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.

The changing landscape of pharmaceutical alternatives to the unregulated drug supply during COVID-19.

BACKGROUND: The dual COVID-19 and overdose emergencies amplified strain on healthcare systems tasked with responding to both. One downstream consequence of the pandemic in the USA and Canada was a surge in drug overdoses resulting from public health-restricted access to services and an increasingly toxic unregulated drug supply. This study aimed to describe changes implemented by programs prescribing pharmaceutical alternatives to the drug supply during the early stages of the COVID-19 pandemic. METHODS: An environmental scan used surveys and qualitative interviews with service providers across Canada to examine pharmaceutical alternative prescribing practices and programs before and during the pandemic. This study summarized the nature, frequency, and reasons for pandemic-driven service delivery changes using directed content analysis, counts, and thematic analysis. RESULTS: Eighty-two of the 103 participating sites reported 1193 unique changes in physical space (368), client protocols (347), program operations (342), ancillary services (127), and staffing (90). Four qualitative themes describing the reasons for these changes emerged, namely (1) decreasing risk of COVID-19 infection; (2) decreasing risk of overdose; (3) prioritizing acute care of COVID-19 patients; and (4) improving client access to treatment. CONCLUSIONS: While most changes were aimed at decreasing risk of COVID-19 infection, some were found to be at odds with the measures needed to combat the overdose crisis; others met dual objectives of decreased risk of both overdose and infection. Further research should examine which changes should be kept or reversed once COVID-19-related public health measures are lifted.

Facilitating the Implementation of Virtual Reality-Based Therapies in Pediatric Rehabilitation.

Aims: Evaluate the impact of a multifaceted knowledge translation (KT) strategy for the implementation of virtual reality (VR) intervention by rehabilitation clinicians in a pediatric hospital setting.Methods: Eleven therapists were recruited and completed a questionnaire on perceptions on VR usage. A multifaceted KT strategy was implemented over five months. VR usage was tracked and clinician perceptions were reassessed. Baseline characteristics were summarized using descriptive statistics and a Wilcoxon signed rank sum test evaluated changes pre- and post-KT.Results: Perceived ease of use, behavioral control, self-efficacy, and barriers to use improved significantly post-KT; however, intention to use did not. Usage was higher pre-KT than the last two months of KT. Pre-KT, barriers included system setup and use, knowledge of games, and lack of resources, whereas post-KT, they were the lack of appropriate patients and patient-specific experience. KT supports and patient engagement were reasons for continued use.Conclusions: This study highlights the importance of supporting clinicians when implementing VR in clinical rehabilitation. Clinicians benefit from experiential and individualized learning opportunities, peer-led coaching, and hands-on training. Whether these strategies translate to increased usage and how usage is influenced by environmental factors (i.e. lack of appropriate clients) warrants additional research.

Facilitating Interviews in Qualitative Research With Visual Tools: A Typology.

Visual methods are gaining traction in qualitative research to support data generation, data analysis, and research dissemination. In this article, I propose a preliminary typology that categorizes five identified purposes of applying visual methods in qualitative interviews: to (a) enable communication, (b) represent the data, (c) enhance data quality and validity, (d) facilitate the relationship, and (e) effect change. Examples of visual tools are presented to demonstrate their utility in addressing these five aims. An existing ethical framework for visual tool use in qualitative research is then presented to structure a discussion on ethical considerations related to confidentiality, consent, representations and audiences, fuzzy boundaries between researchers and participants, authorship and ownership, and minimizing harm. Future directions include testing and extending the typology with respect to other visual methods and qualitative research processes, and research to evaluate the effectiveness of various visual tools at achieving the aims represented in the typology.

Core knowledge translation competencies: a scoping review.

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.

Role Domains of Knowledge Brokering: A Model for the Health Care Setting.

