28
JCPSLP
Volume 16, Number 1 2014
Journal of Clinical Practice in Speech-Language Pathology
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
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