Virtual reality for brain injury rehabilitation : an evaluation of clinical practice, therapists' adoption and knowledge translation

Background: Acquired brain injury (ABI) affects considerable numbers of Canadians every year, resulting in a range of functional impairments requiring rehabilitation. Virtual reality (VR) is a relatively new treatment approach being used increasingly for this purpose. A lack of research documents current practice in VR use, along with the barriers, facilitators and support needs of therapists expected to adopt the technology. Purpose: This research aimed to describe how the GestureTek VR system was being used clinically in ABI rehabilitation, to outline preliminary work addressing the resource needs of clinicians, to examine factors influencing therapists’ adoption of VR and to evaluate the impact of a multi-faceted knowledge translation (KT) intervention at mediating these factors to facilitate VR implementation. Hypotheses: The KT intervention will be associated with improvements in therapists' perceived ease of use and self efficacy in using the technology, and an associated increase in their intentions to use VR. Methods: A single group pretest-posttest design was used to examine the determinants of VR adoption as proposed by the Decomposed Theory of Planned Behaviour and to evaluate change following KT. The intervention included interactive education, the provision of clinical protocols and technical and clinical support. Forty-two therapists from two health centres completed the ADOPT-VR outcome measure. Descriptive measures recorded the nature of therapists’ use of VR with 29 clients. Related-samples Wilcoxon signed ranks tests were used to evaluate pretest-posttest changes in hypothesis variables. Descriptive statistics and content analysis were used to analyse nominal and qualitative data, respectively. Results: Differences existed between clinical application and existing research in both treatment and client characteristics. Overall, therapists had positive attitudes and intentions to use VR. Increases in perceived ease of use and self efficacy, but not behavioural intention, were observed following KT. The most significant barriers to VR use included time and client factors, while primary facilitators included peer influence and organisational-level supports. Conclusion: Preliminary knowledge of current VR practice trends can assist in the design of clinically relevant ABI research. Barriers and facilitators can be targeted by management to support VR implementation. Therapists’ identified knowledge and support needs can inform future KT strategies.Medicine, Faculty ofGraduat

Strengthening networks to improve knowledge translation in paediatric healthcare

Background: Knowledge translation (KT), or the process of moving research into action, takes 10-20 years, resulting in sub-optimal healthcare for Canadians. Most KT strategies designed to shorten this gap neglect the social factors that facilitate research use. Social network analysis (SNA) methodology can be used to examine these factors within a network of individuals, including identifying influential people, and describing interaction patterns that can be targeted to improve KT efficiency. No such studies exist in paediatric healthcare organizations. Aims: 1) determine how SNA can augment KT research; 2) describe the national KT support context within paediatric healthcare and research organizations; and 3) confirm the influence of networks on KT, and identify network-driven KT support strategies. Methods: Study 1: Scoping review of SNA and theory applied to KT research. Study 2: Survey-based environmental scan of organizational KT supports in Canadian paediatric healthcare and research organizations. Study 3: Mixed-methods SNA descriptive case study of one healthcare-research organization dyad’s KT network using visual tools, and SNA survey and interview data from researchers, clinicians, leaders and KT support personnel to triangulate network influences on KT, and to identify network interventions to facilitate KT. Results: Study 1: SNA use is emerging in the KT field, primarily to examine information flow through cross-sectional survey research of physician-only networks, while analyzing few network properties. Diverse theoretical perspectives appear to be applicable for SNA research. Study 2: Organizational supports for KT typically targeted healthcare professionals, leaders and researchers, and included library services, KT support personnel, internal and external collaborations, forums and communication strategies, policies and protocols, consultation, specialized initiatives and funding. Study 3: Multiple network structures were perceived to influence KT. Reasons for network structure included individual attributes, relational considerations, and organizational context. Proposed network-driven KT support strategies included network development, communication, resources, personnel, visibly valuing KT, and evaluation. Conclusion: SNA can advance the science of KT by addressing the under-researched social determinants of evidence use, and by informing the design of network interventions. Participant engagement in applying a network perspective represented a novel application of SNA to KT research.Medicine, Faculty ofGraduat

How the study of networks informs knowledge translation and implementation: a scoping review

