Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol [NCT00298727]

Joy C MacDermid, Patty Solomon, Mary Law, Dianne Russell, Paul Stratford, Joy C MacDermid, Patty Solomon, Mary Law, Dianne Russell, Paul Stratford

Abstract

Background: A substantial number of valid outcome measures have been developed to measure health in adult musculoskeletal and childhood disability. Regrettably, national initiatives have merely resulted in changes in attitude, while utilization remains unacceptably low. This study will compare the effectiveness and mediators of two different knowledge transfer (KT) interventions in terms of their impact on changing knowledge and behavior (utilization and clinical reasoning) related to health outcome measures.

Method/design: Physical and occupational therapists (n = 144) will be recruited in partnership with the national professional associations to evaluate two different KT interventions with the same curriculum: 1) Stakeholder-Hosted Interactive Problem-Based Seminar (SHIPS), and 2) Online Problem-Based course (e-PBL). SHIPS will consist of face-to-face problem-based learning (PBL) for 2 1/2 days with outcome measure developers as facilitators, using six problems generated in consultation with participants. The e-PBL will consist of a 6-week web-based course with six generic problems developed by content experts. SHIPS will be conducted in three urban centers in Canada. Participants will be block-allocated by a minimization procedure to either of the two interventions to minimize any prognostic differences. Trained evaluators at each site will conduct chart audits and chart-stimulated recall. Trained interviewers will conduct semi-structured interviews focused on identifying critical elements in KT and implementing practice changes. Interviews will be transcribed verbatim. Baseline predictors including demographics, knowledge, attitudes/barriers regarding outcome measures, and Readiness to Change will be assessed by self-report. Immediately post-intervention and 6 months later, these will be re-administered. Primary qualitative and quantitative evaluations will be conducted 6-months post-intervention to assess the relative effectiveness of KT interventions and to identify elements that contribute to changing clinical behavior. Chart audits will determine the utilization of outcome measures (counts). Incorporation of outcome measures into clinical reasoning will be assessed using an innovative technique: chart-stimulated recall.

Discussion: A strategy for optimal transfer of health outcome measures into practice will be developed and shared with multiple disciplines involved in primary and specialty management of musculoskeletal and childhood disability.

