Multi-component Knowledge Translation Research Articles

Working Toward Recommended Terminology in the Canadian Preschool Speech-Language Pathology Context.

This quality improvement project aimed to address the inconsistent use of clinical labels across a preschool speech and language program in Ontario, Canada. The study investigated whether a multicomponent knowledge translation (KT) intervention could increase speech-language pathologists' (SLPs') knowledge about the recommended clinical labels, motivate their intentions to use the labels, and facilitate practice change during a 3-month pilot period. The diffusion of innovations theory was utilized to identify and address known and suspected barriers and facilitators that could influence the adoption of consistent terminology. The intervention was evaluated using a pre-experimental study design (with pre, post, and follow-up testing) and included two phases: Phase 1 involved the pretraining survey, KT intervention, and posttraining survey, and Phase 2 included an exit survey after a 3-month pilot period. Five hundred twenty-nine SLPs in Phase 1 and 387 SLPs in Phase 2 participated. Following the web-based intervention, SLPs demonstrated improved knowledge about the recommended labels with most indicating intentions to communicate the labels going forward. SLPs also reported increased comfort using labels and positive views on their importance and value. After the 3-month pilot period, SLPs' reported use of most recommended labels decreased, as did ratings of comfort, value, and importance. However, most SLPs reported intentions to use the labels going forward. Despite having intentions to adopt the recommended labels, the lack of implementation by SLPs suggests the presence of additional barriers impacting their use of the recommended clinical labels in practice. Future work should investigate clinician-identified barriers to inform future implementation efforts. https://doi.org/10.23641/asha.25254940.

Transdisciplinary Implementation of Heart Rate Monitors During Inpatient Rehabilitation

<h3>Research Objectives</h3> Clinical practice guidelines demonstrate clear benefits of cardiovascular intensity on movement recovery after a neurologic injury, particularly walking recovery. However, research shows a lack of sufficient intensity during inpatient rehabilitation for both physical and occupational therapy sessions. Knowledge translation efforts and implementation of wearable heart rate monitors have been shown to support increased intensity during physical therapy directed interventions. Through a year-long effort, we have investigated the feasibility of implementing transdisciplinary heart rate monitoring informed by the knowledge to action cycle. <h3>Design</h3> 1 year transdisciplinary feasibility study. <h3>Setting</h3> 114 bed inpatient rehabilitation hospital. <h3>Participants</h3> 16 clinicians (9 physical therapists, 6 occupational therapists, 1 recreational therapist). <h3>Interventions</h3> 1 year, 4 phase Multicomponent Knowledge Translation initiative using the Knowledge to Action Cycle Framework. <h3>Main Outcome Measures</h3> -Clinician Participation (session count). Clinician Satisfaction, Clinician Perceived Relevance (summative feedback questionnaire). <h3>Results</h3> This four phase study will end August 2022. The first 13-week phase included 6 therapists (4 PTs, 2 OTs) that engaged in 70 sessions with an average of 5.38 sessions/week. The second phase included 10 therapists (6 PTs, 4 OTs), engaging in 152 sessions, averaging 11.69 sessions/week. The third phase included 13 therapists (8 PTs, 5 OTs), engaging in 436 sessions, averaging 33 sessions/week. The final phase included 16 therapists (9 PTs, 6 OTs, 1 RT), engaging in 503 sessions, averaging 38 sessions/week. In the one year follow up survey responses, 81% of pilot group users reported high satisfaction with heart rate monitor use. Clinician perceived relevance of heart monitor use differed for persons with non-neurological and neurological diagnoses. <h3>Conclusions</h3> Current data suggests that implementation of wearable heart rate monitoring devices for a transdisciplinary inpatient rehab team is feasible and supported by a multicomponent knowledge to action framework. Majority of pilot group participants were very satisfied with participation in heart rate monitoring interventions and highest perceived clinical relevance was for patients with neurological injuries, consistent with clinical practice guideline recommendations. Future studies will expand implementation among onsite clinicians, further investigate barriers of use, and determine optimal interventions for promoting high intensity and specificity within each discipline. <h3>Author(s) Disclosures</h3> None.

