Translating knowledge and beyond in SCI rehabilitation

1. Translating knowledge and beyond in SCI rehabilitation Janice Eng, PhD, BSc(PT/OT) Dept of Physical Therapy, University of BC, Vancouver, Canada GF Strong Rehab Centre & International Collaboration on Repair Discoveries

2. Lack of knowledge translation in clinical practice Peer reviewed journals are rewarded as the traditional method of knowledge translation Consistent failure to translate research findings into practice Gap between what care people should receive and care they do receive What percent of time are treatments of proven effectiveness not provided? 15% 45% 75%

3. Lack of knowledge translation In US: 45% of time, treatments of proven effectiveness not provided McGlynnet al. 2003, N Engl J Med 20% of patients get care that is potentially harmful Schuster et al. 1998, Milbank Quarterly

4. Knowledge translation in SCI: From the literature to changing practice • Knowledge translation is the synthesis, dissemination, exchange and ethically-sound application of research findings among researchers and knowledge users

5. KT requires a body of evidence-based info Individual studies rarely by themselves provide sufficient evidence for policy or practice changes Individual studies are often misleading or conflicting

6. Early highly positive results often contradicted1/3 were contradicted or less effective

7. Why is research not translated to practice? 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) Relevant literature not compiled all in one place(Closs & Lewin, 1998. Br J of Therapy & Rehab). 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).

8. Knowledge Synthesis Knowledge syntheses are the cornerstone of knowledge translation because they transform vast libraries of scientific literature into knowledge that is reliable, relevant and readable for knowledge users.

9. Knowledge to Action Cycle

10. www.scireproject.com One Solution to Knowledge Synthesis

17. Body-weight Support Treadmill Training What’s the evidence? Does body-weight support treadmill training improve gait outcomes?

18. Levels of Evidence • Level 1a > 1 Rigorous RCTs (PEDro ≥ 6) • Level 1b 1 Rigorous RCT • Level 2 RCTs (PEDro 5), non-randomized prospective controlled studies • Level 3 Case-control studies • Level 4 Pre-test/post-test studies, case series • Level 5 Observational, case reports, expert consensus opinion

19. Body-weight Support Treadmill Training There is level 3 evidence (Wernig et al. 1995) using historical controls that BWSTT is effective in improving ambulatory function. However, stronger evidence from two level 2 RCTs (Dobkin et al. 2006; Hornby et al. 2005a) demonstrates that BWSTT has equivalent effects to conventional rehabilitation consisting of an equivalent amount of overground mobility practice for gait outcomes in acute/sub-acute SCI.

20. Over 1/2 million downloadsfrom 174 countries (US, Canada, UK, Australia, India) • 150 presentations • 50 peer-reviewed publications A new model of knowledge dissemination

21. Can access to knowledge improve practice? Clinician Evaluation (n=92)

22. SCIREKnowledge Platform www.scireproject.com Knowledge Translation Standards of Care Priority Setting • Dissemination of evidence • Educational Modules • Outcome Measure Standardization (Toolkit) • Practice Guideline Development • Implementation of Best Practice Research & Strategic Funding Priority Setting