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Stander J.1, Grimmer K.1,2, Brink Y.1
1Stellenbosch University, Faculty of Medicine & Health Sciences, Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Cape Town, South Africa, 2University of South Australia, International Centre for Allied Health Evidence, School of Health Sciences, Adelaide, Australia
Background: Knowledge translation (KT) describes implementation approaches that bridge the gap between research and clinical practice. Intervention studies of KT strategies to improve uptake of evidence in physiotherapy practice have shown significant positive effects for practice behaviour changes However, these studies generally have low methodological quality, poorly described KT interventions and difficulty with outcome measurement. Evidence-based KT strategies which are underpinned by well-developed theoretical frameworks are urgently needed to assist the seamless integration of research evidence into practice.
Purpose: The purposes of this scoping review were to:
1) identify components of KT training programmes tailored to physiotherapists to enhance evidence-based practice (EBP) and clinical practice guideline (CPG) utilisation;
2) map the elements of KT training programmes against evidence of effectiveness;
3) describe outcome measures reported from these training programmes; and
4) identify elements of KT training programmes that were consistently associated with effective outcomes.
1) identify components of KT training programmes tailored to physiotherapists to enhance evidence-based practice (EBP) and clinical practice guideline (CPG) utilisation;
2) map the elements of KT training programmes against evidence of effectiveness;
3) describe outcome measures reported from these training programmes; and
4) identify elements of KT training programmes that were consistently associated with effective outcomes.
Methods: Nine electronic databases (CINAHL, BIOMED CENTRAL, Cochrane, Web of Science, PROQUEST, PUBMED, OTseeker, Scopus, ERIC) were searched using the keywords: (clinical practice guidelines OR evidence-based practice) AND (physiotherapy OR physical therapy) AND (strategies OR interventions) AND effect. Primary research articles that described either strategies of training programmes and/ or the effectiveness of strategies for physiotherapists, regarding EBP and CPG utilisation, were sought. An adapted Arksey and OMalley framework for the systematic execution of a scoping review, was used to ensure a systematic search, literature evaluation and descriptive synthesis of current research evidence for this topic.
Results: Ten systematic reviews (SR), one non-randomised controlled trial and one pre-post study were identified, that reported on physiotherapy-related studies. The SRs were unpicked to identify primary studies which were then included if they had not already been identified in the search. This approach provided 18 relevant articles (both observational and intervention studies). KT strategies such as educational meetings and outreach strategies, and reminders offer better end-results than persuasive processes, such as opinion leaders and consensus processes. If KT strategies are combined, it can lead to positive practice behaviour change. The dissemination of a CPG may improve practice behaviour and patient outcomes when forming part of a multi-faceted approach. Also, if barriers to practice behaviour change and EBP utilisation are identified beforehand and strategies formed around it, there are possibly higher success rates for the improvement of EBP utilisation. Audit and feedback processes or activity diaries can effectively assess the alignment of the physiotherapists attitude and behaviour, as both processes showed improved adherence to EBP and could help assess patient outcomes.
The outcome measures that were reported on were the EBP questionnaire, Questions to EBP attitudes and different versions of the Fresno test. Multi-faceted KT strategies with different components, including educational meetings, reminders, audit and feedback and CPG hand-outs were consistently associated with effective outcomes.
Conclusion(s): An active KT strategy with multifaceted interventions needs to be developed to align with common and relevant barriers to the use of EBP in daily physiotherapy practice and its effect on patient outcomes.
Implications: Evidence-based KT strategies are implemented to optimise physiotherapy behaviour change and learning outcomes.
Funding acknowledgements: The study was not funded.
Topic: Education: methods of teaching & learning
Ethics approval: No ethics approval was required for the study.
All authors, affiliations and abstracts have been published as submitted.
