Knowledge Translation: Putting the “Practice” in Evidence-Based Practice

doi:10.1016/j.hcl.2008.10.003

Hand Clinics

Volume 25, Issue 1, February 2009, Pages 125-143

https://doi.org/10.1016/j.hcl.2008.10.003 Get rights and content

Knowledge translation (KT) is an iterative process that involves knowledge development, synthesis, contextualization, and adaptation, with the expressed purpose of moving the best evidence into practice that results in better health processes and outcomes for patients. Optimization of the process requires engaged interaction between knowledge developers and knowledge users. Knowledge users include consumers, clinicians, and policy makers. KT is highly reliant on understanding when research evidence needs to be moved into practice. Social, personal, policy, and system factors contribute to how and when change in practice can be accomplished. Evidence-based practitioners need to understand a conceptual basis for KT and the evidence indicating which specific KT strategies might help them move best evidence into action in practice. Audit and feedback, knowledge brokering, clinical practice guidelines, professional standards, and “active-learning” continuing education are examples of KT strategies.

Section snippets

Evidence must be moved into action to accomplish health benefits

You ask me why I do not write something….I think one's feelings waste themselves in words, they ought all to be distilled into actions and into actions which bring results.
—Florence Nightingale, in Cecil Woodham-Smith, Florence Nightingale (1951); English nurse in Crimean War (1820–1910)

EBP hinges on the assumption that once new (higher-quality) knowledge is generated, it will be applied/implemented. When knowledge is available and is not used, a gap is created between knowledge and practice or

The evidence–practice gap in hand surgery and therapy

The way to answer this question is to examine the evidence on practice patterns and compare them with the best available evidence. The authors looked for examples of where practice patterns had been studied and then compared those with the available evidence.

Perhaps the most studied aspect of practice attitudes and patterns is the use of hand surgery for the rheumatoid hand. Thanks to a series of surveys conducted by Alderman and Chung¹ and their co-investigators, we have some indication of the

Knowledge-to-action cycle

KT is optimized if research informs practice and practice informs research, which is best accomplished by the engagement of knowledge developers and different end users in sustained partnerships that contribute to all aspects of the generation and use of new knowledge. This process has been well described in the knowledge-to-action (KTA) cycle (Fig. 1). It contains iterative cycles of knowledge creation and application (action). Knowledge creation can begin with individual research studies, be

Why do evidence–practice gaps exist? Barriers to implementation of evidence-based practice

Evidence–practice gaps evolve in two basic areas. One is related to EBP itself and the other is related to changing behavior.

Gaps may exist because of a lack of awareness of how to practice EBP or because of barriers to practicing it once these skills are developed. Numerous studies have addressed these barriers and consistently found that lack of awareness of how to search the literature, lack of critical appraisal skills, and, most importantly, lack of time are perceived barriers to

Theoretic aspects of knowledge translation

All human actions have one or more of these seven causes: chance, nature, compulsion, habit, reason, passion, and desire.
—Aristotle, Greek critic, philosopher, physicist, and zoologist (384 bc–322 bc)

Practical aspects of knowledge translation

Everybody gets so much information all day long that they lose their common sense.
—Gertrude Stein, American author in France (1874–1946)

No theory fully explains the complex processes that govern how knowledge moves into action in clinical environments.³⁶ In fact, studies typically show that mathematic models based on these theories explain a small percentage of the variation in behavior.37, 38 So although conceptual frameworks or theories can provide guideposts on how to approach KT, a strong

The action cycle: how to approach knowledge translation process

Take time to deliberate, but when the time for action has arrived, stop thinking and go in.
—Napoleon Bonaparte, French general and politician (1769–1821)

The process through which knowledge becomes actionable is, by nature, one that involves local contextualization, management, and ongoing support, which can be challenging for the surgeon or therapist and often requires a broader level of collaboration than is required for the management of individual patients. Various approaches have been

Promoting action on research implementation in a health services framework

A framework entitled Promoting Action on Research Implementation in Health Services (PARIHS) was developed to represent the complexity of change processes involved in implementing EBP.45, 46 Successful research implementation is considered to be a function of the relationships among evidence, context, and facilitation (Fig. 3). Successful implementation is more likely if research evidence is clear and of high quality. However, the framework also emphasizes the importance of using clinical

Knowledge translation interventions

Various specific KT interventions can be used to increase awareness of a problem, develop useable/actionable forms of evidence, inform end users about the evidence, and promote change in practice. Literature synthesis is one form of KT and is partially addressed in other articles in this issue (eg, systematic reviews). Thus, the authors highlight other KT interventions that are meant to promote change in clinical practice.

An important source of evidence on the effectiveness of KT interventions

Key messages

Knowledge, if it does not determine action, is dead to us.
—Plotinus, Roman philosopher (205 ad–270 ad)

The key messages of this article may be summarized as follows. Additional tools are available in Appendix 1.

