Knowledge Translation Task Force for core measures clinical practice guideline: a short report on the process and utilization

Lost in translation: priorities in the application of evidence to practice.

BackgroundResearch training programmes are a knowledge translation (KT) intervention which aim to improve research evidence uptake by clinicians. Whilst KT training programmes have been reported to significantly improve evidence uptake by physiotherapists, it is unclear which aspects of training optimally assist KT into physiotherapy practice. The purpose of the review was to establish the body of evidence regarding KT training programmes to improve physiotherapists’ use of evidence-based practice (EBP) and clinical practice guidelines (CPG).MethodsA systematic scoping review was undertaken in line with the adapted Arksey and O’Malley framework. Nine electronic databases (CINAHL, BIOMED CENTRAL, Cochrane, Web of Science, PROQUEST, PUBMED, OTseeker, Scopus, ERIC) were searched. Targeted keywords identified primary research articles of any hierarchy, that described the nature and impact of KT training programmes for physiotherapists. Where systematic reviews were identified, the component primary studies were considered individually for relevance. Critical appraisal was not undertaken due to the nature of a scoping review, and data was reported descriptively.ResultsTen systematic reviews were identified (yielding four relevant primary studies). Five additional primary studies were identified (two randomised controlled trials, two non-randomised controlled trials and one pre-post study) which were not included in the original systematic reviews. This provided nine eligible primary research studies for review. The KT strategies were all multi-faceted. Interactive sessions, didactic sessions, printed material and discussion and feedback were consistently associated with effective outcomes. When KT strategies addressed local barriers to EBP utilisation, there were better success rates for EBP and CPG uptake, irrespective of the outcome measures used. There were no consistent ways of measuring outcome.ConclusionMulti-faceted KT strategies designed to address local barriers to knowledge translation were most effective in improving EBP/ CPG uptake among physiotherapists.

Knowledge Translation, Evidence-Based Practice, and You

Teaching health sciences students how to evaluate and implement clinical practice guidelines (CPGs) is challenging. Physical therapist education offers experiential learning opportunities to teach students how to evaluate and implement CPGs. Knowledge translation (KT) guides the process of moving research evidence into practice. Experiential learning using KT principles can teach students to assess barriers to evidence use and overcome implementation challenges. The purpose of this retrospective phenomenological qualitative study was to explore the beliefs, perceptions, and experiences of former physical therapist students' who completed a neurologic elective course implementing 2 CPGs. Furthermore, how the course impacted their clinical experiences is also described. Nine third-year physical therapist students. Students who participated in an elective experiential learning course developed using KT principles were recruited. Focus groups were held to determine the students' perceptions and experiences with implementing CPGs in the classroom and during their clinical experiences. Content analysis was used to identify codes and categories, and they were aligned with the Consolidated Framework of Implementation Research. Trustworthiness was established through member checking, peer debriefing, and an external audit. Students reported individual and contextual facilitators during the elective that supported CPG use. Students identified improved knowledge, confidence, and skill to perform the CPGs that facilitated their transfer of knowledge from the classroom to the clinic. During their clinical experiences, students discussed contextual factors, such as culture, environment, and patient population, which served as both facilitators and barriers to CPG use. Experiential learning enhanced knowledge, confidence, and skill with using CPGs and facilitated students' integration of evidence-based practice into their clinical experiences. Where possible, physical therapy curricula should incorporate experiential learning with KT principles to help students identify barriers to CPG use and develop strategies to enhance future evidence-based practice implementation.

Measures of Evidence in Evidence-Based Practice

Background Clinical practice guidelines are systematically developed statements that assist clinicians in making evidence informed decisions regarding patient care. Within pediatric concussion, the Ontario Neurotrauma Foundation released the Guidelines for Diagnosing and Managing Pediatric Concussion in 2014. The purpose of this study was to evaluate the 2014 guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool, in addition to a brief knowledge translation survey, and to utilize the collected feedback from end users to inform improvements to support an updated version. An integrated knowledge translation approach was employed using clinical experts as guideline appraisers. Methods A purposive sample of researchers, physicians, allied health professionals, policy makers, educators and knowledge translation experts involved in updating the guidelines (N = 31) completed the AGREE II Likert scale survey regarding the 2014 guideline, and provided written justifications for their ratings. Domain and item AGREE II scaled scores were reported stratified by demographic factors, and written justifications were synthesized using content analysis to determine areas of improvement for the 2014 guideline. Results Appraisers scored the editorial independence (88.9%) and scope and purpose (80.8%) domains the highest, indicating high quality. The guidelines scored the lowest in the applicability domain (69.3%). Participants with less than 10 years of experience in their respective disciplines, as well as physicians and allied health professionals consistently provided higher ratings across domains compared to other professions. Conclusions The process of evaluating the 2014 guideline resulted in these important outcomes: (1) identified areas of the guideline that may have affected the lack of previous clinical uptake while abiding by a clinical practice guideline development framework; (2) shared and informed decision making regarding content and format of the revised clinical practice guideline; and (3) targeted content, clinical questions and dissemination strategies, which are key to clinical uptake.

Parental perspectives on physiotherapy for infants born preterm: negotiating the child

IntroductionAcademic–government partnerships are important to advance timely, responsive and relevant evidence for decision-making (policy, guideline, law and regulation) deliberations. Deliberate and strategic integrated knowledge translation (KT) approaches within such partnerships...

Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies

Since the publication of the initial American College of Cardiology (ACC)/American Heart Association (AHA) Methodology for the Selection and Creation of Performance Measures,1 there has been an explosion in the development and application of performance measures. Although initially envisioned as a means for physician-led quality-improvement efforts, performance measures have been primarily used as tools for accountability and performance-based reimbursement instead. Given the centrality of and experience with performance measures for quantifying healthcare quality, the American College of Cardiology Foundation (ACCF)/AHA Task Force on Performance Measures sought to update its methodology so that ongoing efforts to measure performance could benefit from emerging insights. The original methodology, proposed in 2005,1 remains the foundation for developing process performance measures. The principal recommendations of the 2005 report are summarized in Table 1. The 2010 report does not address detailed issues of analysis,3 pay for performance,4 or nonfinancial rewards for better performance5 because these topics have been addressed in other statements. The focus of the 2010 report is to provide a state-of-the-art perspective on the construction, collection, and emerging directions of performance measurement as a means to improve healthcare quality. View this table: Table 1. ACCF/AHA Attributes of Performance Measures Figure 1. An overview of the steps in providing care by domain. Reprinted from Spertus et al.1 Performance measures that articulate discrete processes of care, as opposed to structural aspects of care or outcomes, are distinctly different from both clinical practice guidelines and appropriate use criteria because they represent a subset of the clinical guidelines for which the evidence is sufficiently strong: typically where the highest-quality evidence of benefit unequivocally exceeds risk (Class I recommendation, Level of Evidence: A),8 failure to provide the therapy to an eligible patient meaningfully reduces the likelihood that the patient will experience the best possible outcome. In this report, …

Defining 'best practice' is one of the first and crucial steps in any Knowledge Translation (KT) research project. Without a sound understanding of what exactly should happen in practice, it is impossible to measure the extent of existing gaps between 'desired' and 'actual' care, set implementation goals, and monitor performance. The aim of this paper is to present a practical, stepped and interactive process to develop best practice recommendations that are actionable, locally applicable and in line with the best available research-based evidence, with a view to adapt these into process measures (quality indicators) for KT research purposes. Our process encompasses the following steps: (1) identify current, high-quality clinical practice guidelines (CPGs) and extract recommendations; (2) select strong recommendations in key clinical management areas; (3) update evidence and create evidence overviews; (4) discuss evidence and produce agreed 'evidence statements'; (5) discuss the relevance of the evidence with local stakeholders; and (6) develop locally applicable actionable best practice recommendations, suitable for use as the basis of quality indicators. Actionable definitions of local best practice are a prerequisite for doing KT research. As substantial resources go into rigorously synthesizing evidence and developing CPGs, it is important to make best use of such available resources. We developed a process for efficiently developing locally applicable actionable best practice recommendations from existing high-quality CPGs that are in line with current research evidence.

The Year in Review: Time to Celebrate

Alice K. Jacobs, MD, FACC, FAHA, Chair Jeffrey L. Anderson, MD, FACC, FAHA, Chair-Elect Nancy Albert, PhD, CCNS, CCRN, FAHA Mark A. Creager, MD, FACC, FAHA Steven M. Ettinger, MD, FACC Robert A. Guyton, MD, FACC Jonathan L. Halperin, MD, FACC, FAHA Judith S. Hochman, MD, FACC, FAHA

Health care policy can facilitate emergency medicine knowledge translation (KT). Because of this, the 2007 Academic Emergency Medicine Consensus Conference on KT identified a specific theme regarding issues of health care policy and KT. Six months before the Consensus Conference, international experts in the area were invited to communicate on health care policies regarding all areas of KT via e-mail and "Google groups." From this communication, and using available evidence, specific recommendations and research questions were developed. At the Consensus Conference, additional comments were incorporated. This report summarizes the results of this collaborative effort and provides a set of recommendations and accompanying research questions to guide development, implementation, and evaluation of health care policies intended to promote KT in emergency medicine. The recommendations are to 1a) involve appropriate stakeholders in the health care policy process; 1b) collaborate with policy makers when health care policy focus areas are being developed; 2) use previously validated clinical practice guideline development tools; 3) address implementation issues during the development of health care policies; 4) monitor outcomes with performance measures appropriate to different practice environments; and 5) plan periodic reviews to uncover new clinical evidence, new methods to improve KT, and new technologies. To advance the further development of these recommendations, a research agenda is proposed.

To develop consensus on a core set of standardized outcome measures to be applied to each domain of the previously developed core outcome set for lower limb orthopaedic surgery for ambulant children with cerebral palsy (CP). This work consisted of the following three steps: (1) a scoping review of the literature to identify previously used outcome measures to assess lower limb orthopaedic surgery of ambulant children with CP; (2) searching the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) and PubMed databases to assess the quality of the psychometric properties of outcome measures and feasibility criteria; and (3) a consensus meeting with seven healthcare professionals with expertise in CP research and in the assessment of outcome measure psychometric properties was held in September 2021. Consensus on the outcome measures core set was developed through presentation of the evidence and whole-group discussions. A combination of clinician-driven and patient-reported outcome measures was considered the most appropriate way to assess the outcome of orthopaedic surgical interventions. Agreement was reached on seven core outcome measures: three-dimensional gait analysis, Edinburgh Visual Gait Scale, Gross Motor Function Measure, Gait Outcome Assessment List, Gillette Functional Assessment Questionnaire, Patient-Reported Outcome Measure Instrument System (pain interference, and fatigue), and Cerebral Palsy Quality of Life for Children questionnaire. This study recommends a set of core outcome measures for use in research on lower limb orthopaedic surgery for ambulant children with CP. Consistent use of this core set would enhance validity and comparability of future research.