Background: To date, implementation science has focused largely on identifying the individual and organizational barriers, processes, and outcomes of knowledge translation (KT) (including implementation efforts). Social network analysis (SNA) has the potential to augment our understanding of KT success by applying a network lens that examines the influence of relationships and social structures on research use and intervention acceptability by health professionals. The purpose of this review was to comprehensively map the ways in which SNA methodologies have been applied to the study of KT with respect to health professional networks. Methods: Systematic scoping review methodology involved searching five academic databases for primary research on KT that employed quantitative SNA methods, and inclusion screening using predetermined criteria. Data extraction included information on study aim, population, variables, network properties, theory use, and data collection methods. Descriptive statistics and chronology charting preceded theoretical analysis of findings. Results: Twenty-seven retained articles describing 19 cross-sectional and 2 longitudinal studies reported on 28 structural properties, with degree centrality, tie characteristics (e.g., homophily, reciprocity), and whole network density being most frequent. Eleven studies examined physician-only networks, 9 focused on interprofessional networks, and 1 reported on a nurse practitioner network. Diffusion of innovation, social contagion, and social influence theories were most commonly applied. Conclusions: Emerging interest in SNA for KT- and implementation-related research is evident. The included articles focused on individual level evidence-based decision-making: we recommend also applying SNA to meso- or macro-level KT activities. SNA research that expands the range of professions under study, examines network dynamics over time, extends the depth of analysis of the role of network structure on KT processes and outcomes, and employs mixed methods to triangulate findings, is needed to advance the field. SNA is a valuable approach for evaluating key network characteristics, structures and positions of relevance to KT, implementation, and evidence informed practice. Examining how network structure influences connections and the implications of those holding prominent network positions can provide insights to improve network-based KT processes.Applied Science, Faculty ofMedicine, Faculty ofOther UBCNon UBCNursing, School ofReviewedFacult

Protocol of a scoping review on knowledge translation competencies

Abstract Background Knowledge translation (KT) activities can reduce the gap between “what is known” and “what is done”. Several factors hinder or facilitate KT activities including individual characteristics and organizational attributes; we will focus on individual healthcare professional modifiable characteristics. The purpose of this scoping review is to summarize knowledge on KT competencies for knowledge users, knowledge brokers, and knowledge producers/researchers to support evidence-based practice (EBP) and inform policy and research in health. Our objectives are to explore the relevant theoretical and empirical literature; map the publications for key themes and research gaps of KT competencies, and interventions for enhancing KT competencies; summarize and disseminate findings; produce an action plan and research agenda; and develop self-assessment tools (the KT Pathways) for professional development for our three target audiences. Methods The scoping review method will guide our study by following six stages: formulating the research question; identifying relevant studies; selecting the literature; charting the data; collating, summarizing, and reporting the results; and developing a KT plan and consulting stakeholders involved in the fields of KT, EBP, evidence-informed policy-making, and/or research. We will include empirical and theoretical/conceptual peer-reviewed and grey literature in health that examine knowledge user, knowledge broker and knowledge producer KT competencies. Publications written in the English language and published after 2003 only will be considered. Our multidisciplinary research team will collaborate using technology (i.e., WebEx for discussions and a Web 2.0 website for storing documents). Our KT plan consists of an Advisory Group and dissemination plan of the findings. Discussion We expect the identified KT competencies to contribute to the KT science by providing positive outcomes in practice, policy, education, and future research. Incorporation of the core KT competencies may enhance safety, effectiveness of clinical care, and quality of health outcomes; contribute to and facilitate collaboration among practitioners, knowledge users, knowledge brokers, researchers, employers, and educators; improve education of healthcare professionals and inform policy-making process; benefit practitioners by guiding their KT professional development to become effective at moving evidence into practice and policy; guide suitable interventions and strategies to enhance KT activities in the health sector; and direct future research

Organizational supports for knowledge translation in paediatric health centres and research institutes: insights from a Canadian environmental scan

