Systematic review of knowledge translation strategies in the allied health professions

Implementation Science

Donna M Dryden¹  David Thompson⁵  Amanda S Newton⁴  Katharina Kovacs Burns²  Terry P Klassen³  C Allyson Jones⁸  Anne Hofmeyer⁶  Lisa Hartling¹  Geoff DC Ball⁴  Kathy O’Leary⁷  Lauren Albrecht⁷  Shannon D Scott⁷ 

[1] Alberta Research Centre for Health Evidence, University of Alberta, Level 4, Edmonton Clinic Health Academy, Edmonton, AB, Canada;Glenrose Rehabilitation Hospital, 10230 111 Avenue, Edmonton, AB, Canada;Winnipeg Regional Health Authority, 650 Main Street, Winnipeg, MB, Canada;Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 8213 Aberhart Centre, Edmonton, AB, Canada;Northern Ontario School of Medicine, 955 Oliver Road, Thunder Bay, ON, Canada;School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia;Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, Edmonton, AB, Canada;Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 3-48 Corbett Hall, Edmonton, AB, Canada

关键词: Systematic review;    Behaviour change interventions;    Research use;    Knowledge translation;    Allied health;   

Others  :  814721
DOI  :  10.1186/1748-5908-7-70

 received in 2011-11-09, accepted in 2012-07-04,  发布年份 2012

【 摘 要 】

Background

Knowledge translation (KT) aims to close the research-practice gap in order to realize and maximize the benefits of research within the practice setting. Previous studies have investigated KT strategies in nursing and medicine; however, the present study is the first systematic review of the effectiveness of a variety of KT interventions in five allied health disciplines: dietetics, occupational therapy, pharmacy, physiotherapy, and speech-language pathology.

Methods

A health research librarian developed and implemented search strategies in eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, CENTRAL) using language (English) and date restrictions (1985 to March 2010). Other relevant sources were manually searched. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Within each profession, evidence tables were created, grouping and analyzing data by research design, KT strategy, targeted behaviour, and primary outcome. The published descriptions of the KT interventions were compared to the Workgroup for Intervention Development and Evaluation Research (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions.

Results

A total of 2,638 articles were located and the titles and abstracts were screened. Of those, 1,172 full-text articles were reviewed and subsequently 32 studies were included in the systematic review. A variety of single (n = 15) and multiple (n = 17) KT interventions were identified, with educational meetings being the predominant KT strategy (n = 11). The majority of primary outcomes were identified as professional/process outcomes (n = 25); however, patient outcomes (n = 4), economic outcomes (n = 2), and multiple primary outcomes (n = 1) were also represented. Generally, the studies were of low methodological quality. Outcome reporting bias was common and precluded clear determination of intervention effectiveness. In the majority of studies, the interventions demonstrated mixed effects on primary outcomes, and only four studies demonstrated statistically significant, positive effects on primary outcomes. None of the studies satisfied the four WIDER Recommendations.

Conclusions

Across five allied health professions, equivocal results, low methodological quality, and outcome reporting bias limited our ability to recommend one KT strategy over another. Further research employing the WIDER Recommendations is needed to inform the development and implementation of effective KT interventions in allied health.

