Translating knowledge in rehabilitation

Article Reviews
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Read Full Text: Translating knowledge in rehabilitation: Systematic review (Free to access)
Journal: Physical Therapy (2018 Impact Factor 2.53)
Year Published: 2015
Ranked 46th on our 2014-2019 list of the 50 most influential articles

Based on my work for the OT Potential Club, I know that about 1,000 articles that refer to occupational therapy are published every year.

The sheer amount of information being released annually makes it challenging enough to keep up with the latest research.

To make things even more difficult, this week’s article shows us that the best strategies to actually translate all that new knowledge into our clinical practice remains largely unknown.

When the authors of this article sought out information about knowledge translation in rehab, they found articles with predominantly modest to low methodological quality. Overall, this highlights the need for more rigorous research on this important topic.

(After all, what’s the use of all that research coming out if we can’t translate into practice?!)

That being said, this article did give us some good news. That includes a good look at what we suspect works best—and it should feel similar to the other research we have read about learning theory:

Passive strategies (like simply giving out education materials) do not seem to stick.

The good news is that active, multi-faceted approaches hold much more promise.

So, let’s dive in!

What exactly is knowledge translation?

The phrase “knowledge translation” attempts to capture the “complex systems of interactions and engagement factors” that influence clinical behaviors and outcomes.

The simplest way the article said it was:

“Knowledge translation is an active process that facilitates the introduction of new evidence into practice and may identify optimum strategies to close the gap between research and clinical practice.”

In other words, it’s how we take all that convoluted, technical research
and actually put it into practice.

Why is knowledge translation important?

The article does not belabor this point, but does remind us that knowledge translation should, hypothetically, be a basic competency for all rehab therapists.

On a personal note, my favorite reads about the gap between research and practice is the article, When Evidence Says No, But Doctors Say Yes.

What are barriers to knowledge translation?

You are probably personally familiar with the barriers to applying evidence to practice. The article identifies some of the barriers as:

  • Institutional barriers
  • Resistance to change
  • Lack of confidence in evaluating the evidence

What types of research did the authors find about knowledge translation?

In their systematic review of research, the authors located 26 studies that looked at knowledge translation in rehab.

Seven studies targeted occupational therapy.

Three studies looked at occupational therapy and physical therapy.

18 of the 24 of the articles examined multiple knowledge translation interventions, as opposed to singular approaches.

Examples of knowledge translation strategies included:

  • Educational meetings
  • Educational material
  • Educational outreach visit
  • Reminders
  • Local opinion leaders
  • Audits
  • Feedback
  • Local consensus

Primary outcomes the studies looked at included:

  • Professional/process outcomes
  • Patient outcomes
  • Economics outcomes

What were the results?

Fewer than half of the quantitative studies showed a consistent effect on the primary outcome measures.

Notably, two studies did show a consistent, significant positive effect on primary outcomes. Both of these studies used multicomponent knowledge translation strategies.

And yet, given the limited information, the authors concluded that “the effectiveness of single or multi component interventions is not clearly delineated.”

This conclusion was also influenced by the fact that the studies were largely rated as having low to modest quality.

Takeaways for OT practitioners

(These are my personal takeaways, and were not mentioned in the article.)

1. My hope is that the OT Potential Club helps you actively engage with research in a multifaceted way.

For us at OT Potential, this research really highlights the problem that we are striving to help you address with the Club.

Translating evidence into practice is hard.

But, we believe that OTs are uniquely poised to be leaders in knowledge translation. Our holistic and agile thinking, along with our knowledge of what behavior change entails, uniquely positions us to evaluate and modify our own behavior.

Not to mention, OT is a much smaller field than, say, general medicine. And that means that the amount of evidence related to our profession is much more manageable—and we should have an easier time incorporating it into our clinical practice.

2. Personally, I hope to see updates to our continuing education requirements—specifically, ones that require more active learning.

NBCOT is nudging us that way, but I would like to see an approach like that undertaken by PAs.

