Training model for promoting translation from research to clinical settings: University of Alabama at Birmingham training for constraint-induced movement therapy

Abstract

INTRODUCTION A common challenge in stroke rehabilitation research is the translation of research findings into the clinical setting. Multiple factors present obstacles to dissemination and adoption, including the complexity of the physical rehabilitation protocols and the shift in practice required by treatment philosophies that require innovative approaches. The Constraint-Induced Movement (CI) Therapy Research Group (CITRG) at the University of Alabama at Birmingham (UAB) has developed and conducted a 5-day training program for clinicians and researchers that has been delivered semiannually since 2005. The goals of this training program are to accurately disseminate the CI therapy protocol for upper-limb recovery after stroke that has been researched at UAB, provide hands-on instruction, clarify questions and correct misunderstandings about components of the treatment protocol, and provide advice on implementing it in clinical and research settings. To date, more than 170 clinicians and researchers, from the United States and abroad, have participated in the training program at UAB. Many have successfully carried out the protocol back in their institutions. This JRRD guest editorial describes the evolution of the UAB CI Therapy Training Program, details the instructional elements provided in the program, describes posttraining experiences of selected program participants, and discusses future plans for the training program to further enhance the translation of CI therapy into other clinical and research settings. The program provides an example of how research findings can be translated into a practical clinical program and then disseminated for use by clinicians and researchers. CHALLENGE OF RESEARCH TRANSLATION It is well known that advances in rehabilitation research face many obstacles to adoption in clinical practice. The Agency for Healthcare Research and Quality reports that it may take clinicians as long as 1 or 2 decades to incorporate original research into clinical practice [1]. In 2006, Graham and colleagues published an article discussing the slow, haphazard, and often incomplete transfer of findings from research into the clinical setting, calling this phenomenon a knowledge-to-action gap [2]. This delay creates a substantial obstacle to improving the quality of healthcare. A 2010 literature review concerning knowledge translation in healthcare further explores this issue by describing evolving models that have been proposed to integrate research into clinical practice [3]. Early models conceptualized a linear, unidirectional model of information sharing in which researchers simply reported their findings to clinicians in hopes that their innovations would be adopted into practice. This approach has been ineffective because it is too passive and fails to recognize the important cultural differences between the research and clinical communities and the resistance to making changes in established clinical practice. Later models called attention to these important cultural differences, yet did little to resolve the barriers to translation they create. The evidence-based medicine (EBM) movement of the 1990s aimed to increase the scientific rigor of clinical investigations and improve clinicians' ability to evaluate research publications before incorporating them into their clinical decision-making. While significantly enhancing the connection between the research and clinical communities, the EBM approach is still challenged by the lack of a tradition or sufficient reward for clinicians to publish and disseminate research findings in a timely fashion, difficulties faced by clinicians in interpreting the results presented in research publications, misunderstandings encountered when attempting to implement multicomponent and complex protocols that are inadequately described because of space limitations applied to manuscripts by most journals, and the remaining cultural differences that exist between the research and clinical communities. …