#75: Knowledge Translation and OT with Tim Dionne

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Full Course Details: Public course page
Learn more about our guest: Tim Dionne, PhD, OTR/L

:white_check_mark: Agenda

Intro (5 minutes)

Breakdown and analysis of journal article (5 minutes)

Discussion on practical implications for OTs (50 minutes)

  • 00:11:11 How Tim became interested in knowledge translation?
  • 00:14:54 OT-brain and knowledge translation
  • 00:17:54 Article impressions
  • 00:27:55 Visualizing knowledge translation
  • 00:32:40 Knowledge translation success stories?
  • 00:36:40 How to find the right evidence to implement
  • 00:46:58 Where do clients fit in knowledge translation?
  • 00:49:06 Advice for an individual OT who wants to get better at knowledge translation
  • 00:52:50 How is AI going to change knowledge translation?

:white_check_mark: Supplemental Research

:white_check_mark: Article Review

Read Full Text: Knowledge Translation Research to Promote Behavior Changes in Rehabilitation: Use of Theoretical Frameworks and Tailored Interventions: A Scoping Review
Journal: Archives of Physical Medicine and Rehabilitation
Year Published: 2022

What tipped me over into starting the OT Potential Club was finding a research article with a protocol for POTS that I still credit with saving me from two years of debilitating symptoms.

I knew there were more gems like this that could help so many others—but they simply weren’t making it into practice.

In fact, it takes an average of 17 years for new evidence to enter into clinical practice.

The fields of knowledge translation and implementation science have emerged to change this. Today, we are looking at a scoping review of rehab-focused knowledge translation research.

To be frank, I think this article is pretty convoluted. (Which is funny since it comes from researchers who are interested in knowledge translation. :thinking:) But, it certainly gives us a good jumping-off point to talk about the challenges surrounding knowledge translation—and the clear need for innovation in this field.

Next week, we’ll welcome Tim Dionne, PhD, OTR/L, to the podcast. His research centers on supporting therapists in quality care delivery through the dissemination of knowledge and implementation research methods.

Let’s dive in.

What is knowledge translation?

Knowledge translation is a complex, yet fundamental aspect of rehabilitation care.

We all engage in knowledge translation anytime we put what we know into practice. But often, this process happens subconsciously.

In its ideal form, knowledge translation is a dynamic and iterative process for:

  • Digesting the best evidence.
  • Applying it.
  • Sharing about it.

In a perfect world, this process:

  • Involves the best evidence from systematic reviews and clinical practice guidelines.
  • Is guided by sound theoretical frameworks.

Theory and knowledge translation

There are multiple theories to help individuals translate new knowledge based on their local circumstances and barriers.

There is also an abundance of high-quality systematic reviews that evaluate the effectiveness of different knowledge translation strategies, but most of them focus on nursing and physical medicine.

Rehabilitation, on the other hand, suffers from a distinct lack of systematic reviews of knowledge translation research. Which leads us to this paper…

What was the intent of this paper?

The aim of this research was to explore how theories, models, and frameworks are used to guide knowledge translation for rehab professionals (e.g., OTs, PTs, and SLPs).

Specifically, the authors examined the theories, models, and frameworks used to guide:

  • The overall knowledge translation process
  • Barrier assessment and intervention development
  • Evaluation of outcomes

What were their methods?

Studies were included in this scoping review if they:

  • Were published from 2010–2020.
  • Evaluated OT, PT, and/or SLP behavior change after a knowledge translation intervention.

The authors first identified the theories and models used in each study.

Then, they mapped each theory and model to the 73 knowledge translation strategies described in the Expert Recommendations for Implementing Change (ERIC) project.

Results

56 studies were included in this review. (And, 22 of them involved OT!)

The use of specific theoretical frameworks

16 of the 56 studies included the use of a specific theoretical framework to guide knowledge translation. Some used more than one framework.

But, one framework stood out as the clear favorite, with 13 studies citing it:

The Knowledge-to-Action Framework

1003×997 129 KB

Barriers to identification and implementation

39% of included studies reported using barrier assessments to tailor interventions. Most were conducted informally, and only 4 articles articulated how they used the information to select specific strategies.

18 specific knowledge translation strategies were identified:

  1. Educational Meeting/Outreach
  2. Education Material
  3. Model/Simulate Change
  4. Tailor Strategies
  5. Barrier Assessment
  6. Reminders
  7. Ongoing Consultation
  8. Facilitation
  9. Train the Trainer
  10. Prepare Champions
  11. Change Record Systems
  12. Mandate
  13. Local Consensus Discussion
  14. Ongoing Training
  15. Audit and Feedback
  16. Learning Collaborative
  17. Revise Professional Roles
  18. Obtain Formal Commitments

Outcomes

Outcomes of tailored knowledge translation interventions were most frequently measured using chart audits (50%) and questionnaires (41%).