Implementation of Subluxation Stimulation Protocol post stroke in Inpatient Rehabilitation setting

<h3>Research Objectives</h3> Glenohumeral subluxation is a common post-stroke complication, affecting up to 80% of patients. Long duration neuromuscular electrical stimulation has been shown to reduce subluxation, decrease shoulder pain, and can improve motor outcomes for the affected extremity. This poster aims to investigate the feasibility of implementing a long duration subluxation stimulation protocol for the hemiparetic upper extremity post stroke while in inpatient rehabilitation. <h3>Design</h3> Feasibility study 12-month period. <h3>Setting</h3> Inpatient rehabilitation hospital. <h3>Participants</h3> 9 occupational therapists serving dedicated stroke unit. <h3>Interventions</h3> 1 year, 2 phase multicomponent knowledge translation interventions. Attended and unattended neuromuscular electrical stimulation to support glenohumeral subluxation for 3 – 6 hours, 5 days a week. <h3>Main Outcome Measures</h3> Number of referring therapists Average number of hours per day of subluxation stimulation <h3>Clinician survey results</h3> barriers, satisfaction, relevance. <h3>Results</h3> Nineteen patients received long duration subluxation stimulation over the course of this year, 13 patients during phase 1 and 7 during phase 2. Phase 1 consisted of 10 months of providing a goal of 3.5 hours of subluxation stimulation for no more than 2 patients per day facilitated by supervised rehabilitation technician. Phase 2 consisted of 2 months of providing a goal of 6 hours for up to 8 patients per day. Data collection during phase 2 shows an average of 4.36 actual stimulation hours per day. Eight of nine occupational therapists who received training (didactic and experiential) on this protocol referred at least 1 patient to this service. After 12 months of participation, all survey respondents reported that they were 'very satisfied' with this protocol and that they 'strongly agree' that this protocol has a positive effect on patient outcomes and is relevant to persons with stroke during inpatient rehabilitation. <h3>Conclusions</h3> Occupational therapists at an inpatient facility demonstrate adoption of a long duration subluxation stimulation protocol when facilitated by a supervised rehabilitation technician. Knowledge translation efforts and innovative service provision techniques have led to increased duration of stimulation and reduced clinician's perceived barriers of conflicting treatment demands and time limitations. <h3>Author(s) Disclosures</h3> None.

How to get the most out of the fit note.

<h3>PURPOSE</h3> We report on the effectiveness of the Ottawa Model for Smoking Cessation (OMSC), a multicomponent knowledge translation intervention, in increasing the rate at which primary care providers delivered smoking cessation interventions using the 3 A’s model—<i>Ask</i>, <i>Advise</i>, and <i>Act</i>, and examine clinic-, provider-and patient-level determinants of 3 A’s delivery. <h3>METHODS</h3> We examined the effect of the knowledge translation intervention in 32 primary care practices in Ontario, Canada, by assessing a cross-sectional sample of patients before the implementation of the OMSC and a second cross-sectional sample following implementation. We used 3-level modeling (clinic, clinician, patient) to examine the main effects and predictors of 3 A’s delivery. <h3>RESULTS</h3> Four hundred eighty-one primary care clinicians and more than 3,500 tobacco users contributed data to the evaluation. Rates of delivery of the 3 A’s increased significantly following program implementation (<i>Ask</i>: 55.3% vs 71.3%, <i>P</i> &lt;.001; <i>Advise</i>: 45.5% vs 63.6%, <i>P</i> &lt;.001; <i>Act</i>: 35.4% vs 54.4%, <i>P</i> &lt;.001). The adjusted odds ratios (AOR) for the delivery of 3 A’s between the pre- and post-assessments were AOR = 1.94; (95% CI, 1.61–2.34) for <i>Ask</i>, AOR = 1.92; (95% CI, 1.60–2.29) for <i>Advise</i>, and AOR = 2.03; (95% CI, 1.71–2.42) for <i>Act</i>. The quality of program implementation and the reason for clinic visit were associated with increased rates of 3 A’s delivery. <h3>CONCLUSIONS</h3> Implementation of the OMSC was associated with increased rates of smoking cessation treatment delivery. High quality implementation of the OMSC program was associated with increased rates of 3 A’s delivery.

