JCPSLP Vol 16 Issue 1 2014

Table 1. KTE intervention search summary Article citation Type/level of

Practice change intervention (EPOC)

Summary

evidence

Grimshaw et al. (2012). Knowledge translation of research findings. Implementation Science, 7(50). doi:

N/A

A range of interventions Provides an overview of the concepts, principles and

Overview of systematic

targeting professionals, clients and policy-makers

evidence for KTE interventions for health professionals.

10.1186/1748-5908-7-50 reviews Scott et al. (2012). Systematic review of Level 1

Predominantly

A systematic review of KTE interventions for five allied health professionals including speech pathology (n = 2 studies). Mixed results with low methodological quality, lack of clear descriptions of interventions and outcome measurement focus on clinician behaviours. All studies showing non-significant outcomes used education- only methods. Compared two KTE interventions to (i) increase SLP (n = 34) adherence to post stroke swallowing guidelines and (ii) determine relative cost effectiveness of the KTE interventions. No significant differences in KTE interventions in (i) improving adherence or (ii) cost Examined the impact of a structured model of journal club from the iCAHE (International Centre for Allied Health Evidence) on the EBP knowledge, skills and behaviour of the different allied health disciplines. Included SLPs (n = 10) who had a significant increase in knowledge but not attitude and evidence uptake. Results differed across the disciplines. System level KTE intervention with 37 members of acute, rehabilitation and long-term multidisciplinary teams to improve access to health information and supported decision-making for people with aphasia. Positive changes observed in rehabilitation and effectiveness.

knowledge translation strategies in the

Systematic

“educational meetings” Approximately 50%

allied health professions.

review

Implementation Science, 7(1), 70. doi

(n = 32 studies) include multiple KTE

10.1186/1748-5908-7-70

interventions

Pennington et al. (2005). Promoting research use in speech and language therapy: a cluster RCT to compare the clinical effectiveness and costs of two

Level II Cluster

Educational meetings

randomised control trial

Single strategy

(RCT)

training strategies. Clinical Rehabilitation, 19, 387–397.

Lizarondo et al. (2012). Does journal club membership improve research

Level IV

Educational meetings

Pilot pre-post

Single strategy

evidence uptake in different allied health design

disciplines: a pre-post study? BMC Research Notes, 5(1), 588. doi:

10.1186/1756-0500-5-588

Simmons-Mackie et al. (2007). Communicative access and decision making for people with aphasia: Implementing sustainable healthcare systems change. Aphasiology, 21, Molfenter et al. (2009). Decreasing the knowledge-to-action gap through research-clinical partnerships in speech-language pathology. Canadian Journal of Speech-Language Pathology 39–66.

Level IV

Educational outreach

Qualitative

visits

study

Tailored interventions Multifaceted strategies

long-term settings.

Level IV

Educational outreach

Outlines a positive KTE implementation based on the

Qualitative case study

visits (academic detailing) KTA framework for four speech pathologists who had

with some tailoring of interventions based on

not implemented dysphagia rehabilitation program using surface electromyography (sEMG) biofeedback after an initial 2-day didactic education session.

barriers.

and Audiology, 33, 82–88. Multifaceted strategies Note: based on the National Health and Medical Research Council levels of evidence (2009).

median score with interquartile range is calculated across all included studies. Thus, the median absolute improvement of change in practice is a measure of the degree of change of behaviour or adherence that the KTE intervention provided over the control intervention. For the EPOC KTE interventions, the median absolute improvement of change in practice ranged from approximately 4% for printed educational materials and computerised reminders, 6% for educational meetings and outreach, to 12% for local opinion leaders (with interquartile ranges from –0.8% to 18.8%, see Grimshaw et al., 2012 for details). So for our scenario, all interventions (e.g., educational outreach) potentially may have some degree of efficacy but the effect sizes are variable and mostly small to moderate. Individual differences are observed within interventions types. For example, audit and feedback interventions had stronger outcomes when the baseline adherence was low and so a better target for our department may be treatment intensity (52%) rather than initial assessment (72%). In the critically appraised article (Pennington et al., 2005), initial mean compliance with a dysphagia guideline was 71%. Therefore if KTE interventions result in smaller changes, it may have been difficult for Pennington et al. (2005) to demonstrate significant outcomes for their KTE interventions.

for professionals, consumers and policy-makers that may provide a useful starting point for clinicians and researchers (see Grimshaw et al., 2012). The individual speech pathology study with the highest level of evidence (RCT) according to the NH&MRC criteria (Pennington, Roddam, Burton, Russell, & Russell, 2005) was selected and critically appraised (see Table 2). In each table, interventions have been described using definitions obtained from the Cochrane Effective Practice and Organisation of Care (EPOC) Taxonomy of practice change interventions (http:// www.epoc.cochrane.org). The definitions are designed to increase the clarity of description and categorisation of KTE interventions and are presented in Table 3. Which KTE interventions have good efficacy in the broader literature? Grimshaw et al. (2012) provides a summary of the evidence for each of the KTE interventions listed in Table 3 based on previous systematic reviews of a broad range of health professions. The median absolute improvement of change in practice is often reported for practice change intervention meta-analyses (Grimshaw et al., 2004). Essentially, the absolute difference between intervention group and control group scores for each outcome measure is calculated. To then understand this effect size for a number of studies, a

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JCPSLP Volume 16, Number 1 2014

Journal of Clinical Practice in Speech-Language Pathology