Applying Knowledge Translation in Clinical Practice

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Applying Knowledge Translation in Clinical Practice
 
I first wrote about Knowledge Translation in the January 2016 Clinical Corner article, Knowledge to Action: Wheelchair Cushions.  The article used an example of staff training with wheelchair cushions to illustrate an application of the Canadian Institutes of Health Research (CIHR) Knowledge to Action Process Model, which is a model used in knowledge translation (CIHR, 2015).  I was fortunate to present this information also at several conferences between 2016 and 2018.  During the conference presentations, I was able to share some personal experiences with different approaches of knowledge translation from a recipient perspective.  This led to discussion from a clinical perspective of how we, as therapists, communicate with clients about seating and mobility issues.  In this month’s Clinical Corner article, I will share with you some thoughts as to how principles of knowledge translation can apply to clinical practice, working with clients and caregivers. 
 
Evidence-Based Practice and Knowledge Translation
Evidence-based practice (EBP) can be considered 3-pronged, in that it includes not only evidence from systematic research, but also clinical expertise and patient values and preferences (Sackett, 2002, as cited in Duke University, 2018).  The integration of sound research-based evidence, clinical experience and patient preferences and expectations form the decision-making process for patient, or client, care. 
 
Knowledge translation serves to fill the gap that exists between existing knowledge and action.  Sometimes when we think of knowledge translation, we erroneously think of it as only applying evidence into clinical practice, but it is broader than that, just like EBP is more than evidence from research.  Knowledge translation aims to bridge the gap between high quality evidence that exists and decision-making at all levels, which includes health care professionals, managers, policy makers and clients (Strauss, Tetroe & Graham, 2013).  The knowledge translation strategies that are selected will depend on the audience – the user of the information – and the type of knowledge that is being translated, such as clinical knowledge or policies.     
 
Knowledge Translation in Practice
One of the strategies of knowledge translation is providing education.  Education can, and should, be provided in many forms.  (For more on knowledge translation strategies, refer to the Clinical Corner article Knowledge to Action: Wheelchair Cushions.)  Let me use a personal example to illustrate the benefits of education in several formats.  Some of you may know that I enjoy training for marathons.  (I have a goal to run a marathon in every province!)  Over the years, I have had different running injuries at different times.  Several years ago, I saw a physiotherapist for a running injury.  The physio provided me with exercises to do, which I did in the clinic when they were first shown to me.  When I got home and tried to do the exercises on my own, I could not recall all of the exercises and I was not sure if I was doing some of the exercises correctly.  At my next appointment, I asked the physiotherapist to provide me with a written resource for the exercises so that I would have something to refer back to, rather than just relying on my memory.  The physio hand-wrote a simple exercise program, with few details. 
 
Unfortunately, this past year, I had another running injury.  (I blame it on the poor, winter road conditions.)  This time, I saw a different physiotherapist, who provided me with exercises to do.  I completed the exercises at the clinic and when I got home, I also had an email with my prescribed exercise program.  It included photos of the exercises and written directions, as well as the number of reps and sets for the exercises.  I could also click on the photograph to get to a video of how to do the exercises.  For me, this was a better experience as I am a visual learner and I had a great reference for doing my home exercise program.  (I also recovered in time to complete another marathon in another province!)
 
Now, let’s take my example of the different approaches to translating clinical knowledge to practice and apply it to seating and mobility to think about how we communicate with clients.  Let’s also think about different situations, such as a client feeling overwhelmed about being discharged from hospital when given instructions from multiple disciplines or a parent being provided with instructions for the future when the child grows or whatever is relevant for your clinical setting.  Are all of the instructions given verbally?  How much of that information will be retained if the client or caregiver is feeling overwhelmed at the appointment?  Is any written material provided?  If there is written material, are any pictures included?  Is the document so lengthy that it will not be read?  Is the document available in other languages, if required? Will the client remember that they were provided with a written resource if it is not needed immediately?  If the program is facility-based, are there any wall posters that help to reinforce learning? 
 
Whether we are trying to teach clients about pressure management or wheelchair maintenance or anything else related to seating and mobility, it is important to remember that we all have different learning styles and learning needs.  Some people may be auditory learners; some people may be visual learners; while others may be kinesthetic learners, where they like to learn through touch and action.  It is important to think about the different ways that people learn and to incorporate more than one method of communication and education for improved retention of information.  In terms of resources, think about multiple formats.  For example, can educational videos be produced and shared on-line that serve as a resource for clients, rather than relying on the spoken or written word? 
 
Summary
Creativity in knowledge translation helps to produce different resources that are available when and where the client needs them.  Having information shared in multiple formats helps to reinforce learning, which bridges the knowledge to action gap, which is what knowledge translation is all about!  
 
As always, please provide your comments, questions and suggestions regarding Clinical Corner.  Please email me at Sheilagh.Sherman@sunmed.com.  I look forward to hearing from you!
 
 
Sheilagh Sherman, BA, BHScOT, MHM, OT Reg. (Ont.)
Clinical Educator
Sunrise Medical Canada
 
 
References and Resources
Canadian Institutes of Health Research. (2016, July 28). About us - Knowledge translation. Retrieved from http://www.cihr-irsc.gc.ca/e/29418.html.
 
Duke University Medical Center. (2018, August 15).  What is Evidence-Based Practice (EBP)?  Retrieved from https://guides.mclibrary.duke.edu/c.php?g=158201&p=1036021
 
Strauss, S. Tetroe, J. and Graham, D. (2013).  Knowledge Translation: What it is and what it isn’t.  In. S.E. Straus, J. Tetroe, & I.D. Graham (Eds.), Knowledge translation in health care. Moving evidence to practice (pp. 3-13). Oxford: Wiley-Blackwell.
 
Wensing, M., Bosch, M., & Grol, R. (2013). Developing and selecting knowlede translation interventions. S.E. Straus, J. Tetroe, & I.D. Graham (Eds.), Knowledge translation in health care. Moving evidence to practice (pp. 150-162). Oxford: Wiley-Blackwell.
 
Note: The content of this article is not meant to be prescriptive; rather, it is meant as a general resource for clinicians to then use clinical reasoning skills to determine optimal seating and mobility solutions for individual clients.  Sheilagh is unable to answer questions from members of the general public.  Members of the general public are directed to their own therapists or other health care professionals to ask questions regarding seating and mobility needs.
 
This article is © Sunrise Medical, Inc., 2018 and cannot be copied, distributed, or otherwise reproduced in whole or in part without the express written permission of Sunrise Medical Canada.
 

Sheilagh Sherman,
BA, BHScOT, MHM, OT Reg. (Ont.)

Sheilagh joined Sunrise Medical Canada in 2010 as our full-time Clinical Educator. Prior to joining Sunrise, Sheilagh gained extensive clinical experience from working in a variety of settings, including in-patient rehabilitation, complex continuing care, and community rehabilitation. As Clinical Educator, Sheilagh is a clinical resource for therapists across Canada involved in seating and mobility. She teaches in-services and leads workshops and seminars on the clinical aspects of seating and mobility. In addition, Sheilagh hosts monthly webinars for therapists and vendors.

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