【 授权许可】

   
2012 Scott et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Dault M, Lomas J, Barer M: Listening for directions II: National consultation on health services and policy issues for 2004–2007. CIHR: CHSRFand Institute of Health Services and Policy Research; 2004.
• [2]World Health Organization: Bridging the ‘know-do’ gap. Geneva: Meeting on knowledge translation in global health; 2006.
• [3]Canadian Institutes of Health Research (CIHR): Innovation in action. Ottawa: The CIHR Knowledge Translation Strategy 2004–2009; 2004.
• [4]Oxman A, Thomson MA, Davis DA, Haynes RB: No magic bullets: a systematic review of 102 strategies to improve professional practice. CMAJ 1995, 153:1423-1431.
• [5]Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ 1998, 317:465-468.
• [6]Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004, 8(6):1-72.
• [7]O’Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forselund L, Bainbridge D, Freemantle N, Davis D, Haynes RB, Harvey E: Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2008, 4:000409.
• [8]Jamtvedt G, Young J, Kristoffersen DT, O’Briend MA, Oxman AD: Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database of Syst Rev 2006, 2:000259.
• [9]Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR: An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database of Systematic Reviews 2011, 7:009255.
• [10]Foxcroft DR, Cole N: Organizational infrastructures to promote evidence based nursing practice. Cochrane Database of Systematic Reviews 2003, 4:002212.
• [11]Thompson D, Estabrooks C, Scott-Findlay S, Moore K, Wallin L: Interventions to increase research use in nursing: a systematic review. Implement Sci 2007, 2:15. BioMed Central Full Text
• [12]Barrett J, Curran VR, Glynn L, Godwin M: CHSRF synthesis. Ottawa: Interprofessional collaboration and quality primary healthcare; 2007.
• [13]Canadian Interprofessional Health Collaborative Vancouver: A national interprofessional competency framework; 2010.
• [14]Curran VR, Sharpe D: A framework for integrating interprofessional education curriculum in the health sciences. Education for Health 2007, 20:1-7.
• [15]Health Professions Regulatory Advisory Council: An interim report to the Minister of Health and Long-Term Care on mechanisms to facilitate and support interprofessional collaboration among health colleagues and regulated health professionals. Ottawa; 2008.
• [16]Suter E, Deutschlander S: Can interprofessional collaboration provide health human resource solutions?. Ottawa: A knowledge synthesis; 2010.
• [17]World Health Organization: Framework for action on interprofessional education and collaborative practice. Geneva: Framework for action on interprofessional education and collaborative practice; 2010.
• [18]Thomas LH, Cullum NA, McColl E, Rousseau N, Soutter J, Steen N: Guidelines in professions allied to medicine (review). Cochrane Database of Syst Rev 1999, 1:000349.
• [19]Hakkennes S, Dodd K: Guideline implementation in allied health professions: a systematic review of the literature. Qual Saf Health Care 2008, 17:296-300.
• [20]Menon A, Korner-Bitensky N, Kastner M, McKibbon KA, Straus S: Strategies for rehabilitation professionals to move evidence based knowledge into practice: a systematic review. J Rehabil Med 2009, 41:1024-1032.
• [21]Eccles M, Grimshaw J, Walker A, Johnson J, Pitts N: Changing the behavior of health care professionals: the use of theory in promoting the uptake of research findings. J Clin Epi 2005, 58:107-112.
• [22]Davies P, Walker A, Grimshaw J: Theories of behavior change in studies of guideline implementation. Proc British Psychological Society 2003, 11:120.
• [23]Michie S, Abraham C: Interventions to change health behaviou rs: evidence-based or evidence-inspired. Psychology and Health 2004, 19(1):29-49.
• [24]Michie S, Johnson M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 2005, 14(26):26-33.
• [25]Michie S, Johnson M, Francis J, Hardeman W, Eccles M: From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol-Int Rev 2008, 57(4):660-680.
• [26]Michie S, Fixsen D, Grimshaw JM, Eccles MP: Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci 2009, 4(40):1-6.
• [27]Michie S, van Stralen MM, West R: The behaviour change wheel: a new method for characterizing and designing behaviour change interventions. Implement Sci 2011, 6(42):1-11.
