How to Improve Knowledge Translation in Stroke Rehabilitation: A View from Occupational Therapy Practice

This is so simple to solve. The occupational therapists write up their interventions into a stroke protocol. Publicly available database. Then as other OTs use it they will write corrections, updates and clarifications.  Right now all I bet they are using are guidelines. Guidelines tell you almost nothing useful.  PROTOCOLS PEOPLE, GET IT DONE.
http://blogs.brighton.ac.uk/bjrhs/2017/06/21/how-to-improve-knowledge-translation-in-stroke-rehabilitation-a-view-from-occupational-therapy-practice/

Category: issue 1, volume 3 Tags: Evidence based practice (EBP), Knowledge translation (KT), KT strategies, Stroke rehabilitation Leave a Comment

Abstract

Background/Aims

The study explores the experience and views of occupational therapists in stroke rehabilitation regarding knowledge translation. The apparent knowledge translation gap is described as the delay of use of research evidence into clinical practice.

Method

A qualitative, descriptive research design was used. The verbatim transcripts of the interviews with special section neurology practice (SSNP) occupational therapists were coded and analyzed using thematic analysis.

Findings

The themes identified included 1) how occupational therapists responded to change, 2) how knowledge translation barriers could be seen as learning needs and may lead to empowerment, 3) the use of knowledge translation strategies and professional body support.

Conclusion

Knowledge translation barriers need to be identified in each single environment in order to recommend solutions. To improve knowledge translation training is needed in time management, coping strategies, assistance through supervision and managerial involvement to prevent workplace burn out.  Personal initiatives must become natural, and networking similar to ‘communities of practice’ may keep healthcare professionals ahead of change. Learning needs appear to exist for clinicians and researchers., and improving knowledge translation in the future lies in personal initiative, innovation and involvement.

Introduction

Graham (2006) highlighted that new developments in health research are often a delayed and the process is uncoordinated, resulting in patients not receiving the optimum interventions due to the late transfer of new knowledge into practice. The definition of knowledge translation (KT) by the World Health Organization (WHO, 2005) is “the synthesis, exchange and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health”. Knowledge translation in other words is the bridge between discovery and impact of evidence (Tetroe, 2008) and, as it has developed, it has been adopted by nursing, medicine and public health. The word knowledge used in the KT context means primarily scientific research (Graham, 2006).

Literature Review

Evidence- Based Practice       

“Evidence-based practice (EBP) is essentially a clinical decision making framework that encourages clinicians to integrate information from high quality quantitative and qualitative research with the clinician’s clinical expertise and the client’s background, preferences and values when making decisions” (Sackett et al. 1996, p. 71). Evidence-Based Practice (EBP) is seen as an essential part of the day to day work of occupational therapists (OT) and other health professionals.
 The results from a multidisciplinary team study by Humphries et al. (2000) suggested that occupational therapists want to base their practice on research outcomes but find the ever-growing amount of evidence difficult to manage. Additionally, they highlighted time restrictions, workload pressures and staff shortages as barriers to evidence-based practice. Over a decade later similar factors remain on the list of barriers (Menon et al., 2010; McCluskey et al., 2013). Therefore, for EBP to work the theory-practice gap has to be bridged by developing KT strategies (Graham, 2006).

 KT and EBP

KT has developed immensely over the last twenty years (Grimshaw et al., 2012) to translate evidence into practice.  Kielhofner (2005) explored the vast field of stakeholders involved in KT and suggested that more cooperation and teamwork between researchers and clinicians would facilitate more effective KT. Bayley et al. (2012) recommended that guideline developers set priorities in the way they transfer evidence into guidelines and employ easy to use language.
Jansen et al. (2012) performed a cross-sectional survey using focus groups and a two-round Delphi process to explore barriers to KT. The sample included 166 clinicians with varying academic degrees and professional backgrounds. Lack of time, access and the skills to use and appraise evidence-based literature were cited as barriers for clinicians not being up to date with the latest research. Although there was a low response rate of 38%, results highlighted that the allied health professionals (AHP) which included over 10 disciplines (occupational therapists, physiotherapists, dieticians, social workers and speech pathologists) used their colleagues and own experience as their most frequent evidence base, a finding supported by McKenna et al (2005) with occupational therapists. While physiotherapists had more positive results due to having adequate equipment, the occupational therapists reported missing relevance to practice in articles and lacking equipment at workplace to implement research into practice.
McCluskey and Middleton (2010) with community rehabilitation teams, Wilkinson (2012) with allied health staff, and Hughes et al. (2014) with healthcare professionals demonstrated that EBP had not been fully put into practice by the allied health professions. Solutions were identified as a need to change the behaviour of the allied health professions, more training in EBP and involvement in research, but also support from management. In summary, these studies have highlighted that similar barriers to KT still exist in contemporary practice. Suggestions to improve KT have included using peer support networks to promote EBP, and more equipment and training to improve access to research and in appraising information on the web.
The Health and Care Professionals Council (HCPC) requires health professions to maintain standards of proficiency and conduct which include the use of evidence-based practice in order “to be able to draw on appropriate knowledge and skills to inform practice” (HCPC, 2014, p. 12). Clinical guidelines are developed based on research evidence to advise health professionals in their practice. Some guidelines such as the National Clinical Guidelines for Stroke (NCGS) and the International Classifications of Functioning, Disability and Health (ICF) were developed to guide practice of healthcare professions working in neurorehabilitation settings. Hammond et al. (2005) utilized a retrospective audit to determine whether occupational therapists and physiotherapists showed complete compliance with the NCGS and found that there was surprisingly low adherence to them with more than 40% of admitted patients not seen within the recommended time frame, although the reasons for this lack of implementation were not explored. Wiseman-Hakes et al. (2012) highlighted the importance of considering context in EBP and KT and suggested a wider perspective in the definition of EBP.  In a suggested list of ‘key questions’ for EBP they asked for the reasons why recommended interventions worked in a study, under which conditions they worked, for which clients and at what point of their progress they were applicable? The answers to the key questions could provide better information to clinicians and thereby support correct and easier implementation. In summary, although health research evidence is part of policy and guidelines, health professionals still utilize other factors as part of the clinical reasoning process to discern the relevance of this evidence, for example, empirical knowledge and individual patient context, including their preferences, vulnerabilities and co morbidities  (Benner, Hughes & Sutphen, 2008).

Much more at link.