translating knowledge and beyond in sci rehabilitation
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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, Canada GF Strong Rehab Centre & International Collaboration on Repair Discoveries. Lack of knowledge translation in clinical practice. - PowerPoint PPT PresentationTRANSCRIPT
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
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%
• 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
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
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
Early highly positive results often contradicted1/3 were contradicted or less effective
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).
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.
Knowledge to Action Cycle
www.scireproject.comOne Solution to Knowledge Synthesis
Body-weight Support Treadmill Training
What’s the evidence?Does body-weight support
treadmill training improve gait outcomes?
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
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.
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
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?
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