• [28]ICEBeRG Research Group: Designing theoretically-informed implementation interventions. Implement Sci; 2006:1-4.
• [29]Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N: Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epi 2005, 58(2):107-112.
• [30]Bhattacharyya O, Reeves S, Garfinkel S, Zwarenstein M: Designing theoretically-informed implementation interventions. Fine in theory, but evidence of effectiveness in practice is needed. Implement Sci 2006, 1:5.
• [31]Simms A: A novel theory-based implementation intervention to increase prescription of inspiratory muscle training for people with chronic obstructive pulmonary disease. University of British Columbia, Department of Rehabilitation Sciences: Master’s thesis; 2010.
• [32]Scott SD, Osmond MH, O’Leary KA, Graham ID, Grimshaw J, Klassen T: Pediatric Emergency Research Canada (PERC) MDI/spacer Study Group: Barriers and supports to implementation of MDI/spacer use in nine Canadian pediatric emergency departments: a qualitative study. Implement Sci 2009, 4(65):1-10.
• [33]Scott SD, Albrecht L, O’Leary K, Ball GDC, Dryden DM, Hartling L, Hofmeyer A, Jones CA: Kovacs Burns K, Newton AS, Thompson, D. Klassen TP: A protocol of a systematic review of knowledge translation strategies in the allied health professions. Implement Sci 2011, 6:58.
• [34]Pawson R, Greenhalgh T, Harvey G, Walshe K: Realist review – a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy 2005, 10(Suppl 1):21-34.
• [35]Mays N, Pope C, Popay J: Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. J Health Serv Res Policy 2005, 10(Suppl 1):6-20.
• [36]Morrison A, Moulton K, Clark M, Polisena J, Fiander M, Mierzwinski-Urban M, Mensinkai S, Clifford T, Hutton B: English-language restriction when conducting systematic review-based meta-analyses. Canadian Agency for Drugs and Technologies in Health Ottawa: Systematic review of published studies; 2009.
• [37]Cochrane Effective Practice and Organisation of Care Review Group: Data collection checklist. [ http://epoc.cochrane.org/sites/epoc.cochrane.org/files/uploads/datacollectionchecklist.pdf webcite]
• [38]Hartling L, Bond K, Santaguida PL, Viswanathan M, Dryden DM: Testing a tool for the classification of study designs in systematic reviews of interventions and exposures showed moderate reliability and low accuracy. J Clin Epi 2011, 64:861-871.
• [39]Workgroup for Intervention Development and Evaluation Research: WIDER recommendations. [ http://interventiondesign.co.uk/wp-content/uploads/2009/02/wider-recommendations.pdf webcite]
• [40]Consolidated Standards of Reporting Trials (CONSORT) Group: Consolidated standards of reporting trials (CONSORT) statement. [ http://www.consort-statement.org/home/ webcite]
• [41]Effective Public Health Practice Project Quality assessment tool for quantitative studies. [ http://www.ephpp.ca/Tools.html webcite]
• [42]Thomas H, Ciliska D, Dobbins M, Micucci S: A process for systematically reviewing the literature: providing evidence for public health nursing interventions. Worldv Evid-Based Nu 2004, 2:91-99.
• [43]Hutchinson AM, Mallidou AA, Toth F, Cummings GG, Schalm C, Estabrooks CA: Review and synthesis of literature examining characteristics of organizational context that influence knowledge translation in healthcare: Technical Report. Edmonton: University of Alberta, Faculty of Nursing; 2010.
• [44]Altman DG: Practical statistics for medical research. London: Chapman and Hall; 1991.
• [45]Airaksinen M, Ahonen R, Enlund H: The ‘questions to ask about your medicines’ campaign: an evaluation of pharmacists and the public’s response. Med Care 1998, 36:422-427.
• [46]Banz MF: Vineyard Most P, Banz WJ: A workshop designed to educate dietetics professionals about the cardiovascular benefits of soyfoods. J Nutr Educ Behav 2004, 36:103-104.
• [47]Bekkering GE, Hendriks HJM, van Tulder MW, Knol DL, Hoeijenbos M, Oostendorp RAB, Bouter LM: Effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain: a cluster randomized controlled trial. Qual Saf Health Care 2005, 14:107-112.