1.
The benefits of EBP depend on KT, moving evidence into practice.
2.
KT should be embedded in the creation of knowledge and drive new knowledge inquiry.
3.
KT should consider and apply theory that informs our understanding of how systems and individuals change and use knowledge.
4.
KT must capture the

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Cited by (48)

From dental science to clinical practice: Knowledge translation and evidence-based dentistry principles
2017, Saudi Dental Journal
Citation Excerpt :
Knowledge translation (KT) concerns the application of the best available evidence to benefit health and well-being. This is a substantive process that involves a range of stakeholders who interact within the healthcare system (Salbach, 2010; MacDermid and Graham, 2009; Hassan, 2013). Evidence-based dentistry (EBD), on the other hand, is the process of combining the best available scientific evidence and the clinical expertise of dentists with patient needs and preferences in order to serve as the foundation for clinical care (Niederman et al., 2011; Ismail et al., 2004).
It has been claimed that in order to decrease the gap between what we know and what we do, research findings must be translated from knowledge to action. Such practices better enable dentists to make evidence-based decisions instead of personal ideas and judgments. To this end, this literature review aims to revisit the concepts of knowledge translation and evidence-based dentistry (EBD) and depict their role and influence within dental education. It addresses some possible strategies to facilitate knowledge translation (KT), encourage dental students to use EBD principles, and to encourage dental educators to create an environment in which students become self-directed learners. It concludes with a call to develop up-to-date and efficient online platforms that could grant dentists better access to EBD sources in order to more efficiently translate research evidence into the clinic.
Therapist's practice patterns for subsequent fall/osteoporotic fracture prevention for patients with a distal radius fracture
2019, Journal of Hand Therapy
Citation Excerpt :
Thus, knowledge regarding SFOFP applicable to hand therapy practice is available.35,36,38-40,42 However, implementation of decision support tools is an important step for translating knowledge into the routine clinical practice of hand therapists who treat these fractures.43 In North America, most patients with DRF are treated by a registered physical therapist (PT), occupational therapist (OT), or certified hand therapist (CHT) after the injury.44,45
Cross-sectional survey.
Multifactorial risk factor screening and treatment is needed for subsequent falls/osteoporotic fractures prevention (SFOFP), given the elevated risk among patients with distal radius fracture (DRF).
The primary objective was to describe hand therapists' knowledge and clinical practice patterns for assessment, treatment, referral, and education with respect to SFOFP for patients with DRF older than 45 years. Secondary objective was to explore therapist's preferences in content and delivery of knowledge translation tools that would support implementation of SFOFP.
A cross-sectional multinational (Canada, the United States, and India) survey was conducted among 272 therapists from August to October 2014. Completed surveys were analyzed descriptively.
Surveys were completed by 157 therapists. Most respondents were from the United States (59%), certified hand therapists (54%), and females (87%). Although 65%-90% believed that they had knowledge about SFOFP assessment, treatment, and referral options, 55% did not include it in their routine practice for patients with DRF. Most assessed medication history (82%) and never used a Fracture Risk Assessment Tool (90%) or lower extremity muscle strength testing (54%) to identify those at risk of secondary fractures. With respect to treatment, approximately 33% always used upper extremity muscle strengthening exercises. Most reported rarely (sometimes to never) using balance (79%), lower extremity muscle strengthening (85%), bone strengthening (54%), or community-based physical activity (72%) programs. Similarly, when surveyed about patient education, therapists rarely (sometimes to never) advised patients about web-based resources (94%), regular vision testing (92%), diet for good bone health (87%), bone density evaluation (86%), footwear correction (73%), and hazard identification (67%). Most hand therapists were interested to receive more information on SFOFP for patients with DRF. Nearly one-half preferred to have Web sites for patients, and two-fifth were in favor of pamphlets for patients.
Current practice patterns reveal care gaps and limited implementation with respect to SFOFP for patients with DRF. Future research should focus on web-based educational/knowledge translation strategies to promote implementation of multifactorial fall risk screening and hand therapist's engagement in SFOFP for patients with DRF.
Hand therapists' attitudes, environmental supports, and self-efficacy regarding intimate partner violence in their practice
2019, Journal of Hand Therapy
Citation Excerpt :
Furthermore, the institutions in which HTs work share some responsibility in preparing their staff to deal with IPV, including facilitating access to appropriate internal or external health or community agencies. From an implementation science perspective, a coordinated site-specific strategy is needed to address important contextual issues and foster linkages with local resources.32 The present study has several strengths.
Descriptive, cross-sectional.
Intimate partner violence (IPV) may involve physical, psychological, or sexual abuse. Although hand injuries are reported as common sequelae of IPV, there is limited attention to this issue in hand therapy research reports or practice recommendations.
The primary aim is to describe the attitudes and beliefs of hand therapists (HTs) about IPV issues.
A sample of 189 HT completed a standardized survey investigating perceptions regarding issues pertaining to IPV. Areas addressed included self-efficacy (in dealing with IPV), perceived systemic support, victim blaming, professional role responsibility, and safety. Data were analyzed using descriptive statistics while between-group comparisons evaluating the impact of prior IPV experience and demographic variables of gender, country, certified hand therapy, and occupation on questionnaire scores used Mann-Whitney U analysis.
The majority of therapists (66%) had some prior experience with IPV. HTs reported neutral perceptions about self-efficacy (M = 2.9/5), client or personal safety (M = 3/5), and support systems available when addressing IPV in practice (M = 3/5). However, therapists considered intervening as part of their professional role (M = 3.8/5) and reported low levels of victim-blaming attitudes (M = 4.4/5). Those with firsthand IPV experience reported lower victim blaming (mdn = 4.9/5 vs 4.6/5, P = .02). Additionally, females were less likely to blame victims of IPV than males (mdn = 4.7/5 vs 4.3/5, P = .003).
Although Hand Therapists believe their professional role includes addressing IPV, confidence to deal with IPV, access/awareness of resources and perceived safety were substantive barriers.
Continuing research should identify effective tools to educate and assist therapists to identify and support victims of IPV in hand therapy.
The majority of clinical trials assessing mobilization and manipulation for neck pain lack a pragmatic approach: a systematic review of 174 trials
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The impact of surgical randomised controlled trials on the management of FAI syndrome: a citation analysis
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Barriers for the implementation of research outcomes in practice
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View all citing articles on Scopus