I like that NBCOT is attempting to nudge practitioners toward more active continued competency through the NBCOT Navigator. If you are not familiar with the Navigator, it offers case simulations and practice quizzes to assess your knowledge across various clinical settings.

More and more states are accepting Navigator activities as CEUs.

However, the continued competency advance that impresses me the most is in the physician assistant ¶ world. PAs can now take advantage of a performance improvement component in their continued competency. This allows them to receive continuing education credit for implementing a quality improvement program (and evaluating its effectiveness) within their specific setting. Now, that is knowledge translation!

Listen to my takeaways in podcast form:

Find other platforms for listening to the OT Potential Podcast here.

(Possibly) Earn CEUs/PDUs for reading this article

Many of you can receive continuing education credits for reading this article. Here’s a form to help you do it, along with information to help you understand who qualifies.

And, here’s the full APA citation you might need:

Jones, C. A., Roop, S. C., Pohar, S. L., Albrecht, L., & Scott, S. D. (2014). Translating Knowledge in Rehabilitation: Systematic Review. Physical Therapy, 95(4), 663–677. doi: 10.2522/ptj.20130512

What questions/thoughts does this article raise for you?

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Interesting article. As OT practitioners, our practice generally includes patient/family education designed to change routines or promote health. But as a profession, we appear to lack methods of teaching ourselves best practice/evidence-based advances in our profession. Or is it we do not assess our methods of teaching and learning related to the translation of knowledge?
Sarah, I think your method of encouraging practitioners to read and discuss the latest research articles is supported within this systematic. The authors note ‘that active multi-component KT strategies were effective in physical therapy knowledge and practice behaviors. We also found that active multi-component strategies were used in physical therapy and occupational therapy yet few in speech-language pathology’ (Jones, Roop, Pohar, Albrecht, & Scott, 2014, p.674). The OT Potential journal group uses a multi-component approach each week: read, think, post, question, and read other’s thoughts. I found the use of the COPM insightful. I wonder about the motivation of therapy or rehabilitation practitioners to stay current and not continue the same old approaches based on experience instead of considering new methods and approaches. This study had significant outcomes so I am thinking understanding motivation is important to practitioners. We already apply this to practice.
So I joined OT Potential because I am motivated to change. I want to know what the research says and ultimately want to create the best interventions to meet my client’s needs. Strong evidence-based practice to me = better client outcomes. I would further advocate that the methodology used each week by participants of the club would create a great study. Each week, I am challenged to think about what I do and why from a clinical perspective. The challenge also includes considering what the research says regarding practice. I find the weekly discussions stimulating, refreshing, and validating, depending on the week. Why did others of you join? What is your motivation?
From a practice standpoint, I think this article substantiates the need to have a multi-component to our patient education. Some facilities and health care practices actively use the Teach-Back Method, demonstration, or another interactive method to assess learning. Clients are learners, and understanding phases of learning, Acquisition, Retention and Generalization or transfer to their environment is needed to create change.
Jones, C. A., Roop, S. C., Pohar, S. L., Albrecht, L., & Scott, S. D. (2014). Translating Knowledge in Rehabilitation: Systematic Review. Physical Therapy, 95(4), 663–677. doi: 10.2522/ptj.20130512

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Thanks for this summary Sarah. You’re a shining example of someone trying to make the translation happen and I think you are definitely achieving your first point. You’ve created a novel, interesting and engaging way to get involved in reading, discussing and challenging our knowledge as practitioners, so thanks!

Over my recent career, in the clinic I work in I’ve noticed that “bottom up” change is almost always more effective than “top down”. In the context of knowledge translation, I believe strongly that the desire needs to come from each of us individually to seek out new “stuff”, challenge our beliefs and biases and make change in our own practice. You can’t really force information into people’s minds or practice, and incentives only work so far. The focus probably needs to be on on how interest individual OTs in shifting their practice, and maintain that curiosity - in a genuine way, not just to fulfill requirements.

The sample of people who visit this site is a bit skewed - because obviously we care about this stuff. The thing I’ve struggled with more is how to get people who are ambivalent more engaged in the process of learning. Maybe that too comes down to an individual basis: trying to serve as an example, as an inspiration or leader in your own workplace or context and get other people fired up (or get them to join the club
).