Prospective application of implementation science theories and frameworks to inform use of PROMs in routine clinical care within an integrated pain network

PurposeThe objective of this study is to present the implementation science approaches that were used before implementing electronic patient-reported outcome measures (ePROMs) across an integrated chronic pain network that includes primary, rehabilitation, and hospital-based care.MethodsThe Theoretical Domains Framework (TDF) was used to identify potential barriers and enablers to the use of ePROMS by primary care clinicians. In rehabilitation and tertiary care, the Consolidated Framework for Implementation (CFIR) was used to guide the identification of determinants of implementations, through observation of workflow, patient and clinician surveys, and clinician interviews. A mixed-method concurrent design comprising a quantitative and qualitative analysis was used. The results were reviewed by a steering committee to iteratively inform the ePROM implementation plan. The Proctor framework of evaluation was used to guide the development of an evaluation plan for the implementation of ePROMs in the integrated chronic pain network.ResultsBoth frameworks provided similar results with respect to healthcare provider knowledge, behaviour, and experience interpreting PROM scores. The TDF and CFIR frameworks differed in identifying organizational-level determinants. The resultant implementation plan was structured around the adoption of PROMs to inform individual treatment planning and quality improvement. The evaluation plan focused on implementation and impact outcomes to evaluate the ePROM intervention.ConclusionsThe TDF and CFIR guided the development of a multi-component knowledge translation and training intervention that will address multiple gaps and barriers to implementation of PROMs across the integrated network. The ePROM intervention will aim to increase clinicians’ knowledge and skills and foster best practices.

Developing theory-informed knowledge translation strategies to facilitate the use of patient-reported outcome measures in interdisciplinary low back pain clinical practices in Quebec: mixed methods study

BackgroundThere is a growing interest among healthcare providers (HCPs) to use Patient Reported Outcome Measures (PROMs) in clinical care. PROMs can help improve patient-care provider communication and may be used to inform the need for interdisciplinary care for Low Back Pain (LBP). However, PROM implementation to support clinical decision-making is complex and requires knowledge translation (KT) interventions that will overcome barriers to using PROMs in interdisciplinary clinical settings.Objectivesto 1) identify potential barriers and enablers to using PROMs in primary care LBP clinical practice from the perspective of healthcare team members, and 2) develop a theory-based tailored KT intervention to facilitate the use of PROMs in interdisciplinary clinical practice.MethodsWe invited 25 HCPs working in an interdisciplinary team to complete a self-administered survey designed based on the Theoretical Domain Framework (TDF) to identify the barriers and enablers to using PROM scores in LBP clinical practice. The questionnaire consisted of 30 questions rated on a 5-point Likert scale (quantitative) and included open-ended questions (qualitative). Quantitative and qualitative data were analysed to estimate the frequency of barriers and enablers. Findings were then reviewed by a panel of four KT experts who mapped behaviour change techniques to barriers identified that informed the design of a KT intervention.ResultsEighteen HCPs responded to the survey. Factors identified as likely to restrict the use of PROM scores included knowledge, skills, social/professional role and identity, goals, decision processes, beliefs about consequences, environmental context and resources, behavioural regulation, and social influence. A multi-component evidence-based KT intervention was proposed by the panel of experts to address these barriers: a training workshop; educational materials; and use of PROM score reports to HCPs that were all delivered by an opinion leader.ConclusionThe routine use of PROMs in clinical practice may optimize the quality of LBP care and improve patients’ outcomes. The proposed multi-component KT intervention is expected to be an effective strategy to increase HCPs’ ability to integrate PROMs into clinical decision-making and to engage patients in their care.