Knowledge brokering is a strategy to support collaborations and partnerships within and across clinical, research, and policy worlds to improve the generation and use of research knowledge. Knowledge brokers function in multiple roles to facilitate the use of evidence by leveraging the power of these partnerships. The application of theory can provide clarity in understanding the processes, influences, expected mechanisms of action, and desired outcomes of knowledge brokering. Viewing knowledge brokering from the perspective of its role domains can provide a means of organizing these elements to advance our understanding of knowledge brokering. The objectives of this special interest article are (1) to describe the context for knowledge brokering in health care, (2) to provide an overview of knowledge translation theories applied to knowledge brokering, and (3) to propose a model outlining the role domains assumed in knowledge brokering. The Role Model for Knowledge Brokering is composed of 5 role domains, including information manager, linking agent, capacity builder, facilitator, and evaluator. We provide examples from the literature and our real-world experience to demonstrate the application of the model. This model can be used to inform the practice of knowledge brokering as well as professional development and evaluation strategies. In addition, it may be used to inform theory-driven research examining the effectiveness of knowledge brokering on knowledge generation and translation outcomes in the health care field, as well as on patient health outcomes.Video Abstract is available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A126).

A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation.

BACKGROUND: Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills. METHODS: A multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study. RESULTS: Eleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19th percentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported that client motivation to engage with VR facilitated IREX use in practice but that environmental and IREX-specific barriers limited use. CONCLUSIONS: Despite increased knowledge and skills in VR use, the KT intervention did not alter the number of perceived barriers to VR use, intention to use or actual use of VR. Poor perceived system usability had an impact on integration of this particular VR system into clinical practice.

Realist process evaluation of the knowledge translation programme of a patient-oriented research network.

RATIONALE: The Knowledge Translation (KT) Programme of a pan-Canadian strategic patient-oriented research network focused on brain-based developmental disabilities aimed to mobilize knowledge relevant to the network members. The programme also promotes and studies integrated Knowledge Translation (iKT) approaches involving different interested parties, such as researchers, patient-partners and decision-makers, in all parts of the knowledge creation process. AIMS AND OBJECTIVES: The objective of this study is to advance research programme evaluation methods through a realist evaluation of the process of implementing iKT activities. METHODS: Realist process evaluation included: (1) development of initial programme theories (using the partnership synergy theory); (2) data collection and analysis; (3) synthesis and refinement of theories through engagement with literature; and (4) presentation of findings in context-mechanism-outcome (C-M-O) configurations. A range of project documentation records were reviewed for analysis, and three co-leads, a programme coordinator, and a senior research associate were consulted to contextualize the implementation process of relevant KT activities. RESULTS: Based on the developed C-M-O configurations, we identified five key mechanisms of generating synergy in the iKT processes: (1) Visible shared leadership that embodies what iKT looks like; (2) Researchers' readiness for iKT; (3) Adaptation and flexible allocation of resources to emerging needs; (4) Power sharing to create practical and creative knowledge; and (5) Collective voice for potential transformative impacts at the policy level. CONCLUSIONS: The current realist evaluation demonstrated how partnerships between researchers, patient-partners and other interested parties can synergistically generate new ways of thinking among all interested parties, actionable strategies to integrate users in research, and solutions to disseminate knowledge. In particular, we identified a pivotal role for patient-partners to act as equal decision-maker helps building and maintaining partnerships and consolidating KT strategies.

"COVID just kind of opened a can of whoop-ass": The rapid growth of safer supply prescribing during the pandemic documented through an environmental scan of addiction and harm reduction services in Canada.

OBJECTIVES: In the context of the ongoing overdose crisis, a stark increase in toxic drug deaths from the unregulated street supply accompanied the onset of the COVID-19 pandemic. Injectable opioid agonist treatment (iOAT - hydromorphone or medical-grade heroin), tablet-based iOAT (TiOAT), and safer supply prescribing are emerging interventions used to address this crisis in Canada. Given rapid clinical guidance and policy change to enable their local adoption, our objectives were to describe the state of these interventions before the pandemic, and to document and explain changes in implementation during the early pandemic response (March-May 2020). METHODS: Surveys and interviews with healthcare providers comprised this mixed methods national environmental scan of iOAT, TiOAT, and safer supply across Canada at two time points. Quantitative data were summarized using descriptive statistics; interview data were coded and analyzed thematically. RESULTS: 103 sites in 6 Canadian provinces included 19 iOAT, 3 TiOAT and 21 safer supply sites on March 1, 2020; 60 new safer supply sites by May 1 represented a 285% increase. Most common substances were opioids, available at all sites; most common settings were addiction treatment programs and primary care clinics, and onsite pharmacies models. 79% of safer supply services were unfunded. Diversity in service delivery models demonstrated broad adaptability. Qualitative data reinforced the COVID-19 pandemic as the driving force behind scale-up. DISCUSSION: Data confirmed the capacity for rapid scale-up of flexible, community-based safer supply prescribing during dual public health emergencies. Geographical, client demographic, and funding gaps highlight the need to target barriers to implementation, service delivery and sustainability.

