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
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
What is KT?
Translational
Research
(KT1)
Lab
Knowledge
Translation (KT2)
Clinical
Research
Health
Care
CIHR; Hulley et al, 2007
Many terms, same basic idea …
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
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
KT “closing the know-do
gap”
Know
Do
But, fails to account for …
Ask
Answer
KT key concepts
Ask
Do
Answer
Know
Researchers
 Knowledge
Users
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’
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
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:
Most impt infuence
 Experience
 Continuing education (practical)
 Colleague Influence
 Continuing Education (theory)
 Professional Literature * secondary sources
 Entry Level Training
Least impt infuence
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
 There
seems to be little relation
between the quality of the evidence and
its diffusion into practice (Fitzgerald et al 2002)
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).
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
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)
KT framework
Knowledge-to-Action Cycle
Monitor
Knowledge
Use
Synthesis
Adapt
Knowledge
to Local Context
ow
led
ge
Knowledge
Inquiry
Products/
Tools
Evaluate
Outcomes
Kn
Assess
Barriers to
Knowledge Use
KNOWLEDGE CREATION
Ta
ilor
ing
Select, Tailor,
Implement
Interventions
Sustain
Knowledge
Use
Identify Problem
Identify, Review,
Select Knowledge
Graham et al., 2006
‘Knowledge to Action’ Cycle
Ian Graham, VP, KT, CIHR
Types of KT

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
How 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 interventions
Intervention
Number of
CRCTs
Range
Median
effect size
Educational
materials
4
+3.6%, +17.0%
+8.1%
Audit and
feedback
5
+1.3%, +16.0%
+7.0%
Reminders
14
–1.0%, +34.0%
+14.1%
What is effective?

Little to no effect



Sometimes effective





Educational materials
Didactic sessions
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)
An 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 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?
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
THE ROLE OF THE KT BROKER
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
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
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
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
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
Goals & Deliverables
 Establish



a web presence
UBC Dept of Physical Therapy –
Knowledge Broker, under ‘Research’
PABC – members portion of website
Links to other partners
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
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
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
D
D
ire
ct
o
RESOURCES
s
s
ch
er
s
ch
ar
ea
rc
e
rc
e
se
ar
ar
re
ry
-re
se
nt
tic
e
ou
re
s
ou
re
s
ts
-p
ra
c
en
e
ry
-c
ur
re
al
er
ire
ct
o
Ar
tic
le
lin
W
rit
t
O
n-
PERCENTAGE OF
RESPONDENTS
CLINICIAN NEEDS
80
70
60
50
40
30
20
10
0
Not at all interested
Mildly interested
Moderately interested
Very interested
70
60
50
40
30
20
10
0
RESOURCES
Directory researchers
& area
Inventory current
projects
KT template
for grants
Directoryadministative
collaborators
Directoryclinician
collaborators
PERCENTAGE OF
RESPONDENTS
RESEARCHER NEEDS
Not at all interested
Mildly interested
Moderately interested
Very interested
80
70
60
50
40
30
20
10
0
Not at all interested
Mildly interested
Moderately interested
RESOURCES
Directory clinician
collaborators
Directory researcher &
areas
Very interested
Inventory current
projects
PERCENTAGE OF
RESPONDENTS
ADMINISTRATORS NEEDS
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
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
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 know
where to find guidance & information on
more advanced assessment & interventions
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
Clinician Needs
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Not at all interested
Mildly interested
Moderately interested
Resources
Directoy of
researchers
Directory of
current
research
Practice
specific
journal alerts
Written
directions
for EBP
Very interested
On-line
training for
EBP
Percentage of Respondents
Needs Assessment
Resources
Directoy of
researchers
Directory of
current
research
KT template
for grants
Directory of
administrative
collaborators
Directory of
clinician
collaborators
Percentage of respondents
Needs Assessment
Researcher Needs
60
50
40
30
20
10
0
Not at all interested
Mildly interested
Moderately interested
Very interested
Needs Assessment
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Inventory of current
research
Resources
Very
interested
Moderately
interested
Mildly
interested
Inventory of researchers
Not at all
interested
Percentage of
Respondents
Administrator Needs
Directory of clinician
collaborators
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