Classification schemes for knowledge translation interventions: a practical resource for researchers

Abstract Background As implementation science advances, the number of interventions to promote the translation of evidence into healthcare, health systems, or health policy is growing. Accordingly, classification schemes for these knowledge translation (KT) interventions have emerged. A recent scoping review identified 51 classification schemes of KT interventions to integrate evidence into healthcare practice; however, the review did not evaluate the quality of the classification schemes or provide detailed information to assist researchers in selecting a scheme for their context and purpose. This study aimed to further examine and assess the quality of these classification schemes of KT interventions, and provide information to aid researchers when selecting a classification scheme. Methods We abstracted the following information from each of the original 51 classification scheme articles: authors’ objectives; purpose of the scheme and field of application; socioecologic level (individual, organizational, community, system); adaptability (broad versus specific); target group (patients, providers, policy-makers), intent (policy, education, practice), and purpose (dissemination versus implementation). Two reviewers independently evaluated the methodological quality of the development of each classification scheme using an adapted version of the AGREE II tool. Based on these assessments, two independent reviewers reached consensus about whether to recommend each scheme for researcher use, or not. Results Of the 51 original classification schemes, we excluded seven that were not specific classification schemes, not accessible or duplicates. Of the remaining 44 classification schemes, nine were not recommended. Of the 35 recommended classification schemes, ten focused on behaviour change and six focused on population health. Many schemes (n = 29) addressed practice considerations. Fewer schemes addressed educational or policy objectives. Twenty-five classification schemes had broad applicability, six were specific, and four had elements of both. Twenty-three schemes targeted health providers, nine targeted both patients and providers and one targeted policy-makers. Most classification schemes were intended for implementation rather than dissemination. Conclusions Thirty-five classification schemes of KT interventions were developed and reported with sufficient rigour to be recommended for use by researchers interested in KT in healthcare. Our additional categorization and quality analysis will aid in selecting suitable classification schemes for research initiatives in the field of implementation science

Understanding the Relationship Between Health Technology Reassessment and Knowledge Translation

Until now, it was not well understood how the field of Knowledge Translation (KT) would be applicable to Health Technology Reassessment (HTR). This thesis reports on three studies to determine how KT approaches are used to translate HTR outputs to achieve the desired outcomes. The first study was a scoping review of full-spectrum (phases of planning/design, evaluation, implementation, sustainability/scalability) KT Theories, Models, Frameworks (KT TMFs). Thirty-six KT TMFs were identified and categorized according to five approaches: process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks. It provided a starting point for the selection of KT TMFs for HTR. The second study employed a modified Delphi process and expert survey to review the 36 full-spectrum KT TMFs and determined which may be suitable for HTR. The three-round modified Delphi process resulted in 16 KT TMFs. Twenty-two international experts (11 KT and 11 HTR) were surveyed. None of the 16 KT TMFs reached ≥ 70% agreement when ratings of “yes” were considered. However when ratings of “yes” and “partially yes” were combined, the Consolidated Framework for Implementation Research (CFIR) was considered the most suitable by both KT and HTR experts (86%). One additional KT TMF was selected by KT experts: the Knowledge-to-Action framework. HTR experts selected two additional KT TMFs: the co-KT framework and the Plan-Do-Study-Act cycle. The third study involved 13 one-to-one semi-structured interviews on characteristics of KT TMFs that were important to consider for the HTR outputs of decreased use or de-adoption of a technology. Four foundational principles, three levers of change, and five steps for knowledge to action emerged as KT TMF traits for HTR. From the KT TMFs that were mapped onto the characteristics, CFIR had the most characteristics (11/12) missing only the ability to map to the micro, meso, macro levels. This is the first body of work that examines the relationship between HTR and KT. The findings offer guidance to users on the application of KT TMFs to the HTR process and implementation of its outputs. Practical use of these KT TMFs to the HTR process will provide further advancement in this area

Knowledge translation and health technology reassessment: identifying synergy

Abstract Background Health Technology Reassessment (HTR) is an emerging field that shifts the focus from traditional methods of technology adoption to managing technology throughout its lifecycle. HTR is a mechanism to improve patient care and system efficiency through a reallocation of resources away from low-value care towards interventions and technologies that are high value. To achieve this, the outputs of HTR and its recommendations must be translated into practice. The evolving field of knowledge translation (KT) can provide guidance to improve the uptake of evidence-informed policies and recommendations resulting from the process of HTR. This paper argues how the theories, models and frameworks from KT could advance the HTR process. Discussion First, common KT theories, models and frameworks are presented. Second, facilitators and barriers to KT within the context of HTR are summarized from the literature. Facilitators and barriers to KT include ensuring a solid research evidence-base for the technology under reassessment, assessing the climate and context, understanding the social an political context, initiating linkage and exchange, having a structured HTR Process, adequate resources, and understanding the roles of researchers, knowledge users, and stakeholders can enhance knowledge translation of HTR outputs. Third, three case examples at the individual (micro), organizational (meso), and policy (macro) levels are used to illustrate to describe how a KT theory, model or framework could be applied to a HTR project. These case studies show how selecting and applying KT theories, models and frameworks can facilitate the implementation of HTR recommendations. Conclusion HTR and KT are synergistic processes that can be used to optimize technology use throughout its lifecycle. We argue that the application of KT theories, models and frameworks, and the assessment of barriers and facilitators to KT can facilitate translation of HTR recommendations into practice

