Improving rehabilitation treatment in a local setting: a case study of prosthetic rehabilitation

Twillert, Sacha van; Postema, Klaas; Geertzen, Jan H. B.; Hemminga, Titia; Lettinga, Ant T.

doi:10.1177/0269215509338125

Cited by 13 publications

(20 citation statements)

References 39 publications

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“…If we argue that research evidence produced in experimental settings should not override, or take precedence over, clinical experience, clinical embodied skills, patients' needs, values and knowledge, then the relationship between evidence and practice cannot be that of supplying a basis for that very practice. 9,15,51 It is of course important to critical appraise rehabilitation practices in experimental settings and conduct creative scientific investigations that may help to (im)prove it. But we suggest that all three knowledge practices, scientific knowledge from researchers, clinical knowledge from clinicians and practical knowledge from patients are important and should inform and strengthen each other.…”

Section: Discussionmentioning

confidence: 99%

“…In evidenceinformed practice (EIP), clinicians are encouraged to be knowledgeable about the findings coming from all types of scientific studies, and researchers are urged to support them in translating it to the local realities of different rehabilitation settings in an integrative manner. 9,51 …”

Section: Discussionmentioning

confidence: 99%

“…This definitely yields for clinicians working in prosthetic rehabilitation with lower-limb amputee patients. 9 In line with Sackett et al's 10 definition of evidencebased medicine (EBM), EBP in prosthetic rehabilitation is characterized as the process of integrating individual clinical expertise and patient values with the best available evidence from systematic research, in order to provide the best clinical care. [1][2][3][4] This definition comes across as attractive.…”

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confidence: 99%

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Reconsidering evidence-based practice in prosthetic rehabilitation

Twillert

Geertzen

Hemminga

et al. 2013

Prosthetics &Amp; Orthotics International

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Background: A divide is experienced between producers and users of evidence in prosthetic rehabilitation. Objective: To discuss the complexity inherent in establishing evidence-based practice in a prosthetic rehabilitation team illustrated by the case of prosthetic prescription for elderly dysvascular transfemoral amputee patients. Study Design: A qualitative research design was used, in which data from multiple sources was triangulated to extract themes for discussion. Methods: This discussion paper draws on empirical material gathered by individual and focus-group interviews with members of a prosthetic rehabilitation team, information on technological advancements presented on websites of orthopaedic industry, guidelines and literature study. Results: A prosthetic rehabilitation team needs to deal with lack of evidence, contradictory results, various classification systems, diverging interests of different stakeholders and many modifying factors, and all of this in a continuous technological changing environment. Integrating research designs with different strengths but not sharing the same biases may help researchers to deal with the multimorbidity and multifaceted disability of the target group. Articulating clinical knowledge, patients’ needs and values in a systematic way provides depth, detail, nuance and context for evidence-based practice issues in prosthetic rehabilitation. Conclusions: Reconsidering the relationship between evidence, technology and rehabilitation practice is an imperative shared enterprise for clinicians and researchers. Scientific, clinical and patient-related knowledge are seen as important knowledge practices that should inform and strengthen each other. Clinical relevance This discussion paper puts the academic clinical debate on evidence-based practice in prosthetics and orthotics in another light. By demonstrating the complexities surrounding evidence-based practice, it is argued and illustrated how both researchers and clinicians can contribute to optimal patient care in which evidence, technology and rehabilitation practice are integrated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Reconsidering evidence-based practice in prosthetic rehabilitation

Twillert

Geertzen

Hemminga

et al. 2013

Prosthetics &Amp; Orthotics International

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“…This case report is part of a larger research project in which participatory action research methodology is used to engage the multidisciplinary team in the evidence-informed improvement process. 5,10,11 Two problems were leading motives at the start of this bidirectional KTA process, as was described in a previous article. 5 First, therapists were concerned about a possible decline in outcome after rehabilitation discharge in elderly people with amputations.…”

Section: Case Descriptionmentioning

confidence: 91%

“…4 -7 They thereby assume that evidence produced in clinical trials is ready-made knowledge, is easy to access, and is simple to implement in local practices as long as therapists are willing to act upon that proven knowledge. 4,5 There is growing recognition, however, that a problem in knowledge production rather than in knowledge transfer hinders the knowledge-toaction (KTA) translation process. 4,8,9 Most knowledge transfer approaches value objective knowledge gained in clinical trials over subjective knowledge from, for example, therapist and patient experiences.…”

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confidence: 99%

Incorporating Self-Management in Prosthetic Rehabilitation: Case Report of an Integrated Knowledge-to-Action Process

et al. 2015

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Background. In improvement of clinical practice, unidirectional approaches of translating evidence into clinical practice have been pinpointed as main obstacles. The concept of engaged scholarship has been introduced to guide knowledge-toaction (KTA) processes, in which research knowledge and practical knowledge derived from therapists, patients, and organizational structures mutually inform each other. Accordingly, KTA experts should engage end-users earlier in knowledge translation and work in concert with them on both knowledge creation and knowledge implementation.Purpose. The purposes of this case report are: (1) to provide an illustrative example of an evidence-informed improvement process in prosthetic rehabilitation in a local setting and (2) to articulate the bidirectional translation work incorporated into an integrated KTA process.Case Description. A KTA expert translated research knowledge on selfmanagement and task-and context-specific training into a functional prosthetic training program for patients with a lower limb amputation. Therapists contributed as co-creators to the translation process with practical knowledge of the specificities of the target group and local organizational context. The KTA expert moved the co-created knowledge into action in iterative and interactive steps with local therapists, patients, and managers.Outcome. This bidirectional KTA translation process led to shared ownership of the functional prosthetic training program, in which self-management and task-and context-specific training principles and practices were integrated.Discussion. Bidirectional knowledge translation builds on explicating and integrating the different knowledge practices of researchers, therapists, and their patients. Knowledge-to-action experts and end-users have their own roles and activities in such knowledge translation processes. Appreciating these different roles in genuine partnerships and acknowledging the distinct but equally valued knowledge practices can help in effectively translating evidence into action.

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Construct Validity and Test-Retest Reliability of the Climbing Stairs Questionnaire in Lower-Limb Amputees

Laat

Rommers

Geertzen

et al. 2010

Archives of Physical Medicine and Rehabilitation

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Improving rehabilitation treatment in a local setting: a case study of prosthetic rehabilitation

Abstract: Improving rehabilitation practice with the use of available evidence is a heterogeneous and multifaceted scientific enterprise. Such an enterprise requires as much self-reflexivity from researchers as from practitioners.

Cited by 13 publications

References 39 publications

Reconsidering evidence-based practice in prosthetic rehabilitation

Reconsidering evidence-based practice in prosthetic rehabilitation

Incorporating Self-Management in Prosthetic Rehabilitation: Case Report of an Integrated Knowledge-to-Action Process

Construct Validity and Test-Retest Reliability of the Climbing Stairs Questionnaire in Lower-Limb Amputees

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