interactive education (with discussion of practice) • Social marketing (Bero et al., 1998, Grimshaw et al., 2001)

21. An example: Inspiratory Muscle Training & COPD Knowledge to Action Cycle • Identify a problem that needs addressingHighly effective but greatly underutilized • Identify, review, and select knowledge relevant to the problem Demonstrate value • Adapt this knowledge to the local context PT vs Nrsg vs RT led respiratory rehab programs • Assess the barriers to using the knowledge Knowledge of how to do it? Accessibility to equipment? Time?

22. An 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

23. THE ROLE OF THE KT BROKER

24. THE ROLE OF THE KT BROKER • Knowledge Broker • Definitions of ‘Broker” • Business person who buys and sells for another in exchange for a commission • A party who mediates between buyer & seller • An agent involved in the exchange of messages or transactions • Definitions of ‘Knowledge Broker”: • An intermediary who connects individuals to knowledge providers • Core function is connecting people to share & exchange knowledge Dr. David Yetman - Knowledge Mobilization Manager, Harris Center

25. THE ROLE OF THE KT BROKER • Engage stakeholders; promote interaction • Involve partners in knowledge generation & dissemination • Identify champions • Build awareness • Build relationships • Strategic communication • Facilitate capacity for ‘evidence-informed’ decision making • Incorporate evaluation to ensure accountability Dobbins et al (2009). Implementation Science Dr. David Yetman - Knowledge Mobilization Manager, Harris Center

26. THE ROLE OF THE KT BROKER • 1. Needs evaluation • Identify knowledge gaps • Identify opportunities • Inventory of resources (current studies, areas of expertise, areas of interest); contact list of researchers & clinicians for specific areas of practice • 2. Acquire • Strategies to acquire ‘best’ knowledge • Tools 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 librarian Dobbins et al. (2009). A description of a KTB role implemented as part of a RCT evaluating 3 KT strategies

27. THE ROLE OF THE KT BROKER • 3. Appraise • Strategies to enhance ability to critically appraise quality of evidence • Tools for appraisal of RCTs, systematic reviews, Meta-analyses • 4. Apply • Strategies to enhance application of clinically relevant evidence • Development of Clinical Practice Guidelines • Development 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 RCT evaluating 3 KT strategies

28. PT KTB Deliverables • 1. Establish a web presence • 2. Facilitate PT clinician / researcher partnerships • 3. Enhance access to evidence-based learning resources & knowledge products • 4. Identify & facilitate 1 KT initiative for each funding partner • 5. 1 joint PT & OT KB activity and share outcomes from all PT KB & OT KB activities • 6. Provide progress reports & year-end report

29. Goals & Deliverables • Establish a web presence • UBC Dept of Physical Therapy – Knowledge Broker, under ‘Research’ • PABC – members portion of website • Links to other partners

30. Goals & Deliverables • Facilitate PT clinician / researcher partnerships • Identify clinicians for potential partnerships • Link clinicians & researchers for integrated KT and end-of-grant KT collaboration opportunities

31. Goals & Deliverables • Enhance access to evidence-based learning resources & knowledge products • Identify existing & develop new learning resources & online guides to assist clinicians in acquiring, appraising, synthesizing & applying knowledge into practice • Provide on-line access to the learning resources, guides & other knowledge products

32. Goals & Deliverables • Identify & facilitate 1 KT initiative for each funding partner • Best practice for arthroplasty patients • Use of outcome measurement • Best practice for skin & wound management • Guidelines on when it is safe to mobilize the acute medical or post-surgical client

37. Best Practice for Joint Arthroplasty • Baseline: VCHRI Program Evaluation Course • Regional Orthopaedic Working Group • PRAG Outcome Measures SubCommittee • MSc: evaluation • PABC • Practice Guideline Advisors Group • Communications Director • UBC Faculty sponsor: Dr. Elizabeth Dean • CADTH? - Canadian Agency for Drugs and Technologies in Health (CADTH) • CESEI? – Center for Excellence in Simulated Education and Innovation

38. Best Practice in Skin &Wound Care • VCH/PHC Skin & Wound Care PT Committee • VCH/PHC OT Pressure Ulcer Guidelines – in conjunction with OT KB • VCH/PHC Interdisciplinary Skin & Wound Care Committee • PABC • Practice Guideline Advisors Group • Communications Director • UBC Faculty sponsor – Alison Hoens • CADTH? - Canadian Agency for Drugs and Technologies in Health (CADTH) • CESEI? – Center for Excellence in Simulated Education and Innovation

39. Best Practice in Skin &Wound Care • 1. To increase the awareness of the role of PTs in prevention & management of skin & wound issues • 2. To increase the number of PTs who undertake a basic risk assessment & utilize basic interventions • 3. To increase the number of PTs who knowwhere to find guidance & information on more advanced assessment & interventions

40. When is it safe to mobilize the acute medical / post surgical pt? • PABC • Practice Guideline Advisors Group • Communications Director • UBC Faculty sponsor: Dr. Darlene Reid • CADTH? - Canadian Agency for Drugs and Technologies in Health (CADTH) • CESEI? – Center for Excellence in Simulated Education and Innovation

41. Needs Assessment

42. Needs Assessment

43. Needs Assessment

44. Acknowledgements • The content of the preceding slides was derived from: • Dr. David Johnson “Developing a KT Plan in Grant Applications” www.ahfmr.ab.ca/download.php/1ad4799af7bd4c0810fcaf2d571272f • CIHR website • http://www.cihr-irsc.gc.ca/e/39128.html • http://ktclearinghouse.ca/ • CEBM website • www.cebm.net • McMaster KT+ website • http://plus.mcmaster.ca/KT/Default.aspx • Dr. DP Ryan, Director of Education & Knowledge Translation, Toronto • rgps.on.ca/slides/knowledgetopracticeprocess.pdf