Stephanie M. N. Glegg

Measures of knowledge and skills for evidence-based practice: : A systematic review

Background. Lack of knowledge and skills in seeking, evaluating, and applying evidence are barriers to evidence-based practice (EBP). The measurement of these constructs can inform educational initiatives aimed at reducing EBP barriers. Purpose. The purpose of this systematic review is to provide a critical appraisal of the rehabilitation literature describing quantitative measures of EBP knowledge and skills. Methods. Measures used with occupational therapists to evaluate EBP knowledge or skills were compiled from a search of the EMBASE, MEDLINE, CINAHL, EBM Reviews, and PSYCINFO databases. Measures were evaluated using adapted criteria from the CanChild Outcome Measures Rating Form. Findings. Of the 15 measures identified, three met criteria as being adequate for the measurement of EBP knowledge and skills. Implications. Further measure development needs to address limitations of existing measures. Research to evaluate the psychometric properties of existing or novel measures of knowledge and skills related to EBP may improve their utility.

The GestureTek virtual reality system in rehabilitation: a scoping review

Abstract Purpose: To identify, to map out and to appraise research examining GestureTek virtual reality (VR) use for physical and cognitive rehabilitation and to highlight areas for future research. Method: Scoping review methodology was used to systematically and comprehensively search the academic and grey literature for GestureTek-specific research. Consensus was achieved following two reviewers’ independent inclusion screening, data extraction and appraisal. Results: Forty-four studies evaluated the utility and efficacy of the IREX, GX, VMall and Meal Maker software for rehabilitation across a range of populations, with few adverse events reported. Stroke and cerebral palsy research dominated, while geriatrics was largely overlooked. Efficacy research provided support for balance, mobility, upper extremity, cognitive, fitness and daily living skills outcomes for specific populations with effect sizes ranging from 0.19 to 3.34. Nevertheless, few strong quality or high-level studies are available, and no clear guidelines on optimal treatment characteristics exist. Outcomes of primary interest were at ICF body function and activity levels; evaluation of transfer of training across ICF levels is needed. Conclusions: This literature provides preliminary evidence for the technology’s efficacy for rehabilitation. Identified research gaps relate to study quality and design, treatment characteristics, populations and outcomes of interest, including transfer across ICF levels. Implications for Rehabilitation There is limited high-level evidence to support the use of the GestureTek virtual reality system for rehabilitation. Moderate to strong quality evidence exists primarily for the stroke and cerebral palsy populations, and primarily for balance, mobility and upper extremity outcomes. A lack of consistent outcome measures in this body of literature has created “silos” of research that cannot be quantitatively combined using a meta-analytic strategy.

Protocol of a scoping review on knowledge translation competencies

BackgroundKnowledge translation (KT) activities can reduce the gap between “what is known” and “what is done”. Several factors hinder or facilitate KT activities including individual characteristics and organizational attributes; we will focus on individual healthcare professional modifiable characteristics. The purpose of this scoping review is to summarize knowledge on KT competencies for knowledge users, knowledge brokers, and knowledge producers/researchers to support evidence-based practice (EBP) and inform policy and research in health. Our objectives are to explore the relevant theoretical and empirical literature; map the publications for key themes and research gaps of KT competencies, and interventions for enhancing KT competencies; summarize and disseminate findings; produce an action plan and research agenda; and develop self-assessment tools (the KT Pathways) for professional development for our three target audiences.MethodsThe scoping review method will guide our study by following six stages: formulating the research question; identifying relevant studies; selecting the literature; charting the data; collating, summarizing, and reporting the results; and developing a KT plan and consulting stakeholders involved in the fields of KT, EBP, evidence-informed policy-making, and/or research. We will include empirical and theoretical/conceptual peer-reviewed and grey literature in health that examine knowledge user, knowledge broker and knowledge producer KT competencies. Publications written in the English language and published after 2003 only will be considered. Our multidisciplinary research team will collaborate using technology (i.e., WebEx for discussions and a Web 2.0 website for storing documents). Our KT plan consists of an Advisory Group and dissemination plan of the findings.DiscussionWe expect the identified KT competencies to contribute to the KT science by providing positive outcomes in practice, policy, education, and future research. Incorporation of the core KT competencies may enhance safety, effectiveness of clinical care, and quality of health outcomes; contribute to and facilitate collaboration among practitioners, knowledge users, knowledge brokers, researchers, employers, and educators; improve education of healthcare professionals and inform policy-making process; benefit practitioners by guiding their KT professional development to become effective at moving evidence into practice and policy; guide suitable interventions and strategies to enhance KT activities in the health sector; and direct future research.

Facilitating interprofessional evidence-based practice in paediatric rehabilitation: development, implementation and evaluation of an online toolkit for health professionals.