• [48]Bekkering GE, van Tulder MW, Hendriks EJM, Koopmanschap MA, Knol DL, Bouter LM, Oostendorp RAB: Implementation of clinical guidelines on physical therapy for patients with low back pain: randomized trial comparing patient outcomes after a standard and active implementation strategy. Phys Ther 2005, 85:544-555.
• [49]Benrimoj SL, Gilbert A, Quintrell N: de Almeida Neto AC: Non-prescription medicines: a process for standards development and testing in community pharmacy. Pharm World Sci 2007, 29:386-394.
• [50]Bracchi RCG, Houghton J, Woods FJ, Thomas S, Smail SA, Routledge PA: A distance-learning programme in pharmacovigilance linked to educational credits is associated with improved reporting of suspected adverse drug reactions via the UK yellow card scheme. Br J Clin Pharmacol 2005, 60:221-223.
• [51]Brooks VG: Penick Brock T, Ahn J: Do training programs work? an assessment of pharmacists activities in the field of chemical dependency. J Drug Educ 2001, 31:153-169.
• [52]Brown CJ, Gottschalk M, Van Ness PH, Fortinsky RH, Tinetti ME: Changes in physical therapy providers’ use of fall prevention strategies following a multicomponent behavioral change intervention. Phys Ther 2005, 85(5):394-403.
• [53]Brug J, Spikmans F, Aartsen C, Breedveld B, Bes R, Fereira I: Training dietitians in basic motivational interviewing skills results in changes in their counseling style and lower saturated fat intakes in their patients. J Nutr Educ Behav 2007, 39:8-12.
• [54]Dualde E, Faus MJ, Santonja FJ, Fernandez-Llimos F: Effectiveness of a videoconference training course on implementing pharmacy services. Pharm World Sci 2009, 31:638-642.
• [55]Egen V, Hasford J: Prevention of neural tube defects: effects of an intervention aimed at implementing the offician recommendations. Soz.- Präventivmed 2003, 48:24-32.
• [56]Fjortoft N, Schwartz AH: Evaluation of a pharmacy continuing education program: long-term learning outcomes and changes in practice behaviors. Am J Pharm Educ 2003, 67:1-11.
• [57]Fjortoft N: The effectiveness of commitment to change statements on improving practice behaviours following continuing pharmacy education. Am J Pharm Educ 2007, 71:1-7.
• [58]Gross DP, Lowe A: Evaluation of a knowledge translation initiative for physical therapists treating patients with work disability. Disabil Rehabil 2009, 31:871-879.
• [59]Hammond A, Klompenhouwer P: Getting evidence into practice: implementing a behavioural joint protection education programme for people with rheumatoid arthritis. Br J Occup Ther 2005, 68:25-33.
• [60]Hirsch JD, Rosenquist A, Best BM, Miller TA, Gilmer TP: Evaluation of the first year of a pilot program in community pharmacy: HIV/AIDS medication therapy management for Medi-Cal beneficiaries. J Manag Care Pharm 2009, 15:32-41.
• [61]Hoeijenbos M, Bekkering T, Lamers L, Hendricks E, van Tulder M, Koopmanschap M: Cost-effectiveness of an active implementation strategy for the Dutch physiotherapy guideline for low back pain. Health Policy 2005, 75:85-98.
• [62]Hoffmann W, Herzog B, Muhlig S, Kayser H, Fabian R, Thomsen M, Cramer M, Fiβ T, Gresselmeyer D, Janhsen K: Pharmaceutical care for migraine and headache patients: a community-based, randomized intervention. Ann Pharmacother 2008, 42:1804-1813.
• [63]Johnson ST, Bates H, Fitzpatrick J, Marshall JD, Bell RC, McCargar L: Promotion of physical activity by Canadian registered dietitians in daily practice. Hum Nutr Diet 2007, 20:37-40.
• [64]Kerssens JJ, Sluijs EM, Verhaak PFM, Knibbe HJ, Hermans IMJ: Educating patient educators: enhancing instructional effectiveness in physical therapy for low back patients. Patient Educ Couns 1999, 37:165-176.
• [65]Martin BA, Bruskiewitz RH, Chewning BA: Effect of a tobacco cessation continuing professional education program on pharmacists’ confidence, skills, and practice-change behaviors. J Am Pharm Assoc 2010, 50:9-16.
• [66]McCluskey A, Lovarini M: Providing education on evidence-based practice improved knowledge but did not change behavior: a before and after study. BMC Medical Education 2005, 5:1-12. BioMed Central Full Text
• [67]McKenna K, Bennett S, Dierselhuis Z, Hoffmann T, Tooth L, McCluskey A: Australian occupational therapists’ use of an online evidence-based practice database (OTseeker). Health Information and Libraries Journal 2005, 22:205-214.
• [68]Molfentner SM, Ammoury A, Yeates EM, Steele CM: Decreasing the knowledge-to-action gap through research-clinical partnerships in speech-language pathology. Can J Speech Lang Pathol Audiol 2009, 33:82-88.
