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Translating knowledge and beyond in SCI rehabilitation
Janice Eng, PhD, BSc(PT/OT)Dept of Physical Therapy, University of BC, Vancouver, CanadaGF Strong Rehab Centre & International Collaboration on Repair Discoveries
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Lack of knowledge translation in clinical practice
• Peer reviewed journals are rewarded as the traditional method of knowledge translation
• Consistent failure to translate research findings into practice
• Gap between what care people should receive and care they do receive
• What percent of time are treatments of proven effectiveness not provided?
15% 45% 75%
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• In US:• 45% of time, treatments of proven
effectiveness not provided McGlynn et al. 2003, N Engl J Med
• 20% of patients get care that is potentially harmful
Schuster et al. 1998, Milbank Quarterly
Lack of knowledge translation
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Knowledge translation in SCI: From the literature to changing practice
Knowledge translation is the synthesis, dissemination, exchange and ethically-sound application of research findings among researchers and knowledge users
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KT requires a body of evidence-based info
Individual studies rarely by themselves provide sufficient evidence for policy or practice changes
Individual studies are often misleading or conflicting
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Early highly positive results often contradicted1/3 were contradicted or less effective
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Why is research not translated to practice?
Lack of time, computing resources, not enough evidence, lack of access; lack of skills for searching, appraising, and interpreting; lack of incentives (Bennett S. et al, 2003. Australian OT Journal)
Relevant literature not compiled all in one place (Closs & Lewin, 1998. Br J of Therapy & Rehab).
Publication bias, indexing issues, language issues, assessing internal validity, access to electronic databases, access to full text, assessing applicability, drawing conclusions (Maher. C. et al. Phys Ther).
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Knowledge Synthesis
Knowledge syntheses are the cornerstone of knowledge translation because they transform vast libraries of scientific literature into knowledge that is reliable, relevant and readable for knowledge users.
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Knowledge to Action Cycle
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www.scireproject.comOne Solution to Knowledge Synthesis
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Body-weight Support Treadmill Training
What’s the evidence?Does body-weight support
treadmill training improve gait outcomes?
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Level 1a > 1 Rigorous RCTs (PEDro ≥ 6) Level 1b 1 Rigorous RCT Level 2 RCTs (PEDro 5), non-randomized
prospective controlled studies Level 3 Case-control studies Level 4 Pre-test/post-test studies, case series Level 5 Observational, case reports, expert
consensus opinion
Levels of Evidence
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Body-weight Support Treadmill Training
There is level 3 evidence (Wernig et al. 1995) using historical controls that BWSTT is effective in improving ambulatory function. However, stronger evidence from two level 2 RCTs (Dobkin et al. 2006; Hornby et al. 2005a) demonstrates that BWSTT has equivalent effects to conventional rehabilitation consisting of an equivalent amount of overground mobility practice for gait outcomes in acute/sub-acute SCI.
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A new model of knowledge dissemination Over 1/2 million downloads from
174 countries (US, Canada, UK, Australia, India)
150 presentations 50 peer-reviewed publications
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Clinician Evaluation (n=92)
Item %
SCIRE improved their knowledge of SCI evidence 91%
SCIRE helped to inform changes to their clinical practice
81%
SCIRE increased their confidence in treating SCI clients 69%
Can access to knowledge improve practice?
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Standards of Care Priority Setting
SCIRE Knowledge Platformwww.scireproject.com
Outcome Measure Standardization (Toolkit)
Practice Guideline Development
Implementation of Best Practice
Research & Strategic Funding Priority Setting
Dissemination of evidence
Educational Modules
Knowledge Translation
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