JCPSLP Vol 16 Issue 1 2014

Monitor knowledge use

Select, tailor, implement interventions

Evaluate outcomes of use

KNOWLEDGE CREATION Knowledge Inquiry Knowledge Synthesis

Assess barriers/ facilitators

Tools

Tailor knowledge

Sustain knowledge use

Adapt knowledge locally

Identify clinical problem Identify, review & select knowledge

ACTION CYCLE

Figure 1. The Knowledge-to-Action-Process Framework. Source: From Graham et al. (2006). Lost in knowledge translation: Time for a map? Journal of Continuing Education in the Health Professions , 26 , 13–24. Reproduced and adapted with permission.

used to address a clinical problem, and review evidence for these particular KTE interventions (phase v). Scenario You are an experienced clinician working in an adult rehabilitation setting with a large staff. Your recent stroke audit demonstrated that 72% of clients on your caseload received a speech pathology assessment within 48 hours of admission but only 52% receive the recommended number of hours of communication and swallowing treatment according to the National Stroke Foundation (NSF) recommendations (National Stroke Foundation, 2010). Response to this scenario You are aware of the guideline recommendations for intensity of treatment and agree with them. However, some on your team are not confident providing communication therapy and identify a lack of time to develop treatment materials in the absence of packaged evidence-based therapy programs. You also have staffing pressures and your department contributes to a variety of multidisciplinary teams. You now need to research your evidence-based options for improving your implementation of these NSF recommendations. You are aware of general KTE frameworks and models to guide your implementation of

the evidence-based recommendations but you seek more detailed information on the efficacy of specific KTE interventions to assist you to implement the evidence. Searching for the evidence A systematic search was conducted from a variety of databases including Web of Science, CINAHL, Medline, PubMed, SpeechBITE and the Cochrane Database using search terms: (speech language patholog* OR speech patholog* OR speech therap*) AND (implementation OR knowledge translation OR knowledge transfer and exchange OR practice change OR behaviour change intervention). Additionally, search terms also included aphasia, rehabilitation, swallowing, and communication. The search was limited to articles published in English in the last decade (2003 – October 2013). Abstracts were reviewed according to these inclusion criteria: all study designs (although narrative reviews were excluded), speech pathologists as participants, KTE interventions where the primary purpose was to translate research into clinical practice with quantitative or qualitative outcomes being examined at the clinician, client or service level. Clinical bottom line Table 1 contains a list of speech pathology focused studies as well as a comprehensive overview of KTE interventions

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JCPSLP Volume 16, Number 1 2014

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