Multidisciplinary rehabilitation for chronic low back pain: systematic review

OBJECTIVE: To assess the effect of multidisciplinary biopsychosocial rehabilitation on clinically relevant outcomes in patients with chronic low back pain. DESIGN: Systematic literature review of randomised controlled trials. PARTICIPANTS: A total of 1964 patients with disabling low back pain for more than three months. MAIN OUTCOME MEASURES: Pain, function, employment, quality of life, and global assessments. RESULTS: Ten trials reported on a total of 12 randomised comparisons of multidisciplinary treatment and a control condition. There was strong evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration improves function when compared with inpatient or outpatient non-multidisciplinary treatments. There was moderate evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain when compared with outpatient non-multidisciplinary rehabilitation or usual care. There was contradictory evidence regarding vocational outcomes of intensive multidisciplinary biopsychosocial intervention. Some trials reported improvements in work readiness, but others showed no significant reduction in sickness leaves. Less intensive outpatient psychophysical treatments did not improve pain, function, or vocational outcomes when compared with non-multidisciplinary outpatient therapy or usual care. Few trials reported effects on quality of life or global assessments. CONCLUSIONS: The reviewed trials provide evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain and improves function in patients with chronic low back pain. Less intensive interventions did not show improvements in clinically relevant outcomes

Back schools for non-specific low-back pain

BACKGROUND: Since the introduction of the Swedish back school in 1969, back schools have frequently been used for treating patients with low-back pain (LBP). However, the content of back schools has changed and appears to vary widely today. OBJECTIVES: To assess the effectiveness of back schools for patients with non-specific LBP. SEARCH STRATEGY: We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials to May 2003 for relevant trials reported in English, Dutch, French or German. We also screened references from relevant reviews and included trials. SELECTION CRITERIA: Randomized controlled trials (RCTs) that reported on any type of back school for non-specific LBP were included. DATA COLLECTION AND ANALYSIS: Four reviewers, blinded to authors, institution and journal, independently extracted the data and assessed the quality of the trials. We set the high quality level, a priori, at a trial meeting six or more of 11 internal validity criteria. As data were clinically and statistically too heterogeneous to perform a meta-analysis, we used a qualitative review (best evidence synthesis) to summarize the results. The evidence was classified into four levels (strong, moderate, limited or no evidence), taking into account the methodological quality of the studies. We also evaluated the clinical relevance of the studies. MAIN RESULTS: Nineteen RCTs (3584 patients) were included in this updated review. Overall, the methodological quality was low, with only six trials considered to be high quality. It was not possible to perform relevant subgroup analyses for LBP with radiation versus LBP without radiation. The results indicate that there is moderate evidence suggesting that back schools have better short and intermediate-term effects on pain and functional status than other treatments for patients with recurrent and chronic LBP. There is moderate evidence suggesting that back schools for chronic LBP in an occupational setting, are more effective than other treatments and placebo or waiting list controls on pain, functional status and return to work during short and intermediate-term follow-up. In general, the clinical relevance of the studies was rated as insufficient. REVIEWERS' CONCLUSIONS: There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain, and improve function and return-to-work status, in the short and intermediate-term, compared to exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls, for patients with chronic and recurrent LBP. However, future trials should improve methodological quality and clinical relevance and evaluate the cost-effectiveness of back schools

Characteristics of knowledge translation theories, models and frameworks for health technology reassessment: expert perspectives through a qualitative exploration