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@DevonCochrane I agree that we do have an amazing sampling of therapists in this group! I’ve been so inspired meeting new therapists in this group over the past year - it really has given me hope for the future of rehab!

I hear what you are saying about struggling with therapists that appear more ambivalent. I choose to believe that the vast majority of therapists truly want what is best for their patients, and I understand in some ways why they have given up on evidence based practice. I saw a lot of such comments on this post on social medial just a week ago: Why I’m at Odds with Evidence Based Practice.

I think part of the reason therapists are skeptical of EBP is that they haven’t seen the fruits of it in their own practice. And, honestly we have not been set-up for success to implement changes in our practices.

But, I’m watching our MD colleagues and the successful outcomes they are having from using EBP databases like UptoDate (which I think you introduced me to, @DevonCochrane), and I think we need to be trying to create something similar for OTs. We need to be able to quickly survey evidence, but also be able to dig deep into nuance of new research. Obviously, this is something that I am hoping to build with the OT Potential Club, and any feedback is welcome :slight_smile:

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When I read this article and the review I can instantly relate to knowledge translation. Personally I feel the importance in preventing burn out. I know working in one facility/clinic/home and all settings for a long time can be routine but I think when you read articles and talk with peers it can be inspiring. Very much like this club!

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I love that you highlighted this article Sarah! Knowledge translation is something that has interested me since I began my program in occupational therapy. I’ve spent a great deal of time and dedicated my doctoral work to studying knowledge translation in our field and how new avenues of research dissemination could help narrow the gap between evidence and practice. The top barriers I have found in implementing research into practice are: 1) Lack of access to current evidence due to paid subscriptions to journals and professional organizations, 2) a misunderstanding of scientific writing and validity and 3) a lack of clear clinical recommendations and applications in scientific literature. I think OT Potential does a great job at addressing these barriers and agree that occupational therapists are poised to help make research more accessible, consumable, and applicable to what we do every day.

It makes sense that more active avenues of knowledge translation lead to the most lasting impact, but I also wonder how much time busy practitioners have to be actively engaged in knowledge translation. I feel like the last thing someone wants to do after a ten hour day of client care is to search for the latest evidence in scientific journals. That’s one reason I’m currently studying how Podcasts could be an effective way to promote research dissemination and the implementation of best practices. Podcasts are a passive way to consume information, but since they can be done while commuting, exercising, cleaning, or during most daily activities I think they could help increase exposure to research and hopefully inspire change to practice! I would love to update anyone who is interested on some of the findings of my current study when we begin to collect data!

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You know I definitely want to see this research, @matt :slight_smile:

I’ve been working on doing a brief survey when people enter the Club. I’m thinking my questions will be:

1.) How often do you currently look at primary research?
2.) How confident are you in your ability to decipher and translate research?
3.) How many different types of standardized assessments do you use in a given week?

My hope is then to ask people after a year after being in the Club to see if their answers have changed. What do you think of this @Matt, based on the thinking you’ve done on knowledge translation?

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I think those are the perfect type of questions for beginning to study knowledge translation. Each of those questions is self-report and based on practitioner’s perceptions of their own practice. I think that can provide valuable qualitative data that can guide what aspects of knowledge translation to focus on in collecting even more data moving forward.

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When I first saw this article, it made me think of my teacher always telling us that we need to teach out clients and others about OT and what OT is all about. It is very important though that we continue to educate and learn new things ourselves, so the patients we will have can receive the best care!

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Hi Sarah, I thought that this article was extremely interesting! I really enjoyed your summary of the article as well. It really helped break down some of the concepts for me. One thing that I would like to discuss is is your first takeaway that you mentioned. Being able to use OT Potential club as a way to actively engage with research in a multifaceted way- I think this is great. I can already see it making an impact from a student’s perspective. By trying to bridge the gap between research and the clinical practice itself this is a great way not only to get new ideas but to learn about the research itself and collaborate with others!