Connecting for Care: a protocol for a mixed-method social network analysis to advance knowledge translation in the field of child development and rehabilitation.

BACKGROUND: Connections between individuals and organizations can impact knowledge translation (KT). This finding has led to growing interest in the study of social networks as drivers of KT. Social networks are formed by the patterns of relationships or connections generated through interactions. These connections can be studied using social network analysis (SNA) methodologies. The relatively small yet diverse community in the field of child development and rehabilitation (CD&R) in Canada offers an ideal case study for applying SNA. The purposes of this work are to (1) quantify and map the structure of Canadian CD&R KT networks among four groups: families, health care providers, KT support personnel, and researchers; (2) explore participant perspectives of the network structure and of KT barriers and facilitators within it; and (3) generate recommendations to improve KT capacity within and between groups. Aligning with the principles of integrated KT, we have assembled a national team whose members contribute throughout the research and KT process, with representation from the four participant groups. METHODS: A sequential, explanatory mixed-method study, within the bounds of a national case study in the field of CD&R. Objective 1: A national SNA survey of family members with advocacy/partnership experience, health care providers, KT support personnel, and researchers, paired with an anonymous survey for family member without partnership experience, will gather data to describe the KT networks within and between groups and identify barriers and facilitators of network connections. Objective 2: Purposive sampling from Phase 1 will identify semi-structured interview participants with whom to examine conventional and network-driven KT barriers, facilitators, and mitigating strategies. Objective 3: Intervention mapping and a Delphi process will generate recommendations for network and conventional interventions to strengthen the network and facilitate KT. DISCUSSION: This study will integrate network and KT theory in mapping the structure of the CD&R KT network, enhance our understanding of conventional and network-focused KT barriers and facilitators, and provide recommendations to strengthen KT networks. Recommendations can be applied and tested within the field of CD&R to improve KT, with the aim of ensuring children achieve the best health outcomes possible through timely access to effective healthcare.

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.

Service delivery models for injectable opioid agonist treatment in Canada: 2 sequential environmental scans.

BACKGROUND: Injectable opioid agonist treatment (iOAT) is an emerging evidence-based option in the continuum of care for opioid use disorder in parts of Canada. Our study objective was to identify and describe iOAT programs operating during the ongoing opioid overdose crisis. METHODS: We conducted 2 sequential environmental scans. Programs were eligible to participate if they were in operation as of Sept. 1, 2018, and Mar. 1, 2019. Information was collected over 2-3 months for each scan (September-October 2018, March-May 2019). Programs that participated in the first scan and newly established programs were invited to participate in the second scan. The scans included questions about location, service delivery model, clinical and operational characteristics, numbers and demographic characteristics of clients, and program barriers and facilitators. Descriptive analysis was performed. RESULTS: We identified 14 unique programs across the 2 scans. Eleven programs located in urban centres in British Columbia and Ontario participated in the first scan. At the time of the second scan, 2 of these programs were on hold and 2 of 3 newly established programs were in Alberta. The total capacity of all participating programs was 420 clients at most. Four service delivery models were identified; iOAT was most commonly integrated within existing health and social services. All programs offered hydromorphone, and 1 program also offered diacetylmorphine. In the first scan, 73% of clients (133/183) were male; the mean age of clients was 47 years. Limited capacity, pharmacy operations and lack of diacetylmorphine access were among the most frequently reported barriers. The most commonly reported facilitators included client-centred care, client relationships and access to other health and social support. INTERPRETATION: Evidence indicates that iOAT can be successfully implemented using diverse service delivery models. Future work should facilitate scale-up of this evidence-based treatment where gaps persist in high-risk communities.