References

    1. Canada PHA. Economic Burden of Illness in Canada, 1993. Public Health Agency of Canada; 2005.
    1. Cohn. D'Vera U.S. counts one in 12 children as disabled: census reflects increase of handicapped youth. Washington Post. 2002;B1
    1. Rehabilitation Outcome Measures Conference. Edmonton, Alberta, Canada, October 17-19, 1991. Can J Public Health. 1992;83 Suppl 2:S1–70.
    1. Mayo NE. Outcome measures or measuring outcome. Physiother Can. 1994;46:145–151.
    1. Bellamy N, Buchanan WW. Outcome measurement in osteoarthritis clinical trials: the case for standardisation. Clin Rheumatol. 1984;3:293–303. doi: 10.1007/BF02032334.
    1. Bellamy N. Outcome measurement in osteoarthritis clinical trials. J Rheumatol Suppl. 1995;43:49–51.
    1. Bellamy N, Muirden KD, Brooks PM, Barraclough D, Tellus MM, Campbell J. A survey of outcome measurement procedures in routine rheumatology outpatient practice in Australia. Journal of Rheumatology. 1999;26:1593–1599.
    1. Grimby G. Outcome measures in rehabilitation. J Rehabil Med. 2002;34:249–250. doi: 10.1080/165019702760390329.
    1. Keith RA. Conceptual basis of outcome measures. Am J Phys Med Rehabil. 1995;74:73–80.
    1. Michels E. Interpreting health outcome measures. Phys Ther. 1997;77:314–315.
    1. Nichols PJ. Outcome measures in rehabilitation. Rheumatol Rehabil. 1976;15:170–173.
    1. Piper MC. Rehabilitation outcome measures--where do we go from here? Can J Public Health. 1992;83 Suppl 2:S69–S70.
    1. Stephens D, Jones G, Gianopoulos I. The use of outcome measures to formulate intervention strategies. Ear Hear. 2000;21:15S–23S. doi: 10.1097/00003446-200008001-00004.
    1. Thomas J, Miller P, Silaj A, King ML. Application of physiotherapy outcome measures to the managed care model. Physiother Can. 1994;46:260–265.
    1. Turner-Stokes L, Turner-Stokes T. The use of standardized outcome measures in rehabilitation centres in the UK. Clin Rehabil. 1997;11:306–313.
    1. Law M, King G, Russell D, MacKinnon E, Hurley P, Murphy C. Measuring outcomes in children's rehabilitation: a decision protocol. Archives of Physical Medicine and Rehabilitation. 1999;80:629–636. doi: 10.1016/S0003-9993(99)90164-8.
    1. Cole B, Finch E, Gowland C. Physical Outcome Measures. Toronto, Canadian Physiotherapy Association; 1993. pp. 1–217.
    1. Michlovitz SL, LaStayo PC, Alzner S, Watson E. Distal radius fractures: therapy practice patterns. J Hand Ther. 2001;14:249–257.
    1. Bellamy N, Kaloni S, Pope J, Coulter K, Campbell J. Quantitative rheumatology: a survey of outcome measurement procedures in routine rheumatology outpatient practice in Canada. Journal of Rheumatology. 1998;25:852–858.
    1. Saleh KJ, Bershadsky B, Cheng E, Kane R. Lessons learned from the hip and knee musculoskeletal outcomes data evaluation and management system. Clin Orthop. 2004:272–278.
    1. Davis D, O'Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999;282:867–874. doi: 10.1001/jama.282.9.867.
    1. Thomson O'Brien MA, Freemantle N, Oxman AD, Wolf F, Davis DA, Herrin J. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2001:CD003030.
    1. Smith F, Singleton A, Hilton S. General practitioners' continuing education: a review of policies, strategies and effectiveness, and their implications for the future. Br J Gen Pract. 1998;48:1689–1695.
    1. Little JM. The Jepson Lecture 1991. Clinical databases and surgical research. Aust N Z J Surg. 1992;62:327–332.
    1. Jamtvedt G, Young JM, Kristoffersen DT, Thomson O'Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2003:CD000259.
    1. Thomson O'Brien MA, Oxman AD, Davis DA, Haynes RB, Freemantle N, Harvey EL. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000:CD000409.
    1. Freemantle N, Harvey EL, Wolf F, Grimshaw JM, Grilli R, Bero LA. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000:CD000172.
    1. Thomson O'Brien MA, Oxman AD, Davis DA, Haynes RB, Freemantle N, Harvey EL. Audit and feedback versus alternative strategies: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000:CD000260.
    1. Thomson O'Brien MA, Oxman AD, Davis DA, Haynes RB, Freemantle N, Harvey EL. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000:CD000259.
    1. Jamtvedt G, Young JM, Kristoffersen DT, Thomson O'Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006