Promoting the use of self-management in patients with spine pain managed by chiropractors and chiropractic interns: barriers and design of a theory-based knowledge translation intervention

BackgroundThe literature supports the effectiveness of self-management support (SMS) to improve health outcomes of patients with chronic spine pain. However, patient engagement in SMS programs is suboptimal. The objectives of this study were to: 1) assess participation in self-care (i.e. activation) among patients with spine pain, 2) identify patients’ barriers and enablers to using SMS, and 3) map behaviour change techniques (BCTs) to key barriers to inform the design of a knowledge translation (KT) intervention aimed to increase the use of SMS.MethodsIn summer 2016, we invited 250 patients with spine pain seeking care at the Canadian Memorial Chiropractic College in Ontario, Canada to complete the Patient Activation Measure (PAM) survey to assess the level of participation in self-care. We subsequently conducted individual interviews, in summer 2017, based on the Theoretical Domains Framework (TDF) in a subset of patients to identify potential challenges to using SMS. The interview guide included 20 open-ended questions and accompanying probes. Findings were deductively analysed guided by the TDF. A panel of 7 experts mapped key barriers to BCTs, designed a KT intervention, and selected the modes of delivery.ResultsTwo hundred and twenty-three patients completed the PAM. Approximately 24% of respondents were not actively involved in their care. Interview findings from 13 spine pain patients suggested that the potential barriers to using SMS corresponded to four TDF domains: Environmental Context and Resources; Emotion; Memory, Attention & Decision-Making; and Behavioural Regulation. The proposed theory-based KT intervention includes paper-based educational materials, webinars and videos, summarising and demonstrating the therapeutic recommendations including exercises and other lifestyle changes. In addition, the KT intervention includes Brief Action Planning, a SMS strategy based on motivational interviewing, along with a SMART plan and reminders.ConclusionsAlmost one quarter of study participants were not actively engaged in their spine care. Key barriers likely to influence uptake of SMS among patients were identified and used to inform the design of a theory-based KT intervention to increase their participation level. The proposed multi-component KT intervention may be an effective strategy to optimize the quality of spine pain care and improve patients’ health-outcomes.

A knowledge translation implementation strategy to promote evidence-based practices in the management of lateral ankle sprains by Canadian Armed Forces physiotherapists

Introduction: Lateral ankle sprains (LAS) are the third most common musculoskeletal injury among military members, resulting in considerable time loss and a substantial rehabilitation workload. The operational relevance of these consequences to the Canadian Armed Forces (CAF) should be minimized using evidence-based practices. The purpose of this research project was to use a comprehensive knowledge translation (KT) implementation strategy tailored for CAF physiotherapists to improve their knowledge and use of the rehabilitation interventions and outcome measures recommended in the management of LAS. Methods: All CAF physiotherapists were sent an email invitation to complete an online questionnaire investigating their knowledge and use of rehabilitation interventions and outcome measures recommended in the management of LAS. We then used a distance learning platform to facilitate a 3-hour active, multi-component KT intervention that included summarized research, practice tools, and guided interaction. The primary outcome was the median change reported on the online questionnaire prior to, and 3 months following the intervention. Results: Response rate to the online questionnaire was 75% ( n = 67/89). Respondents reported a change from very good to excellent knowledge and use of rehabilitation interventions recommended in LAS management between baseline and 3 months. Respondents reported a change from poor to good/excellent knowledge and use of outcome measures recommended in LAS management between baseline and 3 months. Respondents reported a KT intervention preference for summarized research. Discussion: Our findings suggest that a KT implementation strategy tailored for CAF physiotherapists can improve their self-reported knowledge and use of outcome measures recommended in LAS management.

Increasing Rates of Tobacco Treatment Delivery in Primary Care Practice: Evaluation of the Ottawa Model for Smoking Cessation.

