JCPSLP Vol 14 No 1 2012

Table 1. Identified relevant evidence translation articles Article Type/Level of

Summary

evidence*

result, to address evidence–practice gaps like those described in the clinical scenario we should look to current evidence into “research translation” and “knowledge transfer” to identify strategies and models that work. This step does not seek to address the specific clinical scenario directly; rather it seeks to provide some recommendations for clinicians who want to demonstrate and address the evidence–practice gaps they observe in their workplace. Searching for the evidence So, what is the evidence for “evidence translation”? To answer this question we can turn to the research databases to look at what has been published in the field. The search undertaken sought to find research studies that tested intervention strategies with a primary purpose of translating research evidence into clinical practice with outcomes measured at the level of the professional (e.g., change in practice, knowledge, or attitudes), the patient or consumer (e.g., improved client satisfaction or outcomes), and/or the service itself (e.g., change in policy, programs, or staffing ratios). Identifying key search terms can be a challenge to EBP, especially when narrow keywords are utilised to find relevant evidence. Search strategies from the related literature, such as those of Evenson, Sanson-Fisher, D’Este, and Fitzgerald (2010), were used to help define the search terms for this review. Starting with PsycINFO (Psychological Abstracts), Medline, and Google Scholar, a title search using the terms (knowledge OR evidence practice gap OR practice guideline* OR recommendation* OR best practice* OR implementation OR knowledge translation) AND (speech patholog* OR speech language therap*) was undertaken. Aphasia, communication, and stroke were additional search terms used. However, very few relevant papers were identified, as shown in Table 1. Interestingly, replacing speech pathology with (nursing) resulted in a much higher return of translation research and review papers, suggesting that more translational research and discussion is taking place in fields beyond speech Kagan, A., Simmons-Mackie, N., Brenneman, G., Conklin, J., & Elman, R.J. (2010). Closing the evidence, research, and practice loop: Examples of knowledge transfer and exchange from the field of aphasia. Aphasiology , 24 (4), 535–548. MacDonald, S., & Wiseman-Hakes, C. (2010). Knowledge translation in ABI rehabilitation: A model for consolidating and applying the evidence for cognitive-communication Molfenter, S.M., Ammoury, A., Yeates, E.M., & Steele, C.M. (2009). Decreasing the knowledge-to-action gap through research-clinical partnerships in speech-language pathology. Canadian Journal of Speech-Language Pathology and Audiology , 33 (2), 82–88. Rose, M., & Baldac, S. (2004). Translating evidence into practice. In S. Reilly, J. Douglas, & J. Oates (Eds.), Evidence- based practice in speech pathology (pp. 317–330). Simmons-Mackie, N.N., Kagan, A., Christie, C.O., Huijbregts, M., McEwan, S., & Willems, J. (2007). Communicative access and decision making for people with aphasia: Implementing sustainable health care systems change. interventions. Brain Injury, 24 (3), 486–508. Philadelphia: Whurr Publishers.

Review article

Provides a comprehensive overview of theoretical models and principles of knowledge transfer and exchange for

clinicians and researchers.

Systematic review Presents a model for consolidating and disseminating

existing evidence for cognitive-communication interventions that is accessible for end users and

promotes knowledge transfer.

Level IV

Presents the outcomes of a successful knowledge-to- action intervention targeting clinicians’ hesitance to adopt a new therapeutic tool (sEMG) in practice despite didactic

training and “knowledge”.

Book chapter

Provides a useful overview of the challenges of, and barriers to, the translation of EBP into practice with practical and theoretically driven strategies for addressing

them.

Level IV

Outlines the outcomes of an implementation project targeting systems-level change to improve access to health care information and supported decision-making

for people with aphasia.

Aphasiology , 21 (1), 39–66. *Source: NH&MRC levels of evidence: http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/cp30.pdf

pathology. The search terms (speech patholog* OR speech language therap*) AND (evidence based practice) returned many more hits; however, very few of these papers appeared to address “translation” specifically or in a systematic way. Clinical bottom line The references identified in Table 1 provide a useful foundation for exploring the research in evidence translation in the speech pathology field and the opportunity to examine strategies that have been proactively used, either successfully or unsuccessfully, to address KTA gaps. The articles by Molfenter et al. (2009) and Simmons-Mackie et al. (2007) have most relevance for the clinical scenario and clearly illustrate the “knowledge transfer and exchange” (KTE) processes or KTA interventions that were used and evaluated. The critically appraised evaluation for the Simmons-Mackie et al. (2007) study is provided in Table 2. The main themes to emerge from this review are provided in Box 1 and explored below, providing some useful tips for clinicians addressing KTA gaps in their own workplace. Overall, the body of work highlights the promise of KTE as a unique skill set for addressing KTA gaps in practice to improve service provision, drive policy change, and most importantly optimise therapeutic outcomes. Box 1. Themes guiding successful EBP translation into practice • Draw upon frameworks, models, and theories to guide knowledge transfer and exchange • Clearly identify a knowledge-to-action or evidence-practice gap

• Use clients as partners and agents for change • Identify readiness for and barriers to change

• Form partnerships and collaborations as drivers of change • Evaluate, measure, and disseminate change outcomes • Ensure continued KTE dialogue between clinicians and researchers

38

JCPSLP Volume 14, Number 1 2012

Journal of Clinical Practice in Speech-Language Pathology