26
JCPSLP
Volume 16, Number 1 2014
Journal of Clinical Practice in Speech-Language Pathology
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 (
). 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
Table 1. KTE intervention search summary
Article citation
Type/level of
Practice change
Summary
evidence
intervention (EPOC)
Grimshaw et al. (2012). Knowledge
N/A
A range of interventions Provides an overview of the concepts, principles and
translation of research findings.
Overview of
targeting professionals,
evidence for KTE interventions for health professionals.
Implementation Science, 7(50). doi:
systematic
clients and policy-makers
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
knowledge translation strategies in the
Systematic
“educational meetings”
health professionals including speech pathology (n = 2
allied health professions.
review
Approximately 50%
studies). Mixed results with low methodological quality,
Implementation Science, 7(1), 70. doi
(n = 32 studies) include multiple KTE
lack of clear descriptions of interventions and outcome
10.1186/1748-5908-7-70
interventions
measurement focus on clinician behaviours. All studies
showing non-significant outcomes used education-
only methods.
Pennington et al. (2005). Promoting
Level II Cluster
Educational meetings
Compared two KTE interventions to (i) increase SLP
research use in speech and language
randomised
Single strategy
(n = 34) adherence to post stroke swallowing guidelines
therapy: a cluster RCT to compare the
control trial
and (ii) determine relative cost effectiveness of the KTE
clinical effectiveness and costs of two
(RCT)
interventions. No significant differences in KTE
training strategies. Clinical
interventions in (i) improving adherence or (ii) cost
Rehabilitation, 19, 387–397.
effectiveness.
Lizarondo et al. (2012). Does journal
Level IV
Educational meetings
Examined the impact of a structured model of journal
club membership improve research
Pilot pre-post
Single strategy
club from the iCAHE (International Centre for Allied
evidence uptake in different allied health design
Health Evidence) on the EBP knowledge, skills and
disciplines: a pre-post study? BMC
behaviour of the different allied health disciplines.
Research Notes, 5(1), 588. doi:
Included SLPs (n = 10) who had a significant increase
10.1186/1756-0500-5-588
in knowledge but not attitude and evidence uptake.
Results differed across the disciplines.
Simmons-Mackie et al. (2007).
Level IV
Educational outreach
System level KTE intervention with 37 members of
Communicative access and decision
Qualitative
visits
acute, rehabilitation and long-term multidisciplinary
making for people with aphasia:
study
Tailored interventions
teams to improve access to health information and
Implementing sustainable healthcare
Multifaceted strategies
supported decision-making for people with aphasia.
systems change. Aphasiology, 21,
Positive changes observed in rehabilitation and
39–66.
long-term settings.
Molfenter et al. (2009). Decreasing the
Level IV
Educational outreach
Outlines a positive KTE implementation based on the
knowledge-to-action gap through
Qualitative
visits (academic detailing) KTA framework for four speech pathologists who had
research-clinical partnerships in
case study
with some tailoring of
not implemented dysphagia rehabilitation program
speech-language pathology. Canadian
interventions based on
using surface electromyography (sEMG) biofeedback
Journal of Speech-Language Pathology
barriers.
after an initial 2-day didactic education session.
and Audiology, 33, 82–88.
Multifaceted strategies
Note:
based on the National Health and Medical Research Council levels of evidence (2009).
