Knowledge Translation Resources Research Articles

Best practice recommendations for the development, implementation, and evaluation of online knowledge translation resources in rehabilitation.

The knowledge-to-practice gap in rehabilitation has spurred knowledge translation (KT) initiatives aimed at promoting clinician behavior change and improving patient care. Online KT resources for physical therapists and other rehabilitation clinicians are appealing because of their potential to reach large numbers of individuals through self-paced, self-directed learning. This article proposes best practice recommendations for developing online KT resources that are designed to translate evidence into practice. Four recommendations are proposed with specific steps in the development, implementation, and evaluation process: (1) develop evidence-based, user-centered content; (2) tailor content to online format; (3) evaluate impact; and (4) share results and disseminate knowledge. Based on KT evidence and instructional design principles, concrete examples are provided along with insights gained from experiences in creating and evaluating online KT resources for physical therapists. In proposing these recommendations, the next steps for research are suggested, and others are invited to contribute to the discussion.

The Use of a Quality Indicator to Reduce Elective Repeat Caesarean Section for Low-Risk Women Before 39 Weeks’ Gestation: The Eastern Ontario Experience

ObjectiveElective repeat Caesarean section (ERCS) for low-risk women at < 39 weeks’ gestation has consistently been associated with increased risks to the neonate, including respiratory morbidity, NICU admission, and lengthier hospital stays than ERCS at 39 to 40 weeks’ gestation. The objective of this quality improvement project was to reduce high rates of ERCS < 39 weeks across the Eastern Ontario region. MethodsAll hospitals within the region providing care during labour and birth (n = 10) were asked to participate. Representatives from each hospital received information about their site-specific rates and knowledge-translation resources to assist them with the project. A benchmark rate for ERCS < 39 weeks was set at 30%. The rates of ERCS < 39 weeks were calculated for two different times (the 2009–2010 and 2010–2011 fiscal years) and the relative difference and 95% confidence intervals were calculated to quantify the magnitude and statistical significance of any change. Qualitative interviews were completed with key informants from each hospital. ResultsThe proportion of ERCS at < 39 weeks’ gestation across the region in the fiscal year 2010–2011 (n = 197/497; 39.6%) was significantly decreased (relative difference: −21%; 95% CI −31% to −8%, P = 0.002) from the previous fiscal year 2009–2010 (n = 229/459; 49.9%). A number of barriers to, and facilitators of, practice change were identified. ConclusionA reduction in the rate of ERCS < 39 weeks among low-risk women was achieved across the region. Awareness of the issue, possession of site-specific data, and agreement about the evidence and the need for change are critical first steps to improving practice.

Introducing the Canadian Thoracic Society Framework for Guideline Dissemination and Implementation, with Concurrent Evaluation

The Canadian Thoracic Society (CTS) is leveraging its strengths in guideline production to enable respiratory guideline implementation in Canada. The authors describe the new CTS Framework for Guideline Dissemination and Implementation, with Concurrent Evaluation, which has three spheres of action: guideline production, implementation infrastructure and knowledge translation (KT) methodological support. The Canadian Institutes of Health Research 'Knowledge-to-Action' process was adopted as the model of choice for conceptualizing KT interventions. Within the framework, new evidence for formatting guideline recommendations to enhance the intrinsic implementability of future guidelines were applied. Clinical assemblies will consider implementability early in the guideline production cycle when selecting clinical questions, and new practice guidelines will include a section dedicated to KT. The framework describes the development of a web-based repository and communication forum to inventory existing KT resources and to facilitate collaboration and communication among implementation stakeholders through an online discussion board. A national forum for presentation and peer-review of proposed KT projects is described. The framework outlines expert methodological support for KT planning, development and evaluation including a practical guide for implementers and a novel 'Clinical Assembly-KT Action Team', and in-kind logistical support and assistance in securing peer-reviewed funding.

Clinicians' Commentary on You et al.

Clinicians' Commentary on You et al.

Maximizing the Impact of Systematic Reviews in Health Care Decision Making: A Systematic Scoping Review of Knowledge-Translation Resources

Barriers to the use of systematic reviews by policymakers may be overcome by resources that adapt and present the findings in formats more directly tailored to their needs. We performed a systematic scoping review to identify such knowledge-translation resources and evaluations of them. Resources were eligible for inclusion in this study if they were based exclusively or primarily on systematic reviews and were aimed at health care policymakers at the national or local level. Resources were identified by screening the websites of health technology assessment agencies and systematic review producers, supplemented by an email survey. Electronic databases and proceedings of the Cochrane Colloquium and HTA International were searched as well for published and unpublished evaluations of knowledge-translation resources. Resources were classified as summaries, overviews, or policy briefs using a previously published classification. Twenty knowledge-translation resources were identified, of which eleven were classified as summaries, six as overviews, and three as policy briefs. Resources added value to systematic reviews by, for example, evaluating their methodological quality or assessing the reliability of their conclusions or their generalizability to particular settings. The literature search found four published evaluation studies of knowledge-translation resources, and the screening of abstracts and contact with authors found three more unpublished studies. The majority of studies reported on the perceived usefulness of the service, although there were some examples of review-based resources being used to assist actual decision making. Systematic review producers provide a variety of resources to help policymakers, of which focused summaries are the most common. More evaluations of these resources are required to ensure users' needs are being met, to demonstrate their impact, and to justify their funding.