We report on the effectiveness of the Ottawa Model for Smoking Cessation (OMSC), a multicomponent knowledge translation intervention, in increasing the rate at which primary care providers delivered smoking cessation interventions using the 3 A's model-Ask, Advise, and Act, and examine clinic-, provider-and patient-level determinants of 3 A's delivery. We examined the effect of the knowledge translation intervention in 32 primary care practices in Ontario, Canada, by assessing a cross-sectional sample of patients before the implementation of the OMSC and a second cross-sectional sample following implementation. We used 3-level modeling (clinic, clinician, patient) to examine the main effects and predictors of 3 A's delivery. Four hundred eighty-one primary care clinicians and more than 3,500 tobacco users contributed data to the evaluation. Rates of delivery of the 3 A's increased significantly following program implementation (Ask: 55.3% vs 71.3%, P <.001; Advise: 45.5% vs 63.6%, P <.001; Act: 35.4% vs 54.4%, P <.001). The adjusted odds ratios (AOR) for the delivery of 3 A's between the pre- and post-assessments were AOR = 1.94; (95% CI, 1.61-2.34) for Ask, AOR = 1.92; (95% CI, 1.60-2.29) for Advise, and AOR = 2.03; (95% CI, 1.71-2.42) for Act. The quality of program implementation and the reason for clinic visit were associated with increased rates of 3 A's delivery. Implementation of the OMSC was associated with increased rates of smoking cessation treatment delivery. High quality implementation of the OMSC program was associated with increased rates of 3 A's delivery.

Evaluating Evidence Aid as a complex, multicomponent knowledge translation intervention.

Evidence Aid, an initiative established by members of The Cochrane Collaboration in the aftermath of the Indian Ocean Tsunami in December 2004, celebrates its first 10 years later this year. Whilst the principles of the Evidence Aid initiative are firmly rooted in evidence-based medicine and public health practice, the initiative itself was born of a humanitarian imperative, compassion and the expressed moral duty to help. The evidence-base for Evidence Aid, (that is, for knowledge translation interventions focused on dissemination of evidence), was not, and is not, well-established This article, which is based on a presentation at the Evidence Aid Symposium on 20 September 2014, at Hyderabad, India presents a unifying conceptual framework for use when researching the impact of Evidence Aid as a knowledge translation intervention. It highlights how each of the core activities can be mapped to this framework and identifies key outcomes of interest for evaluation.

The use of a knowledge translation program to increase use of standardized outcome measures in an outpatient pediatric physical therapy clinic: administrative case report.

Pediatric physical therapists face many challenges related to the application of research evidence to clinical practice. A multicomponent knowledge translation (KT) program may be an effective strategy to support practice change. The purpose of this case report is to describe the use of a KT program to improve the knowledge and frequency of use of standardized outcome measures by pediatric physical therapists practicing in an outpatient clinic. This program occurred at a pediatric outpatient facility with 1 primary clinic and 3 additional satellite clinics, and a total of 17 physical therapists. The initial underlying problem was inconsistency across staff recommendations for frequency and duration of physical therapist services. Formal and informal discussion with the department administrator and staff identified a need for increased use of standardized outcome measures to inform these decisions. The KT program to address this need spanned 6 months and included identification of barriers, the use of a knowledge broker, multiple workshop and practice sessions, online and hard-copy resources, and ongoing evaluation of the KT program with dissemination of results to staff. Outcome measures included pre- and post-knowledge assessment and self-report surveys and chart review data on use of outcome measures. Participants (N=17) gained knowledge and increased the frequency of use of standardized outcome measures based on data from self-report surveys, a knowledge assessment, and chart reviews. Administrators and others interested in supporting practice change in physical therapy may consider implementing a systematic KT program that includes a knowledge broker, ongoing engagement with staff, and a variety of accessible resources.

Translating knowledge in rehabilitation: systematic review.