• [69]Munroe WP, Kunz K, Dalmady-Israel C, Potter L, Schonfeld WH: Economic evaluation of pharmacists involvement in disease management in a community pharmacy setting. Clin Ther 1997, 19:113-123.
• [70]Nikopoulou-Smyrni P, Nikopoulos CK: A new integrated model of clinical reasoning: development, description and preliminary assessment in patients with stroke. Disabil Rehabil 2007, 29:1129-1138.
• [71]Pennington L, Roddam H, Burton C, Russell I, Godfrey C, Russell D: Promoting research use in speech and language therapy: a cluster randomized controlled trial to compare the clinical effectiveness and costs of two training strategies. Clin Rehabil 2005, 19:387-397.
• [72]Rebbeck T, Maher CG, Refshauge KM: Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster-randomised trial. Aust J Physiother 2006, 52:167-174.
• [73]Schreiber J, Stern P, Marchetti G, Provident I: Strategies to promote evidence-based practice in pediatric physical therapy: a formative evaluation pilot project. Phys Ther 2009, 89:918-933.
• [74]Stevenson K, Lewis M, Hay E: Does physiotherapy management of low back pain change as a result of an evidence-based educational programme. J Eval Clin Pract 2004, 12:365-375.
• [75]Tripicchio B, Bykerk K, Wegner C, Wegner J: Increasing patient participation: the effects of training physical and occupational therapists to involve geriatric patients in the concerns-clarification and goal-setting processes. J Phys Ther Educ 2009, 23:55-63.
• [76]Vachon B, Durand MJ, LeBlanc J: Using reflective learning to improve the impact of continuing education in the context of work rehabilitation. Adv in Health Sci Educ 2010, 15:329-348.
• [77]Moher D, Liberati A, Tetzlaff J, Altman DG: The PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009, 6:e1000097.
• [78]Grimshaw J, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, et al.: Changing provider behavior: an overview of systematic reviews of interventions. Medical Care 2001, 8:II2-II45.
• [79]Davis DA, Thomson MA, Oxman AD, Haynes RB: Changing physician performance: a systematic review of the effect of continuing medical education strategies. JAMA 1995, 274:700-705.
• [80]Davis D, O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A: Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behaviour or health care outcomes? JAMA 1999, 282:867-874.
• [81]Wensing M, Grol R: Educational interventions. In Improving Patient Care. Edinburgh: Elsevier: Edited by Grol R, Wensing M, Eccles M; 2005:147-157. [The Implementation of Change in Clinical Practice]
• [82]Chan A, Altman DG: Identifying outcome reporting bias in randomised trials on PubMed: review of publications and survey of authors. BMJ 2005, 330:753-759.
• [83]Hahn S, Williamson PR, Hutton JL: Investigation of within-study selective reporting in clinical research: follow-up of applications submitted to a local research ethics committee. J Eval Clin Pract 2002, 8(3):353-359.
• [84]Chan A, Krleza-Jeric K, Schmid I, Altman DJ: Outcome reporting bias in randomized trials funded by the Canadian Institutes of Health Research. CMAJ 2004, 171(7):735-740.
• [85]Smyth RMD, Kirkham JJ, Jacoby A, Altman DG, Gamble C, Williamson PR: Frequency and reasons for outcome reporting bias in clinical trials: interviews with trialists. BMJ 2010, 341:1-12.
• [86]Macura A, Abraha I, Kirkham J, Gensini GF, Moja L, Iorio A: Selective outcome reporting: telling and detecting true lies. The state of the science. Intern Emerg Med 2010, 5:151-155.
• [87]Dane AV, Schneider BH: Program integrity in primary and early secondary prevention: are implementation effects out of control? Clinical Psychology Review 1998, 18:23-45.
• [88]Gresham FM, Gansle KA, Noell GH: Treatment integrity in appleied behaviour analysis with children. Journal of Applied Behaviour Analysis 1993, 26:257-263.
• [89]Moncher FJ, Prinz RJ: Treatment fidelity in outcome studies. Clinical Psychology Review 1991, 11:247-266.
• [90]Odom SI, Brown WH, Frey T, Karasu N, Smith-Canter LL, Strain PS: Evidence-based practices for young children with autism: contributions for single-subject design research. Focus on Autism and Other Developmental Disabilities 2003, 18:166-175.