Knowledge translation and implementation in spinal cord injury: a systematic review

Abstract

,5 and the SCIRE Research TeamObjective: To conduct a systematic review examining the effectiveness of knowledge translation (KT) interventions in changing clinical practice and patient outcomes. Methods: MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO were searched for studies published from January 1980 to July 2012 that reported and evaluated an implemented KT intervention in spinal cord injury (SCI) care. We reviewed and summarized results from studies that documented the implemented KT intervention, its impact on changing clinician behavior and patient outcomes as well as the facilitators and barriers encountered during the implementation. Results: A total of 13 articles featuring 10 studies were selected and abstracted from 4650 identified articles. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders. The methodological quality of studies was mostly poor. Only 3 out of 10 studies evaluated the success of the implementation using statistical analyses, and all 3 reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements. The commonly cited facilitators and barriers were communication and resources, respectively. Conclusion: The field of KT in SCI is in its infancy with only a few relevant publications. However, there is some evidence that KT interventions may change clinician behavior and improve patient outcomes. Future studies should ensure rigorous study methods are used to evaluate KT interventions.

Professionals’ perceptions of factors affecting implementation and continuation of a physical activity promotion programme in rehabilitation: A qualitative study

“…However, the current study showed that some professionals experienced a lack of support from physiotherapists to embed physical activities into rehabilitation. In line with previous literature (27,39) we found that good communication and collaboration between members of the multidisciplinary team (e.g. sports therapists, physiotherapists, physicians) during implementation seems also essential for successful continuation.…”

Facilitators and Barriers to International Collaboration in Spinal Cord Injury: Results from a Survey of Clinicians and Researchers

“…For example, the challenges with the translation of cellular therapies for SCI was explored by an international group of stakeholders 27 and a systematic review of knowledge translation interventions identified barriers and facilitators to implementation. 28 Work has also been done to investigate the state of international collaborations in the area of science and provide recommendations for supporting collaboration. 29 , 30 From this survey and from the literature cited above, the theme of funding appears to be a common challenge.…”

Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework: a mixed methods study

“…Prior studies have also highlighted the variability that exists in the implementation and subsequent success of HAI prevention programs [ 16 , 37 ]. In SCI/D care delivery, a recent review has shown that knowledge translation and targeted implementation efforts may be particularly effective in changing SCI/D provider behavior and improving patient outcomes [ 38 ]. Our findings align with these studies and corroborate the need to increase provider awareness and knowledge around guidelines, ensure guidelines are tailored to the provider context, and enhance leadership support and provider education [ 16 , 22 , 39 ].…”

“…In addition, we found that the presence of local MPCs, whose role centers on overseeing compliance with the guidelines, was often helpful for implementation; however, a strong group of SCI/D providers could effectively support MRSA prevention activities. This is particularly important in the SCI/D setting given patient needs for interdisciplinary, integrated, and team-based care [ 38 ]. Further, future efforts should ensure that guideline dissemination reaches the full range of providers that care for patients with SCI/D and should focus on disseminating guidelines to providers with hands-on contact with patients in inpatient and other SCI/D care settings.…”