Measures of knowledge and skills for evidence-based practice: a systematic review.

BACKGROUND: Lack of knowledge and skills in seeking, evaluating, and applying evidence are barriers to evidence-based practice (EBP). The measurement of these constructs can inform educational initiatives aimed at reducing EBP barriers. PURPOSE: The purpose of this systematic review is to provide a critical appraisal of the rehabilitation literature describing quantitative measures of EBP knowledge and skills. METHODS: Measures used with occupational therapists to evaluate EBP knowledge or skills were compiled from a search of the EMBASE, MEDLINE, CINAHL, EBM Reviews, and PSYCINFO databases. Measures were evaluated using adapted criteria from the CanChild Outcome Measures Rating Form. FINDINGS: Of the 15 measures identified, three met criteria as being adequate for the measurement of EBP knowledge and skills. IMPLICATIONS: Further measure development needs to address limitations of existing measures. Research to evaluate the psychometric properties of existing or novel measures of knowledge and skills related to EBP may improve their utility.

End-user involvement in rehabilitation virtual reality implementation research.

PURPOSE: Despite increasing evidence for the effectiveness of off-the-shelf and rehabilitation-specific active video games (AVGs) and virtual reality (VR) systems for rehabilitation, clinical uptake remains poor. A better match between VR/AVG system capabilities and client/therapist needs, through improved end-user involvement (UI) in VR/AVG implementation research, may increase uptake of this technology. The purpose of this paper is to review four case examples from the authors' collective experience of including end users in VR/AVG research to identify common benefits, challenges and lessons learned. DESIGN/METHODOLOGY/APPROACH: The authors apply knowledge and lessons learned from the four cases to make recommendations for subsequent user-engaged research design and methods, including evaluation of the impact of end UI. FINDINGS: A better match between VR/AVG system capabilities and client/therapist needs leads to improved end UI in all stages of VR/AVG implementation research. There are common benefits of increasing buy-in and soliciting early on the knowledge and skills of therapists as well as input from the ultimate end users: people participating in rehabilitation. Most settings have the challenges of balancing the technology requirements with the needs and goals of the practice setting and of the end users. RESEARCH LIMITATIONS/IMPLICATIONS: Increasing end UI in VR/AVG implementation research may address issues related to poor clinical uptake. In the VR/AVG context, end users can be therapists, clients or technology developers/engineers. This paper presented four case scenarios describing the implementation of different VR/AVG systems and involving a variety of populations, end users and settings. ORIGINALITY/VALUE: The set of recommendations for subsequent user-engaged research design and methods span the process of development, research and implementation. The authors hope that these recommendations will foster collaborations across disciplines, encourage researchers and therapists to adopt VR/AVGs more readily, and lead to efficacious and effective treatment approaches for rehabilitation clients.

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.

A visual management tool for program planning, project management and evaluation in paediatric health care.

This article describes the development and implementation of a custom-designed Excel-based visual management tool. The tool's purpose was to support program planning and evaluation by our resource support team within a paediatric health care setting. Our aims in developing it were to 1) establish a streamlined process and supporting tools to efficiently plan and prioritize program directions and activities; 2) track progress; and 3) evaluate and report on our performance, outputs and outcomes. A collaborative approach based on the ADKAR (Awareness, Desire, Knowledge, Ability, Reinforcement) change management model and the LEADS (Lead self, Engage others, Achieve results, Develop coalitions, Systems transformation) leadership framework was used to guide the design and implementation processes. Team members reported high perceived effectiveness and efficiency with respect to the tool's utility in supporting its proposed aims. A graded approach to building knowledge and skills in using the tool, to individual responsibility for data entry, and to accountability by team members facilitated its successful implementation. Administrative support is important for sustainability and continual improvement of the tool to address changing team needs over time.

Mixed methods study exploring parent engagement in child health research in British Columbia.