: Funded by a New Investigator Award, Canadian Institutes of Health Research.

View full text

Knowledge Translation: Putting the “Practice” in Evidence-Based Practice

Section snippets

Evidence must be moved into action to accomplish health benefits

The evidence–practice gap in hand surgery and therapy

Knowledge-to-action cycle

Why do evidence–practice gaps exist? Barriers to implementation of evidence-based practice

Theoretic aspects of knowledge translation

Practical aspects of knowledge translation

The action cycle: how to approach knowledge translation process

Promoting action on research implementation in a health services framework

Knowledge translation interventions

Key messages

J Hand Surg [Am]

J Hand Surg [Am]

J Hand Surg [Br]

J Hand Surg [Br]

J Hand Surg [Br]

J Hand Surg [Br]

J Hand Surg [Br]

J Hand Surg [Am]

J Hand Ther

J Hand Ther

Organ Behav Hum Decis Process

Soc Sci Med

Intensive Crit Care Nurs

J Hand Ther

J Hand Ther

J Clin Epidemiol

Injury

Ann Emerg Med

The rheumatoid hand: a predictable disease with unpredictable surgical practice patterns

Arthritis Rheum

Surgical management of the rheumatoid hand: consensus and controversy among rheumatologists and hand surgeons

J Rheumatol

NeuFlex compared with Sutter prostheses: a blind, prospective, randomised comparison of silastic metacarpophalangeal joint prostheses

Scand J Plast Reconstr Surg Hand Surg

Z Rheumatol

Polyurethane versus silicone for endoprosthetic replacement of the metacarpophalangeal joints in rheumatoid arthritis

Scand J Plast Reconstr Surg Hand Surg

Practice patterns in flexor tendon repair

Ir J Med Sci

Predictors of time lost from work following a distal radius fracture

J Occup Rehabil

How good is the quality of health care in the United States?

Milbank Q

The quality of ambulatory care delivered to children in the United States

N Engl J Med

Who is at greatest risk for receiving poor-quality health care?

N Engl J Med

Mapping the research utilization field in nursing

Can J Nurs Res

Translating research into practice: implications for organizations and administrators

Can J Nurs Res

A guide to knowledge translation theory

J Contin Educ Health Prof

Perceptions of evidence-based practice: a survey of Australian occupational therapists

Aust Occ Ther J

Application of current research evidence to clinical physiotherapy practice

J Allied Health

Factors related to evidence-based practice among U.S. occupational therapy clinicians

Am J Occup Ther

What do Swedish physiotherapists feel about research? A survey of perceptions, attitudes, intentions and engagement

Physiother Res Int

Challenges for evidence-based physical therapy: accessing and interpreting high-quality evidence on therapy

Phys Ther

Occupational therapists report on low level of knowledge, skill and involvement in evidence-based practice

Aust Occ Ther J

Comparing evidence-based practice of nurses and physiotherapists

Br J Nurs

Evidence-based medicine in general practice: beliefs and barriers among Australian GPs

J Eval Clin Pract

Diffusion of innovation

Diffusion of innovations in health service organisations: a systematic literature review

From intentions to actions: a theory of planned behavior. Action-control: from cognition to behavior

Designing theoretically-informed implementation interventions: fine in theory, but evidence of effectiveness in practice is needed

Implement Sci

Healthcare professionals' intentions and behaviours: a systematic review of studies based on social cognitive theories

Implement Sci

Some theoretical underpinnings of knowledge translation

Acad Emerg Med