Clinicians are faced with using the current best evidence to make treatment decisions, yet synthesis of knowledge translation (KT) strategies that influence professional practice behaviors in rehabilitation disciplines remains largely unknown. The purposes of this study were: (1) to examine the state of science for KT strategies used in the rehabilitation professions (physical therapy, occupational therapy, speech-language pathology), (2) to identify the methodological approaches utilized in studies exploring KT strategies, and (3) to report the extent that KT interventions are described. Eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, and CENTRAL) were searched from January 1985 to May 2013 using language (English) restriction. Eligibility criteria specified articles evaluating interventions or strategies with a primary purpose of translating research or enhancing research uptake into clinical practice. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. The published descriptions of the KT interventions were compared with the Workgroup for Intervention Development and Evaluation Research's (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions. Of a total of 2,793 articles located and titles and abstracts screened, 26 studies were included in the systematic review. Eighteen articles reported interventions that used a multicomponent KT strategy. Education-related components were the predominant KT intervention regardless of whether it was a single or multicomponent intervention. Few studies used reminders or audit and feedback intervention (n=3). Only one study's primary outcome measure was an economic evaluation. No clear delineation of the effect on KT strategies was seen. Diverse studies were included; however, the heterogeneity of the studies was not conducive to pooling the data. The modest-to-low methodological quality assessed in the studies underscores the gaps in KT strategies used in rehabilitation and highlights the need for rigorously designed studies that are well reported.

Evaluation of a multisite educational intervention to improve mobilization of older patients in hospital: protocol for mobilization of vulnerable elders in Ontario (MOVE ON)

BackgroundFunctional decline is a common adverse outcome of hospitalization in older people. Often, this decline is not related to the illness that precipitated admission, but to the process of care delivered in hospital. The association between immobility and adverse consequences is well established, yet older inpatients spend significant amounts of time supine in bed. We aim to implement and evaluate the impact of an evidence-based strategy to promote early mobilization and prevent functional decline in older patients admitted to university-affiliated acute care hospitals in Ontario, Canada. We will implement a multi-component educational intervention to support a change in practice to enhance mobilization of older patients.Methods/designImplementation of our early mobilization strategy is guided by the Knowledge to Action Cycle. Through focus groups with frontline staff, we will identify barriers and facilitators to early mobilization. We will tailor the intervention at each site to the identified barriers and facilitators, focusing on the following key messages: to complete a mobility assessment and care plan within 24 hours of the decision to admit patients aged 65 years and older; to achieve mobilization at least 3 times per day; and, to ensure that mobilization is scaled and progressive. The primary outcome, number of patients observed out of bed, will be documented three times per day (in the morning, at lunch and in the afternoon), two days each week. This data collection will occur over 3 phases: pre-implementation (10 weeks), implementation (8 weeks), and post-implementation (20 weeks).DiscussionThis is the first large, multisite study to evaluate the impact of a multi-component knowledge translation strategy on rates of mobilization of older patients in hospital. Our implementation is framed by the Knowledge to Action Cycle, and the intervention is being adapted to the local context. These unique features render our intervention approach more generalizable to multiple practice settings. Contextualization of the intervention has also facilitated engagement of participants from multiple hospitals. Upon completion of this study, we will better understand the barriers and facilitators to implementing an early mobilization strategy across a spectrum of hospitals, as well as the impact of a mobilization strategy.

Safe and Effective Prescription of Exercise in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Rationale and Methods for an Integrated Knowledge Translation Study

Patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) engage in low levels of activity, putting them at risk for relapse and future readmissions. There is little direction for health care providers regarding the parameters for safe exercise during an AECOPD that is effective for increasing activity tolerance before discharge from hospital, especially for patients with associated comorbid conditions. To report the rationale for and methods of a study to develop evidence-informed care recommendations that guide health care providers in the assessment, prescription, monitoring and progression of exercise for patients hospitalized with AECOPD. The present study was a multicomponent knowledge translation project incorporating evidence from systematic reviews of exercise involving populations with chronic obstructive pulmonary disease and⁄or common comorbidities. A Delphi process was then used to obtain expert opinion from clinicians, academics and patients to identify the parameters of safe and effective exercise for patients with AECOPD. Clinical decision-making tool(s) for patients and practitioners supported by a detailed knowledge dissemination, implementation and evaluation framework. The present study addressed an important knowledge gap: the lack of availability of parameters to guide safe and effective exercise prescription for hospitalized patients with AECOPD, with or without comorbid conditions. In the absence of such parameters, health care professionals may adopt an 'activity as tolerated' approach, which may not improve physical activity levels in their patients. The present study synthesizes the best available evidence and expert opinion, and will generate decision-making tools for use by patients and their health care providers.

Use of Clinical Decision Support to Improve the Quality of Care Provided to Older Hospitalized Patients

Frail older inpatients are at risk of unintended adverse events while in hospital, particularly falls, functional decline, delirium and incontinence. The aim of this pragmatic trial was to pilot and evaluate a multi-component knowledge translation intervention that incorporated a nurse-initiated computerized clinical decision support tool to reduce harms in the care of older medical inpatients. A stepped wedge trial design was conducted on six medical units at two hospitals in Calgary, Alberta, Canada. The primary quantitative outcome was the rate of order set use. Secondary outcomes included the number of falls, the average number of days in hospital, and the total number of consults ordered for each of orthopedics, geriatrics, psychiatry and physiotherapy. Qualitative analysis included interviews with nurses to explore barriers and facilitators around the implementation of the electronic decision support tool. The estimated mean rate of order set use over a 2 week period was 3.1 (95% CI 1.9-5.3) sets higher after the intervention than before. The estimated odds of a fall happening on a unit over a 2-week period was 9.3 (p = 0.065) times higher before than after the intervention. There was no significant effect of the intervention on length of hospital stay (p = 0.67) or consults to related clinical services (all p <0.2). Interviews with front-line nurses and nurse managers/educators revealed that the order set is not being regularly ordered because its content is perceived as part of good nursing care and due to the high workload on these busy medical units. Although not statistically significant, a reduction in the number of falls as a result of the intervention was noted. Frontline users' engagement is crucial for the successful implementation of any decision support tool. New strategies of implementation will be evaluated before broad dissemination of this knowledge translation intervention.

Effectiveness of a multi-component knowledge translation strategy for changing health professionalʼs evidence-based practice behaviour - An evaluator blinded cluster-randomised controlled trial

s of the 2011 Joanna Briggs Institute International Convention: Mission Impossible? Evidence based practice and the future of global health: 7–9 November 2011, National Wine Centre, Adelaide, South Australia: ABSTRACTS

Strategies for rehabilitation professionals to move evidence-based knowledge into practice: A systematic review

Rehabilitation clinicians need to stay current regarding best practices, especially since adherence to clinical guidelines can significantly improve patient outcomes. However, little is known about the benefits of knowledge translation interventions for these professionals. To examine the effectiveness of single or multi-component knowledge translation interventions for improving knowledge, attitudes, and practice behaviors of rehabilitation clinicians. Systematic review of 7 databases conducted to identify studies evaluating knowledge translation interventions specific to occupational therapists and physical therapists. 12 studies met the eligibility criteria. For physical therapists, participation in an active multi-component knowledge translation intervention resulted in improved evidence-based knowledge and practice behaviors compared with passive dissemination strategies. These gains did not translate into change in clinicians' attitudes towards best practices. For occupational therapists, no studies have examined the use of multi-component interventions; studies of single interventions suggest limited evidence of effectiveness for all outcomes measured. While this review suggests the use of active, multi-component knowledge translation interventions to enhance knowledge and practice behaviors of physical therapists, additional research is needed to understand the impact of these strategies on occupational therapists. Serious research gaps remain regarding which knowledge translation strategies impact positively on patient outcomes.