Background: Organizational supports are thought to help address wide-ranging barriers to evidence-informed health care (EIHC) and knowledge translation (KT). However, little is known about the nature of the resources and services that exist within paediatric health care and research settings across Canada to facilitate evidence use in health care delivery. This survey examined existing supports for EIHC/KT within these organizations to inform the design of similar EIHC/KT support programmes. Methods: A national environmental scan was conducted using a bilingual online survey distributed to leaders at Canadian paediatric academic health science centres and their affiliated research institutes. Participants were invited through email, social media and webinar invitations and snowball sampling. Supports of interest included personnel, resources, services, organizational structures or processes, and partnerships or collaborations; barriers and successes were also probed. Data were compiled by site, reported using descriptive statistics, or grouped thematically. Supports were described using the AIMD (Aims, Ingredients, Mechanism, Delivery) framework. Results: Thirty-one respondents from 17 sites across seven provinces represented a 49% site response rate. Eleven (65%) sites reported an on-site library with variable staffing and services. Ten (59%) sites reported a dedicated KT support unit or staff person. Supports ranged from education, resource development and consultation to protocol development, funded initiatives and collaborations. Organizations leveraged internal and external supports, with the majority also employing supports for clinical research integration. Supports perceived as most effective included personnel, targeted initiatives, leadership, interdepartmental expertise, external drivers and logistical support. Barriers included operational constraints, individual-level factors and lack of infrastructure. Conclusions: This first survey of organizational supports for EIHC/KT identified the range of supports in place in paediatric research and health care organizations across Canada. The diversity of supports reported across sites may reflect differences in resource capacity and objectives. Similarities in EIHC/KT and research integration supports suggest common infrastructure may be feasible. Moreover, stakeholder engagement in research was common, but not pervasive. Tailored support programmes can target multi-faceted barriers. Findings can inform the development, refinement and evaluation of EIHC/KT support programmes and guide the study of the effectiveness and sustainability of these strategies.Medicine, Faculty ofOther UBCNon UBCOccupational Science and Occupational Therapy, Department ofReviewedFacult

Core knowledge translation competencies: a scoping review

Abstract Background Knowledge translation (KT) is the broad range of activities aimed at supporting the use of research findings leading to evidence-based practice (EBP) and policy. Recommendations have been made that capacity building efforts be established to support individuals to enact KT. In this study, we summarized existing knowledge on KT competencies to provide a foundation for such capacity building efforts and to inform policy and research. Our research questions were “What are the core KT competencies needed in the health sector?” and “What are the interventions and strategies to teach and reinforce those competencies?” Methods We used a scoping review approach and an integrated KT process by involving an Advisory Group of diverse stakeholders. We searched seven health and interdisciplinary electronic databases and grey literature sources for materials published from 2003 to 2017 in English language only. Empirical and theoretical publications in health that examined KT competencies were retrieved, reviewed, and synthesized. Results Overall, 1171 publications were retrieved; 137 were fully reviewed; and 15 empirical and six conceptual academic, and 52 grey literature publications were included and synthesized in this scoping review. From both the academic and grey literature, we categorized 19 KT core competencies into knowledge, skills, or attitudes; and identified commonly used interventions and strategies to enhance KT competencies such as education, organizational support and hands-on training. Conclusions These initial core KT competencies for individuals provide implications for education, policy, knowledge brokering, and future research, and on the need for future evaluation of the KT competencies presented. We also discuss the essential role of organizational support and culture for successful KT activities/practice

Community-Engaged Research Ethics Training (CERET) : developing accessible and relevant research ethics training for community-based participatory research with people with lived and living experience using illicit drugs and harm reduction workers