    1. Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ. 1995;153:1423–1431.
    1. Thomson O'Brien MA, Oxman AD, Haynes RB, Davis DA, Freemantle N, Harvey EL. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000:CD000125.
    1. Soumerai SB, Ross-Degnan D. Drug prescribing in pediatrics: challenges for quality improvement. Pediatrics. 1990;86:782–784.
    1. Soumerai SB, Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decision making. JAMA. 1990;263:549–556. doi: 10.1001/jama.263.4.549.
    1. Soumerai SB, McLaughlin TJ, Avorn J. Quality assurance for drug prescribing. Qual Assur Health Care. 1990;2:37–58.
    1. Ray WA, Schaffner W, Federspiel CF. Persistence of improvement in antibiotic prescribing in office practice. JAMA. 1985;253:1774–1776. doi: 10.1001/jama.253.12.1774.
    1. Beggs C, Sumison T. After the workshop: A model to evaluate the long-term benefits of continuing education. Physiother Can. 2004;49:279–291.
    1. Dysart AM, Tomlin GS. Factors related to evidence-based practice among U.S. occupational therapy clinicians. Am J Occup Ther. 2002;56:275–284.
    1. Griffiths JM, Bryar RM, Closs SJ, Cooke J, Hostick T, Kelly S, Marshall K. Barriers to research implementation. Br J Community Nurs. 2001;6:501–510.
    1. Dalton CC, Gottlieb LN. The concept of readiness to change. J Adv Nurs. 2003;42:108–117. doi: 10.1046/j.1365-2648.2003.02593.x.
    1. Kerns RD, Habib S. A critical review of the pain readiness to change model. J Pain. 2004;5:357–367. doi: 10.1016/j.jpain.2004.06.005.
    1. Buckley LL, Goering P, Parikh SV, Butterill D, Foo EK. Applying a 'stages of change' model to enhance a traditional evaluation of a research transfer course. J Eval Clin Pract. 2003;9:385–390. doi: 10.1046/j.1365-2753.2003.00407.x.
    1. Miller ET, Spilker J. Readiness to change and brief educational interventions: successful strategies to reduce stroke risk. J Neurosci Nurs. 2003;35:215–222.
    1. Prochaska JO, Velicer WF. The transtheoretical model - Introduction. Am J Health Promot. 1997;12:6–7.
    1. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12:38–48.
    1. Prochaska JM, Prochaska JO, Levesque DA. A transtheoretical approach to changing organizations. Adm Policy Ment Health. 2001;28:247–261. doi: 10.1023/A:1011155212811.
    1. Prochaska JO, Velicer WF, Rossi JS, Goldstein MG, Marcus BH, Rakowski W, Fiore C, Harlow LL, Redding CA, Rosenbloom D, Rossi SR. Stages of Change and Decisional Balance for 12 Problem Behaviors. Health Psych. 1994;13:39–46. doi: 10.1037/0278-6133.13.1.39.
    1. Prochaska JO, Velicer WF, Rossi JS, Kerns RD, Habib S, et al. A critical review of the pain readiness to change model. J Pain.
    1. Velicer WF, Norman GJ, Fava JL, Prochaska JO. Testing 40 predictions from the transtheoretical model. Addict Behav. 1999;24:455–469. doi: 10.1016/S0306-4603(98)00100-2.
    1. Keefe FJ, Lefebvre JC, Kerns RD, Rosenberg R, Beaupre P, Prochaska J, Prochaska JO, Caldwell DS. Understanding the adoption of arthritis self-management: stages of change profiles among arthritis patients. Pain. 2000;87:303–313. doi: 10.1016/S0304-3959(00)00294-3.
    1. Parker K, Parikh SV. Applying Prochaska's model of change to needs assessment, programme planning and outcome measurement. J Eval Clin Pract. 2001;7:365–371. doi: 10.1046/j.1365-2753.2001.00299.x.
    1. Huberman M. Steps towards an integrated model of research utilization. Knowledge: Creation, Diffusion, Utilization. 1987;8:586–611.
    1. Backer TE. Knowledge utilization. The third wave. Knowledge: Creation, Diffusion, Utilization. 1991;12:225–240.
    1. Hanna S, Russell D, Bartlett DJ, Kertoy M, Rosenbaum P. Measurement practices and professional culture in pediatric rehabilitation: A survery of physical, occupational and speech language therapists in Ontario. 2004.
    1. Regehr G, Norman G. Issues in cognitive psychology: implications for professional education. Acad Med. 2004;71:988–1001.
    1. Saarinen-Rahiika H, Binkley JM. Problem-based learning in physical therapy: a review of the literature and overview of the McMaster University experience. Phys Ther. 1998;78:195–207.
    1. Knowledge Translation Proposal Development Workshop. Ottawa,ON, Canadian Institutes of Health Research; 2004.
    1. Shin JH, Haynes RB, Johnston ME. Effect of problem-based, self-directed undergraduate education on life-long learning. CMAJ. 1993;148:969–976.
