Struggling to provide evidence-based care to your patients? A knowledge broker can help: Case study of the Achilles Tendinopathy Toolkit

By Alison Hoens

It isn’t easy. You want to provide your patients the most effective treatment but you are faced with a mountain of information from an insurmountable number of sources through endless links in your Google search. It isn’t just the volume of information; interpretation is thwarted by differences in methodologies and confusing statistics.  You are not alone in feeling overwhelmed. Increasingly healthcare is recognizing the need for expertise to help with ‘Knowledge Translation’ (KT) and calling upon Knowledge Brokers (KB) to navigate clinicians through the ‘forest of dense content’ to reach the destination of ‘practice bliss’.

KB communicationKnowledge translation has been described with > 125 terms ! But no matter what term is used, the message is the same – knowledge is not enough. Simply producing and disseminating knowledge does not lead to a change in practice. Shockingly, research suggests that it takes 17 years to get 14% of research findings adopted into practice1.  Further, typical strategies to support evidence-informed practice (EIP), such as providing educational materials or didactic lectures, elicit a meager average 10% change in practice2.

A relatively new KT strategy to support EIP is the use of a knowledge broker. A knowledge broker is an intermediary who bridges the gap between evidence and practice and functions as a catalyst to link researchers, clinicians, and decision makers to facilitate co-creation or synthesis, translation, dissemination, and implementation of evidence to change practice3. Essentially, the knowledge broker’s main roles are to act as an: 1) information manager 2) linking agent 3) capacity builder 4) facilitator and 5) evaluator4 (those interested in learning more about these roles can check out a video abstract for our recent manuscript HERE). Indeed, Meyer et al (2010) states that knowledge brokers do more than transfer knowledge, they transform knowledge such that Brokered knowledge is knowledge made more robust, more accountable, more usable; knowledge that ‘serves locally’ …” (pg. 123)5. Basically, a knowledge broker helps, with experts from research and clinical realms, to find, interpret and reshape knowledge so that it can be used more readily in the hands of a clinician.

Practical experience – A KB’s secrets!

I serve as the Physical Therapy Knowledge Broker (PT KB) situated within the Department of Physical Therapy at the University of British Columbia (UBC). Reflecting the breadth of stakeholders, the position is jointly funded by the University, the  provincial professional body (Physiotherapy Association of British Columbia) and the research institutes of two large health regions ( Providence Health Care and Vancouver Coastal Health).

This 0.5 FTE position has enabled partnerships between more than 335 researchers, clinicians and decision makers to enable approximately 2.5 million dollars of funding for 19 rehabilitation relevant research projects and the development of 23 resources and tools to support evidence-informed practice. These resources have been accessed over 164,000 times by physiotherapists throughout the world and have been shared through 24 webinars and more than 50 presentations locally, nationally and internationally. All resources are freely accessible HERE.

Turning Achilles research into changes in clinical management

An example of the KB role in successfully transforming knowledge to “make it more useable” is the Achilles Tendinopathy Toolkit (http://physicaltherapy.med.ubc.ca/physical-therapy-knowledge-broker/tendinopathy-toolkit/). Co-created with research and clinical experts, and recently updated to include new literature, the toolkit includes: (1) a summary of the evidence, clinical implications and ‘take home messages’ for nonpharmacologic interventions such as manual therapy, exercise, low level laser therapy, orthotics, shock wave, ultrasound, taping etc;  (2) an algorithm to guide the sequence of interventions; (3) and appendices including (a) exercise programmes (b) low level laser dosage calculation (c) tabulated details for each article reviewed and (d) a review of common medical interventions. It has been accessed over 85,000 times by therapists throughout the world. Moreover, a recent cross-sectional study demonstrated favourable findings regarding the impact of this KT strategy on the knowledge and attitudes of British Columbia physical therapists6.

The PT KB position provides an opportunity to enable researchers, clinicians, patients, and decision-makers to unite in efforts to support clinicians in the feasible provision of individualized evidence-informed care to our patients.

Your turn

So, what can you do today to support your EIP? Try out some of our free resources at http://physicaltherapy.med.ubc.ca/physical-therapy-knowledge-broker/?login and advocate for developing KB positions in your healthcare communities.

References

  1. Balas E, Boren S. Managing Clinical Knowledge for Health Care Improvement. In: van Bemmel JH, McCray AT, eds. Yearbook of Medical Informatics. Stuttgart: Schattauer Verlagsgesellschaft mbH, 2000:65–70.
  2. Straus SE, Tetroe JM, Graham ID, editors. Knowledge translation in health care: moving from evidence to practice. Chichester (UK): Wiley Blackwell; 2009. http://dx.doi.org/10.1002/9781444311747.
  3. Hoens, A. and Li, L.C. 2014, The knowledge broker’s “Fit” in the world of knowledge translation, Physiotherapy Canada: 66:3:223-227.
  4. Glegg S & Hoens A. Role domains of knowledge brokering: A model for the healthcare setting. Journal of Neurologic Physiotherapy. Journal of Neurologic Physical Therapy. 2016;40: 115–123). org/10.1097/NPT.0000000000000122. Video abstract: https://youtu.be/udp8JNu_tL4
  5. Meyer M. The rise of the knowledge broker. Science Communication 32, 1 (2010) 118-127. DOI : 10.1177/1075547009359797.
  6. Ezzat AM, Schneeberg A, Huisman ES, White LD, Kennedy C, Levesque LA, Scott A, Hoens AM. Is it effective? A cross-sectional evaluation of a toolkit to support evidence-informed management of Achilles Tendinopathy. Disability and Rehabilitation. DOI10.3109/09638288.2016.1160447

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Alison Hoens holds two positions:  (1) Physical Therapy Knowledge Broker within the Department of Physical Therapy, Faculty of Medicine and (2) Research, Education and Practice Coordinator for Physiotherapy at Providence Health Care. At Providence Health Care she is responsible for research, education and evidence-based practice support for over 120 Physiotherapists and Rehabilitation Assistants across the spectrum of acute, rehabilitation and residential care settings. In her role as Knowledge Broker she facilitates partnerships between researchers, clinicians and decision makers for rehabilitation relevant research and the development of resources and tools to support evidence-informed practice.

 

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