No studies used a formal evaluation framework (e.g., PRECEDE-PROCEED), as is often the case in the literature for nurses or physicians.

Discussion

The authors of this paper suggest that their findings contribute to the field of knowledge translation in 4 important ways.

Three relate directly to their stated intent:

  1. Identifying that the majority of research uses a single framework to guide all stages (most frequently, the Knowledge-to-Action Framework).
  2. Identifying that there is a lack of detailed reporting of local barrier assessment.
  3. Identifying the need for more rigorous outcome evaluation in knowledge translation.

Their final takeaway, though not something they set out to explore, is important to highlight nonetheless: The authors state that when choosing which best practices to implement, decisions are often based on local knowledge synthesis rather than clinical practice guidelines or systematic reviews. On one hand, this is surprising—as 1 in 11 Cochrane Reviews are on rehabilitation interventions. However, a 2020 review of 544 clinical practice guidelines in rehab found that their applicability is limited.

Takeaways for OT practitioners

(Please note: These are my personal takeaways. They are not mentioned specifically in the article.)

Takeaway #1: We need more clinician-friendly knowledge translation tools.

I spent a lot of time researching the different resources mentioned in this article, but honestly, they did not feel very clinician friendly. Many of today’s knowledge translation resources are geared toward large systems—not individuals or small groups.

That’s why I’m so thankful to be hosting a capstone student who is working on distilling these resources down for OTs!

Takeaway #2: We, as clinicians, need more lists of reputable clinical guidelines.

It did not surprise me at all that most of the implemented best practices resulted from local knowledge synthesis. Our work is complex, and we often have to synthesize multiple resources. That being said, I do think OTs should be aware of the clinical guidelines that exist—though I’m not sure if those have been compiled anywhere. If you know, please tell me in the comments!

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Please share any other feedback below! Including, ideas for future programming, and most importantly, how you feel this podcast will impact your practice!

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I learned a lot from this article and have been wondering my whole career how to best implement translation of knowledge particularly in those O.T positions where there is limited learning collaboration, time and resources available. MIght O.T.'s adopt a similar approach as in the case of nurses and physicians of Precede-Proceed in a more formal manner. This could be in our future.

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Yes! You are not alone in wondering this. I honestly have been pretty surprised as I dug into knowledge translation/implementation resources how little of it seems geared towards clinicians in the type of settings you describe.

I feel SO lucky that our capstone student, @alana1 has been creating resources to move this conversation forward. I can’t wait to share them with you all!

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We learn in school that we are an evidence-based practice. However, researching and implementing knowledge are often put on the back burner, especially with time limitations. Your personal takeaways are accurate, and how many OTPs are feeling.

I just listened to an article from AOTA called “Everyday Evidence: 50 Studies Every Occupational Therapist Should Know” where the host was met with Beth Pyatak and Elissa Lee who published “50 Studies Every Occupational Therapist Should Know.” They discussed the studies chosen and provided tips, tricks, and recommendations for OTPs to use evidence in the clinic effectively. The 50 studies also allow for a quick and concise review of important evidence in various practice settings to improve overall knowledge. This podcast and their published work seems to start to dive into clinician-friendly knowledge translation tools, but further work is needed to ensure dissemination of this knowledge and to determine effectiveness of carryover into clinical practice.

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Hi @grace12 oooo! Great call out! I think I listened to that episode as well. Linking below for others to reference.

@alana1, I’m wondering if we should scan this book to see if there are any guidelines to include in our EBP post!

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Two cents from an EBP and research nerd:
I feel like this article and the discussions about TMF for KT won’t light a fire for the practicing therapist. It reminded me of honors-level epistemology and theory debates from my college days. I think my focus is more on the ground level of how can we engage and support practicing therapists in the field to actively seek, share and digest current research. I am lucky to work in an organization with access to a large group of OT/PT and SLP and to be able to have journal clubs, EBP committees and pretty simple methods of access to share and discuss evidence/research with a large number of therapists.
I am passionate that our profession actively moves forward to learn and apply knowledge (to avoid the 17-year knowledge-to-practice gap that Sarah referenced!)- but I will admit that the critique of HOW we do KT is less motivating to me than starting at the ground up with identifying the barriers to KT and then implementing solutions. With the ever-advancing connections that technology/social media provide, there are so many untapped or underused ways to support KT. This club is a wonderful example of a tool for KT that didn’t exist when I started practice in 2000!

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