Abstract Background Health Technology Reassessment (HTR) is a process that systematically assesses technologies that are currently used in the health care system. The process results in four outputs: increase use or decrease use, no change, or de-adoption of a technology. Implementation of these outputs remains a challenge. The Knowledge Translation (KT) field enables to transfer/translate knowledge into practice. KT could help with implementation of HTR outputs. This study sought to identify which characteristics of KT theories, models, and frameworks could be useful, specifically for decreased use or de-adoption of a technology. Methods A qualitative descriptive approach was used to ascertain the perspectives of international KT and HTR experts on the characteristics of KT theories, models, and frameworks for decreased use or de-adoption of a technology. One-to-one semi-structured interviews were conducted from September to December 2019. Interviews were audio recorded and transcribed verbatim. Themes and sub-themes were deduced from the data through framework analysis using five distinctive steps: familiarization, identifying an analytic framework, indexing, charting, mapping and interpretation. Themes and sub-themes were also mapped to existing KT theories, models, and frameworks. Results Thirteen experts from Canada, United States, United Kingdom, Australia, Germany, Spain, and Sweden participated in the study. Three themes emerged that illustrated the ideal traits: principles that were foundational for HTR, levers of change, and steps for knowledge to action. Principles included evidence-based, high usability, patient-centered, and ability to apply to the micro, meso, macro levels. Levers of change were characterized as positive, neutral, or negative influences for changing behaviour for HTR. Steps for knowledge to action included: build the case for HTR, adapt research knowledge, assess context, select interventions, and assess impact. Of the KT theories, models, and frameworks that were mapped, the Consolidated Framework for Implementation Research had most of the characteristics, except ability to apply to micro, meso, macro levels. Conclusions Characteristics that need to be considered within a KT theory, model, and framework for implementing HTR outputs have been identified. Consideration of these characteristics may guide users to select relevant KT theories, models, and frameworks to apply to HTR projects

Identification of knowledge translation theories, models or frameworks suitable for health technology reassessment: a survey of international experts

Objective Health technology reassessment (HTR) is a field focused on managing a technology throughout its life cycle for optimal use. The process results in one of four possible recommendations: increase use, decrease use, no change or complete withdrawal of the technology. However, implementation of these recommendations has been challenging. This paper explores knowledge translation (KT) theories, models and frameworks (TMFs) and their suitability for implementation of HTR recommendations.Design Cross-sectional survey.Participants Purposeful sampling of international KT and HTR experts was administered between January and March 2019.Methods Sixteen full-spectrum KT TMFs were rated by the experts as ‘yes’, ‘partially yes’ or ‘no’ on six criteria: familiarity, logical consistency/plausibility, degree of specificity, accessibility, ease of use and HTR suitability. Consensus was determined as a rating of ≥70% responding ‘yes’. Descriptive statistics and manifest content analysis were conducted on open-ended comments.Results Eleven HTR and 11 KT experts from Canada, USA, UK, Australia, Germany, Spain, Italy and Sweden participated. Of the 16 KT TMFs, none received ≥70% rating. When ratings of ‘yes’ and ‘partially yes’ were combined, the Consolidated Framework for Implementation Research was considered the most suitable KT TMF by both KT and HTR experts (86%). One additional KT TMF was selected by KT experts: Knowledge to Action framework. HTR experts selected two additional KT TMFs: Co-KT framework and Plan-Do-Study-Act cycle. Experts identified three key characteristics of a KT TMF that may be important to consider: practicality, guidance on implementation and KT TMF adaptability.Conclusions Despite not reaching an overall ≥70% rating on any of the KT TMFs, experts identified four KT TMFs suitable for HTR. Users may apply these KT TMFs in the implementation of HTR recommendations. In addition, KT TMF characteristics relevant to the field of HTR need to be explored further

Características de una colaboración exitosa en la evaluación de una innovación en el cuidado de la salud: lecciones aprendidas de la tecnología de localización GPS para clientes con demencia

Becoming lost or its risk is a problem for dementia clients, their families and caregivers. The purpose of the paper is to describe, analyze and share lessons from a pilot project to use global positioning system devices to manage the risk of becoming lost and, at the same time, maintaining client autonomy. The study informs technology implementation approaches and strategies for innovative health technologies. The project used a prospective mixed-methods approach including a pre and post paper-based questionnaire, focus groups and individual interviews. Technology uptake was examined post knowledge transfer using the After Action Review method, which has shown utility in military and health care settings. Project successes and weaknesses are identified to inform future approaches of innovative health technology pilot projects. Lessons from the pilot emphasize the need for innovators to understand the multifaceted context they are entering, enlist the support of leaders, dedicate a project lead, support autonomous decision making and problem solving, meet regularly to monitor progress and address issues and support peer-to-peer collaboration

Características de una colaboración exitosa en la evaluación de una innovación en el cuidado de la salud: lecciones aprendidas de la tecnología de localización GPS para clientes con demencia

Becoming lost or its risk is a problem for dementia clients, their families and caregivers. The purpose of the paper is to describe, analyze and share lessons from a pilot project to use global positioning system devices to manage the risk of becoming lost and, at the same time, maintaining client autonomy. The study informs technology implementation approaches and strategies for innovative health technologies. The project used a prospective mixed-methods approach including a pre and post paper-based questionnaire, focus groups and individual interviews. Technology uptake was examined post knowledge transfer using the After Action Review method, which has shown utility in military and health care settings. Project successes and weaknesses are identified to inform future approaches of innovative health technology pilot projects. Lessons from the pilot emphasize the need for innovators to understand the multifaceted context they are entering, enlist the support of leaders, dedicate a project lead, support autonomous decision making and problem solving, meet regularly to monitor progress and address issues and support peer-to-peer collaboration