Background: Community-based participatory research (CBPR) can directly involve non-academic community members in the research process. Existing resources for research ethics training can be inaccessible to team members without an academic background and do not attend to the full spectrum of ethical issues that arise through community-engaged research practices. We detail an approach to capacity building and training in research ethics in the context of CBPR with people who use(d) illicit drugs and harm reduction workers in Vancouver’s Downtown Eastside neighborhood. Methods A project team comprised of academic and community experts in CBPR, research ethics, and harm reduction met over five months to develop the Community-Engaged Research Ethics Training (CERET). The group distilled key principles and content from federal research ethics guidelines in Canada, and developed case examples to situate the principles in the context of research with people who use(d) illicit drugs and harm reduction workers. In addition to content related to federal ethics guidelines, the study team integrated additional content related to ethical issues that arise through community-based research, and ethical principles for research in the Downtown Eastside. Workshops were evaluated using a pre-post questionnaire with attendees. Results Over the course of six weeks in January–February 2020, we delivered three in-person workshops for twelve attendees, most of whom were onboarding as peer research assistants with a community-based research project. Workshops were structured around key principles of research ethics: respect for persons, concern for welfare, and justice. The discussion-based format we deployed allowed for the bi-directional exchange of information between facilitators and attendees. Evaluation results suggest the CERET approach was effective, and attendees gained confidence and familiarity with workshop content across learning objectives. Conclusions The CERET initiative offers an accessible approach to fulfill institutional requirements while building capacity in research ethics for people who use(d) drugs and harm reduction workers. This approach recognizes community members as partners in ethical decision making throughout the research process and is aligned with values of CBPR. Building capacity around intrinsic and extrinsic dimensions of research ethics can prepare all study team members to attend to ethical issues that arise from CBPR.Medicine, Faculty ofOther UBCNon UBCOccupational Science and Occupational Therapy, Department ofPopulation and Public Health (SPPH), School ofReviewedFacultyResearcherGraduateOthe

Advancing Health and Inclusion

As part of the UBC Public Scholars Initiative, a myriad of scholars from a wide variety of disciplines discuss the topic of advancing health and inclusion. Laura Bulk (Rehabilitation Science) is part of the Being Blind team, working to expose misperceptions about what it means to be Blind, and to create an engaging campaign challenging such misperceptions. Bulmaro Valdes (Biomedical Engineering) applies his science and engineering knowledge to help people with disabilities. He works directly with stroke survivors and therapists to develop new technological solutions to current rehabilitation issues. Beth Clark (Interdisciplinary Studies) focuses on how transgender youth, their parents, caregivers, and health care providers can work together to make health care decisions that support trans youth well-being. Stephanie Glegg (Rehabilitation Science) examines how relationships support/hinder evidence uptake in healthcare. By targeting the social influences that drive evidence use, she aims to improve patients’ timely access to healthcare innovations. Aarthi Gobinath (Neuroscience) works on treating postpartum depression, investigating how different types of maternal antidepressant exposure affect the neurobiology of mothers and the male and female offspring in adulthood. Celestin Hategeka (Population and Public Health) evaluates the effectiveness and implementation of a multifaceted quality improvement intervention (ETAT+) in Rwanda to improve quality of hospital care for newborns and children. Jaime Semchuk (Educational and Counselling Psychology) collaborates with high schools in BC to adapt, implement, and evaluate mental health literacy interventions with an aim to build capacity for promoting student wellbeing, reducing stigma, and effectively supporting students who experience mental health difficulties. Evan Taylor (Language and Literacy Education) is a health literacy researcher and advocate whose work focuses on trans* and gender nonconforming people's experiences of cancer and health decision-making.Applied Science, Faculty ofEducation, Faculty ofGraduate and Postdoctoral StudiesMedicine, Faculty ofEducational and Counselling Psychology, and Special Education (ECPS), Department ofLanguage and Literacy Education (LLED), Department ofPopulation and Public Health (SPPH), School ofUnreviewedGraduat

Kinecting the moves: the kinematic potential of rehabilitation-specific gaming to inform treatment for hemiplegia

Two therapy applications for hemiplegic arm rehabilitation were developed and tested, along with a motion tracking application that used two interfaces (PlayStation® Move and Microsoft® Kinect™) for videogame play through a social media application developed on Facebook©. To promote affected arm use, users are required to employ bimanual symmetrical hand motions. Preliminary kinematic data analysis of two subjects obtained during user testing is presented. Clinically relevant information, such as range of motion, trunk compensation, and total distance of hand movement was extracted from kinematic data. Results showed the system is capable of accommodating users with large variation in arm function.(Published in the Proceedings of the 10th International Conference on Disability, Virtual Reality & Associated Technologies held 2-4 Sept. 2014 in Gothenburg, Sweden.)Applied Science, Faculty ofMechanical Engineering, Department ofNon UBCReviewedFacultyResearcherGraduateUndergraduat