Kirsty Forsyth

Key characteristics of knowledge transfer and exchange in healthcare: integrative literature review

AIM This paper presents the results of a review of literature relating to knowledge transfer and exchange in healthcare. BACKGROUND Treatment, planning and policy decisions in contemporary nursing and healthcare should be based on sound evidence wherever possible, but research knowledge remains generally underused. Knowledge transfer and exchange initiatives aim to facilitate the accessibility, application and production of evidence and may provide solutions to this challenge. This review was conducted to help inform the design and implementation of knowledge transfer and exchange activities for a large healthcare organization. DATA SOURCES Databases: ASSIA, Business Source Premier, CINAHL, PsychInfo, Medline and the Cochrane Database of Systematic Reviews. REVIEW METHODS An integrative literature review was carried out including an extensive literature search. English language systematic reviews, literature reviews, primary quantitative and qualitative papers and grey literature of high relevance evaluating, describing or discussing knowledge transfer or exchange activities in healthcare were included for review (January 1990-September 2009). FINDINGS Thirty-three papers were reviewed (four systematic reviews, nine literature reviews, one environmental scan, nine empirical studies and ten case studies). CONCLUSION Robust research into knowledge transfer and exchange in healthcare is limited. Analysis of a wide range of evidence indicates a number of commonly featured characteristics but further evaluation of these activities would benefit their application in facilitating evidence-based practice in nursing.

Scholarship of Practice: Making Occupation-Focused, Theory-Driven, Evidence-Based Practice a Reality:

National and local policies require the profession to provide evidence on which practice is based. This paper illustrates an approach to meeting the expectations of these policies. Specifically, it describes the development of the United Kingdom Centre for Outcomes Research and Education (UKCORE). UKCORE was developed within a ‘scholarship of practice’ framework, which supports the development of robust partnerships between academia and practice whereby academic knowledge influences practice and practice knowledge influences academia. Within the partnership, all academic participants (educators, researchers and students) and practice participants (clinicians, clients and administrators) are called ‘practice scholars’ and are focused on practice scholarship. UKCORE was founded in London in 2001 in order to support the delivery of existing evidence into occupational therapy practice while simultaneously supporting practice to engage in generating new evidence for occupational therapy practice. This article provides an overview of the academic and practice changes that have been put into place. The changes are designed to support the development of practice that is occupation focused, theory driven and evidence based.

The Model of Human Occupation: An Overview of Current Concepts:

The model of human occupation has evolved since it was first published. A number of important changes and refinements have been made. These changes reflect research findings, new interdisciplinary theory and insights encountered in practice. This article provides an overview of the current theoretical arguments. These concepts attempt to offer a way of understanding how human occupation is motivated, organised, performed and influenced by the environment. This is followed by a discussion of how occupational therapists can use this framework in their clinical practice.

Measurement Properties of a Client Self-report for Treatment Planning and Documenting Therapy Outcomes

The purpose of this study was to validate the Occupational Self Assessment (OSA). The Occupational Self Assessment is an evaluation tool and an outcome measure based on the Model of Human Occupation and concepts of client-centered practice. It is a two-part rating form that elicits clients perceptions and values concerning their own occupational competence, values, and the impact of the environment on their occupational behavior. Data were collected from 302 clients which included physically disabled, psychiatrically disabled and non-disabled adults. Rasch analysis was used to analyze the data. Results supported the preliminary validity and reliability of the OSA and recommendations are given for further improvement of the tool.

Implementing the Model of Human Occupation across a Mental Health Occupational Therapy Service: Communities of Practice and a Participatory Change Process:

The implementation of evidence-based change in practice settings is complex and far reaching, but only limited research has been undertaken in this area. This participatory action research study investigated the implementation of the Model of Human Occupation (MOHO) across a mental health occupational therapy service. Method: The study involved preparatory workshops and 12 months of team-based, monthly group reflective supervision sessions, facilitated by a colleague from academia, with follow-up contact for a further 12 months. Findings: The main findings emphasise the importance of developing a critical learning space, or ‘community of practice’, and identify that barriers to theory implementation can be overcome by collective effort with a shared dialectic. The successful development of a community of practice required the careful consideration of a number of interconnected influences, including those of self, peer and facilitator, and contextual and theoretical relationships. Conclusion: The study concluded that the community of practice was central in supporting the effective implementation of MOHO and its associated assessment tools. A key output of the study is a Participatory Change Process, which illustrates the key steps undertaken and interrelated factors affecting theory uptake. The process requires further testing, but has potential to guide theory implementation in other settings.

