JCPSLP Vol 16 Issue 1 2014

What interventions have shown efficacy in speech pathology and allied health? There is less KTE literature in allied health than other fields, with a particular paucity of studies in speech pathology (Scott et al., 2012). Educationally focused interventions (e.g., meetings and printed materials) are most commonly evaluated and they do have the advantage of being potentially more feasible and cost effective than other interventions such as educational outreach. However, results for single educational interventions (e.g., journal clubs) were mainly non-significant in translating research into practice (Lizarondo et al., 2013; Pennington et al., 2005; Scott et al., 2012). More successful KTE interventions and strategies in speech pathology include active, multifaceted and tailored interventions that targeted local barriers to change in collaboration with a multidisciplinary team or academics with expertise in specific interventions (Molfenter et al. 2009; Simmons- Mackie et al., 2007). There is no clear evidence on what intervention is best for specific types of barriers, or whether one intervention is superior to another (Grimshaw et al., 2012; Scott et al., 2012). When considering our scenario above, KTE interventions should be tailored to the identified barriers (phase v of the action cycle). We may then target critical barriers such as a lack of treatment resources and expertise through educational meetings and outreach by collaborating with other successful departments and academics to develop resources and protocols for interventions. Peer-elected opinion leaders could be credible messengers of change and assist with mentoring other staff to implement the evidence. It may also require consensus input from multidisciplinary team members in relation to ward scheduling for increased intensity of treatment, as well as problem-solving ways to provide additional practice through other methods (e.g., volunteers, computer programs). While some of the literature is equivocal on whether multifaceted strategies result in better translation outcomes than single strategies, multimodal strategies were utilised in the more successful speech pathology KTE interventions (Molfenter et al. 2009; Simmons-Mackie et al., 2007) and have also been found to result in better translation than single, more passive strategies for other disciplines such as physiotherapy (Menon, Korner-Bitensky, Kastner, McKibbon, & Straus, 2009). How confident can we be of the KTE evidence in speech pathology and allied health? There is a growing evidence base for the effectiveness of KTE interventions and strategies in improving the implementation of evidence into practice for speech pathologists. However, the evidence base is small, consists of lower quality studies and the single higher quality RCT trial (Pennington et al., 2005) was published in 2005 and had limitations based on our current knowledge of KTE (see Table 2). In addition, definitive conclusions on the effectiveness of KTE interventions cannot be made from the broader allied health literature because of low methodological quality, inconsistent findings for interventions, and outcome reporting bias for measurement of clinician behaviour change but not whether clients benefited from this implementation of evidence (Scott et al., 2012). Furthermore different disciplines of allied health professionals may respond differently to a single KTE

intervention (Lizarondo et al., 2012). Therefore, in our scenario we may have to cautiously make use of the broader research and acknowledge that we need to target interventions purposively and monitor their effectiveness through measurements of outcomes at clinician, client and service level, while also describing the process itself. How can we think about the quality of reported KTE interventions? KTE interventions themselves are well described in only a small percentage of studies (5–30%) and many do not identify the theoretical basis of their intervention, making replication difficult for researchers and clinicians (Albrecht, Archibald, Arseneau & Scott, 2013). To understand the quality of KTE intevention research in relation to important components of behaviour change interventions, clinicians may refer to the Workgroup for Intervention Development and Evaluation Research (WIDER) reporting guidelines (see Albrecht et al., 2013). Conclusion The all too frequent concluding statement is that we need more evidence for implementing the evidence. However, there is an increasing understanding from the wider health professional literature that KTE interventions can result in improvement in implementation albeit with a small to moderate effect. As researchers more clearly describe the important elements of KTE interventions, the theoretical models that underpin those interventions and how interventions are tailored to barriers and facilitators of local contexts, the research evidence may provide more specific direction for researchers and clinicians. Beyond a traditional EBP-focused approach, departments can now utilise KTE models, consider barriers and facilitators to implementation, choose from a variety of interventions that address those barriers, harness the inherent opinion leaders in their organisations and trial and evaluate KTE interventions. Joining in a partnership with consumers, researchers and other stakeholders in this effort is the collaborative way forward for better outcomes for clients and health services in the future. References Albrecht, L., Archibald, M., Arseneau, D. & Scott, S. D. (2013). Development of a checklist to assess the quality of reporting of knowledge translation interventions using the Workgroup for Intervention Development and Evaluation Research (WIDER) recommendations. Implementation Science , 8 (52). doi:10.1186/1748-5908-8-52 Canadian Institutes of Health Research. (2009). About knowledge translation . Retrieved from http://www.cihr-irsc. gc.ca/e/29418.html Cochrane Effective Practice and Organisation of Care (EPOC) Review Group. (2002). Data collection checklist . Retrieved from http://epoc.cochrane.org/sites/epoc. cochrane.org/files/uploads/datacollectionchecklist.pdf (accessed 10 Sept 2013). Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., & Caswell, W. (2006). Lost in knowledge translation: Time for a map? Journal of Continuing Education in the Health Professions , 26 , 13–24. Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of Innovations in Service Organizations: Systematic review and recommendations. Milbank Quarterly , 82 (4), 581–629.

28

JCPSLP Volume 16, Number 1 2014

Journal of Clinical Practice in Speech-Language Pathology