    1. Newman M. A pilot systematic review and meta-analysis on the effectiveness of problem-based learning. 2003.
    1. Lavis J, Robertson D, Woodside J, McLeod C, Abelson J. How can research organizations more effectively transfer research knowledge to decision makers? The Millbank Quarterly. 2003;81:221–248. doi: 10.1111/1468-0009.t01-1-00052.
    1. Leeder SR, Sackett DL. The medical undergraduate programme at McMaster University: learning epidemiology and biostatistics in an integrated curriculum. Med J Aust. 1976;2:875, 878–875, 880.
    1. Williams R, MacDermid JC, Wessel J. Student adaptation to problem- based learning in an entry-level masters physical therapy program. Physiother Theory Pract. 2003;19:199–212.
    1. Curran VR, Fleet L. A review of evaluation outcomes of web-based continuing medical education. Med Educ. 2005;39:561–567. doi: 10.1111/j.1365-2929.2005.02173.x.
    1. O'Brien B, Renner A. Opening minds: values clarification via electronic meeting. Comput Nurs. 1998;16:271.
    1. Souviney R, Saferstein B, Chambers E. Internet: network communication and teacher development. Journal of Computing in Teacher Education. 1995;11:5–15.
    1. Sternberger C. Embedding a pedagogical model in the design of an online course. Nurse Educ. 2002;27:170–173. doi: 10.1097/00006223-200207000-00009.
    1. Dennis J, . Problem based learning in online vs. face-to-face environments. Education for Health. 2003;16:198–209. doi: 10.1080/1357628031000116907.
    1. Chan DH, Leclair K, Kaczorowski J. Problem-based small-group learning via the Internet among community family physicians: a randomized controlled trial. MD Comput. 1999;16:54–58.
    1. Blair E. Gold is not always good enough: the shortcomings of randomization when evaluating interventions in small heterogeneous samples. J Clin Epidemiol. 2004;57:1219–1222. doi: 10.1016/j.jclinepi.2004.06.003.
    1. Hagino A, Hamada C, Yoshimura I, Ohashi Y, Sakamoto J, Nakazato H. Statistical comparison of random allocation methods in cancer clinical trials. Control Clin Trials. 2004;25:572–584. doi: 10.1016/j.cct.2004.08.004.
    1. Scott NW, McPherson GC, Ramsay CR, Campbell MK. The method of minimization for allocation to clinical trials. a review. Control Clin Trials. 2002;23:662–674. doi: 10.1016/S0197-2456(02)00242-8.
    1. Egan M, Dubuolox CJ, Rappolt S, Polatajko H, von GV, Graham I. Enhancing research use through an online action research project: final report. Ottawa,ON, University of Ottawa School of Rehabilitation Sciences; 2003.
    1. Forsberg L, Halldin J, Wennberg P. Psychometric properties and factor structure of the readiness to change questionnaire. Alcohol Alcohol. 2003;38:276–280.
    1. MacDermid JC, O'Callaghan C, Vanderfoort L. Inpatient rehabilitation after total knee arthroplasty:outcome and factors predicting admission. Physiotherapy Canada. Physiother Can. 2000;52:45–49.
    1. Cunnington JP, Hanna E, Turnhbull J, Kaigas TB, Norman GR. Defensible assessment of the competency of the practicing physician. Acad Med. 1997;72:9–12.
    1. Norman GR, Davis DA, Lamb S, Hanna E, Caulford P, Kaigas T. Competency assessment of primary care physicians as part of a peer review program. JAMA. 1993;270:1046–1051. doi: 10.1001/jama.270.9.1046.
    1. Salvatori P, Baptiste S, Ward M. Development of a tool to measure clinical competence in occupational therapy: a pilot study? Can J Occup Ther. 2000;67:51–60.
    1. Goulet F, Jacques A, Gagnon R, Bourbeau D, Laberge D, Melanson J, Menard C, Racette P, Rivest R. Performance assessment. Family physicians in Montreal meet the mark! Can Fam Physician. 2002;48:1337–1344.
    1. Montgomery DC, Peck EA. Introduction to Linear Regression Analysis. Second. New York, John Wiley and Sons; 1992. pp. 1–527.
    1. Glantz SA, Slinker B. Primer of Applied Regression Analysis of Variance. New York, NY, McGraw-Hill Inc; 1992.
    1. Strauss A, Corbin J. Basics of qualitative research. 2. Thousand Oaks, California, Sage Publications; 1998.
    1. Stone S. Qualitative research methods for physiotherapists. Physiotherapy. 1991;77:449–452.
    1. Murphy CE, Dingwall R, Greatbatch D, Parker S, Watson P. Qualitative research methods in health technology assessment: a review of the literature. Health Technol Assess. 1998;2:16.

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