Lost in Knowledge Translation

Abstract

As academic and clinical educators, we accept the responsibility of being advocates of evidence-based practice in our profession. We are uniquely equipped to tackle the complex process of knowledge translation from evidence to practice. Academic faculty monitor new evidence and include the relevant knowledge and skills in classroom. Clinical educators oversee the development of the practice skills that support use of the new evidence in patient care. Only if both groups of educators embrace their role in implementing best evidence does change actually occur. There are age-old claims that physical therapy academic faculty don't know what is relevant and aren't teaching the correct principles, or that the clinical faculty are set in their ways and won't accept new evidence. Continuing to point fingers at each other will accomplish very little. Instead, we need to examine evidence about adoption of the evidence! Two authors in this issue have conducted research to document the barriers to providing physical therapist students with the needed time in the clinic to practice their manual therapy skills of thrust joint manipulation (TIM). They both build their work around the evidence that shows that T]M is a safe and effective intervention for specific patient populations13 and that it is now a standard component of physical therapist education.4'5 These authors find that students report academic education in TIM, similar to the results reported by Boissonault5 who documented an increase of content on TIM in academic programs. Struessel et al studied 460 physical therapist students who reported that their clinical instructors' limited practice of joint manipulation skills influenced their ability to practice these skills during clinical education. Sharma and Sabus studied 48 students and found similar results. Based on this evidence, we appear to have a situation where content has been added to academic programs, but may not be implemented in clinical settings. This, however, is not the end of the story. Boissonault's commentary reminds us to consider the limitations of these studies, (which were based on student perspectives), the need for a better understanding of the barriers to implementation, and the need for research about adoption of evidence-based practice across the continuum of care. Educational researchers need to expand both the quantity and diversity of design in studies focused on the translation of research findings into practice. These research studies need to examine perceptions of all parties, document actual behaviors, and assess the impact of change to clarify the complex issues related to adoption of joint manipulation, or any other change in practice. …