Abstract Purpose: Lack of time, competencies, resources and supports are documented as barriers to evidence-based practice (EBP). This paper introduces a recently developed web-based toolkit designed to assist interprofessional clinicians in implementing EBP within a paediatric rehabilitation setting. Methods: EBP theory, models, frameworks and tools were applied or adapted in the development of the online resources, which formed the basis of a larger support strategy incorporating interactive workshops, knowledge broker facilitation and mentoring. Results: The highly accessed toolkit contains flowcharts with embedded information sheets, resources and templates to streamline, quantify and document outcomes throughout the EBP process. Case examples relevance to occupational therapy and physical therapy highlight the utility and application of the toolkit in a clinical paediatric setting. Workshops were highly rated by learners for clinical relevance, presentation level and effectiveness. Eight evidence syntheses have been created and 79 interventions have been evaluated since the strategy’s inception in January 2011. Conclusions: The toolkit resources streamlined and supported EBP processes, promoting consistency in quality and presentation of outputs. The online toolkit can be a useful tool to facilitate clinicians’ use of EBP in order to meet the needs of the clients and families whom they support. Implications for Rehabilitation A comprehensive online EBP toolkit for interprofessional clinicians is available to streamline the EBP process and to support learning needs regardless of competency level. Multi-method facilitation support, including interactive education, e-learning, clinical librarian services and knowledge brokering, is a valued but cost-restrictive supplement to the implementation of online EBP resources. EBP resources are not one-size-fits-all; targeted appraisal tools, models and frameworks may be integrated to improve their utility for specific sectors, which may limit them for others.

Promoting Therapists’ Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation

Purpose Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. Method A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists’ confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists’ perspectives on MLS use during VR-based therapy provision. Results The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001). Chart-Stimulated Recall indicated a moderate level of competency in therapists’ clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944). On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach. Conclusion The KT intervention improved therapists’ confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy.

Enhancing clinical implementation of virtual reality

Despite an emerging evidence base and rapid increases in the development of clinically accessible virtual reality (VR) technologies for rehabilitation, clinical adoption remains low. This paper uses the Theoretical Domains Framework to structure an overview of the known barriers and facilitators to clinical uptake of VR and discusses knowledge translation strategies that have been identified or used to target these factors to facilitate adoption. Based on this discussion, we issue a ‘call to action’ to address identified gaps by providing actionable recommendations for development, research and clinical implementation.

Facilitating Interviews in Qualitative Research With Visual Tools: A Typology:

Visual methods are gaining traction in qualitative research to support data generation, data analysis, and research dissemination. In this article, I propose a preliminary typology that categorizes five identified purposes of applying visual methods in qualitative interviews: to (a) enable communication, (b) represent the data, (c) enhance data quality and validity, (d) facilitate the relationship, and (e) effect change. Examples of visual tools are presented to demonstrate their utility in addressing these five aims. An existing ethical framework for visual tool use in qualitative research is then presented to structure a discussion on ethical considerations related to confidentiality, consent, representations and audiences, fuzzy boundaries between researchers and participants, authorship and ownership, and minimizing harm. Future directions include testing and extending the typology with respect to other visual methods and qualitative research processes, and research to evaluate the effectiveness of various visual tools at achieving the aims represented in the typology.

Core knowledge translation competencies: A scoping review

BackgroundKnowledge translation (KT) is the broad range of activities aimed at supporting the use of research findings leading to evidence-based practice (EBP) and policy. Recommendations have been made that capacity building efforts be established to support individuals to enact KT. In this study, we summarized existing knowledge on KT competencies to provide a foundation for such capacity building efforts and to inform policy and research. Our research questions were “What are the core KT competencies needed in the health sector?” and “What are the interventions and strategies to teach and reinforce those competencies?”MethodsWe used a scoping review approach and an integrated KT process by involving an Advisory Group of diverse stakeholders. We searched seven health and interdisciplinary electronic databases and grey literature sources for materials published from 2003 to 2017 in English language only. Empirical and theoretical publications in health that examined KT competencies were retrieved, reviewed, and synthesized.ResultsOverall, 1171 publications were retrieved; 137 were fully reviewed; and 15 empirical and six conceptual academic, and 52 grey literature publications were included and synthesized in this scoping review. From both the academic and grey literature, we categorized 19 KT core competencies into knowledge, skills, or attitudes; and identified commonly used interventions and strategies to enhance KT competencies such as education, organizational support and hands-on training.ConclusionsThese initial core KT competencies for individuals provide implications for education, policy, knowledge brokering, and future research, and on the need for future evaluation of the KT competencies presented. We also discuss the essential role of organizational support and culture for successful KT activities/practice.