Gender ratio in a clinical population sample, age of diagnosis and duration of assessment in children and adults with autism spectrum disorder

This article reports on gender ratio, age of diagnosis and the duration of assessment procedures in autism spectrum disorder diagnosis in a national study which included all types of clinical services for children and adults. Findings are reported from a retrospective case note analysis undertaken with a representative sample of 150 Scottish children and adults recently diagnosed with autism spectrum disorder. The study reports key findings that the gender ratio in this consecutively referred cohort is lower than anticipated in some age groups and reduces with increasing age. The gender ratio in children, together with the significant difference in the mean age of referral and diagnosis for girls compared to boys, adds evidence of delayed recognition of autism spectrum disorder in younger girls. There was no significant difference in duration of assessment for males and females suggesting that delays in diagnosis of females occur prior to referral for assessment. Implications for practice and research are considered.2

Developing the Occupational Self Assessment: the use of Rasch analysis to assure internal validity, sensitivity and reliability.

This paper reports the results of three studies that examined the internal validity, sensitivity and reliability of the Occupational Self Assessment (OSA), a self-report of Occupational Competence and Value for occupational performance and participation (Baron et al 2006). All three studies used a Rasch measurement approach to explore the psychometric properties of iterative versions of the OSA. The first study showed that the ‘Myself’ Occupational Competence and Values items constituted a unidimensional construct, but did not discriminate optimally between participants. The results also suggested that the two ‘My Environment’ scales did not contain enough items to exhibit adequate measurement properties. Next, the rating scales were changed from three-point to four-point categories. The second study examined these changes and provided evidence to support the use of a four-point Occupational Competence scale. The Values rating scale was further revised because sensitivity did not improve. The third study confirmed that the OSA items in combination have good internal validity and measure the unidimensional constructs of Occupational Competence and Values. Further, both four-point rating scales resulted in improved person separation, indicated increased sensitivity, and could be used in a consistent manner by 90% of participants with a range of disabilities from a variety of contexts.

Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial

BackgroundAssistive technology and telecare (ATT) are relatively new ways of delivering care and support to people with social care needs. It is claimed that ATT reduces the need for community care, prevents unnecessary hospital admission, and delays or prevents admission into residential or nursing care. The current economic situation in England has renewed interest in ATT instead of community care packages. However, at present, the evidence base to support claims about the impact and effectiveness of ATT is limited, despite its potential to mitigate the high financial cost of caring for people with dementia and the social and psychological cost to unpaid carers.Method/designATTILA (Assistive Technology and Telecare to maintain Independent Living At Home for People with Dementia) is a pragmatic, multi-centre, randomised controlled trial over 104 weeks that compares outcomes for people with dementia who receive ATT and those who receive equivalent community services but not ATT. The study hypothesis is that fewer people in the ATT group will go into institutional care over the 4-year period for which the study is funded. The study aims to recruit 500 participants, living in community settings, with dementia or significant cognitive impairment, who have recently been referred to social services.Primary outcome measures are time in days from randomisation to institutionalisation and cost effectiveness. Secondary outcomes are caregiver burden, health-related quality of life in carers, number and severity of serious adverse events, and data on acceptability, applicability and reliability of ATT intervention packages. Assessments will be undertaken in weeks 0 (baseline), 12, 24, 52 and 104 or until institutionalisation or withdrawal of the participant from the trial.DiscussionIn a time of financial austerity, CASSRs in England are increasingly turning to ATT in the belief that it will deliver good outcomes for less money. There is an absence of robust evidence for the cost-effectiveness and benefit of using assistive technology and telecare. The ATTILA trial meets a pressing need for robust, generalisable evidence to either justify continuing investment or reappraise the appropriate scale of ATT use.Trial registrationCurrent Controlled TrialsISRCTN86537017

Developmental Coordination Disorder: A synthesis of evidence to underpin an allied health professions' framework

Children with Developmental Coordination Disorder (DCD) lack the motor coordination necessary to perform tasks considered appropriate for their age, given normal intellectual ability and the absence of other neurological disorders. DCD is a common childhood disorder that can develop into a long‐term condition that has a significant impact on society. A key method of managing DCD is through the assessment and interventions of allied health professionals (AHPs). To date, no integrated AHP framework for the assessment and treatment of DCD exists. The present article illustrates the methods used to synthesise multiple data sources (policy, scientific evidence, service user views and AHP perspectives) by a multidisciplinary group of AHP researchers and practitioners. Through this process a series of principles of good practice were identified, and then developed into a framework for AHPs working with children with DCD. In this article the methodology used to enable synthesis from different evidence sources will be presented, as will the resultant framework. The findings will then be discussed within the current literature emphasising the importance of health/education partnership in the support and management of these children.

Group Reflective Supervision: Thinking with Theory to Develop Practice

This paper presents a scholarship of practice development, that is, an academic/practice partnership, within a participatory action research study. Three teams of mental health occupational therapists and an occupational therapy academic used a group reflective supervision process to support the development of the skills and tools needed to integrate a conceptual practice model. Some of the opportunities and challenges experienced as a result of using this approach are highlighted. The preliminary findings demonstrate that group reflective supervision has provided a valuable space for reflection on practice and enabled therapists to change aspects of their practice as a consequence of thinking with theory.