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