OBJECTIVES: The objective of this study was to explore parent perspectives of and interest in an interactive knowledge translation platform called Child-Sized KT that proposes to catalyse the collaboration of patients, families, practitioners and researchers in patient-oriented research at British Columbia Children's Hospital (BCCH). METHODS: An explanatory sequential mixed methods design was used over 1 year. Over 500 parents across BC completed an online survey, including a subsample of 102 parents who had accessed care at BCCH within the past 2 years. The survey explored parent perspectives about the value of their engagement at all stages of the research process and their interest in and concerns with using an online platform. Following the online survey, two focus groups were held with parents in the Vancouver area to explore themes emerging from the survey. RESULTS: Parents expressed keen interest in engaging in research at BCCH. Parents perceived benefit from their input at all stages of the research process; however, they were most interested in helping to identify the problem, develop the research question and share the results. Although parents preferred online participation, they had concerns about protecting the privacy of their child's information. CONCLUSIONS: Parents see value in their involvement in all stages of child health research at BCCH. Their input suggests that Child-Sized KT, a hypothetical online platform, would facilitate meaningful stakeholder engagement in child health research, but should offer a customised experience and ensure the highest standard of data privacy and protection.

Barriers, Facilitators and Interventions to Support Virtual Reality Implementation in Rehabilitation: A Scoping Review.

Virtual reality and active video games (VR/AVGs) are promising rehabilitation tools because of their potential to facilitate abundant, motivating, and feedback-rich practice. However, clinical adoption remains low despite a growing evidence base and the recent development of clinically accessible and rehabilitation-specific VR/AVG systems. Given clinicians' eagerness for resources to support VR/AVG use, a critical need exists for knowledge translation (KT) interventions to facilitate VR/AVG integration into clinical practice. KT interventions have the potential to support adoption by targeting known barriers to, and facilitators of, change. This scoping review of the VR/AVG literature uses the Theoretical Domains Framework (TDF) to (1) structure an overview of known barriers and facilitators to clinical uptake of VR/AVGs for rehabilitation; (2) identify KT strategies to target these factors to facilitate adoption; and (3) report the results of these strategies. Barriers/facilitators and evaluated or proposed KT interventions spanned all but 1 and 2 TDF domains, respectively. Most frequently cited barriers/facilitators were found in the TDF domains of Knowledge, Skills, Beliefs About Capabilities, Beliefs About Consequences, Intentions, Goals, Environmental Context and Resources, and Social Influences. Few studies empirically evaluated KT interventions to support adoption; measured change in VR/AVG use did not accompany improvements in self-reported skills, attitudes, and knowledge. Recommendations to target frequently identified barriers include technology development to meet end-user needs more effectively, competency development for end-users, and facilitated VR/AVG implementation in clinical settings. Subsequent research can address knowledge gaps in both clinical and VR/AVG implementation research, including on KT intervention effectiveness and unexamined TDF domain barriers. LEVEL OF EVIDENCE: IV.

Application of Commercial Games for Home-Based Rehabilitation for People with Hemiparesis: Challenges and Lessons Learned.

OBJECTIVE: To identify the factors that influence the use of an at-home virtual rehabilitation gaming system from the perspective of therapists, engineers, and adults and adolescents with hemiparesis secondary to stroke, brain injury, and cerebral palsy. MATERIALS AND METHODS: This study reports on qualitative findings from a study, involving seven adults (two female; mean age: 65 ± 8 years) and three adolescents (one female; mean age: 15 ± 2 years) with hemiparesis, evaluating the feasibility and clinical effectiveness of a home-based custom-designed virtual rehabilitation system over 2 months. Thematic analysis was used to analyze qualitative data from therapists' weekly telephone interview notes, research team documentation regarding issues raised during technical support interactions, and the transcript of a poststudy debriefing session involving research team members and collaborators. RESULTS: Qualitative themes that emerged suggested that system use was associated with three key factors as follows: (1) the technology itself (e.g., characteristics of the games and their clinical implications, system accessibility, and hardware and software design); (2) communication processes (e.g., preferences and effectiveness of methods used during the study); and (3) knowledge and training of participants and therapists on the technology's use (e.g., familiarity with Facebook, time required to gain competence with the system, and need for clinical observations during remote therapy). Strategies to address these factors are proposed. CONCLUSION: Lessons learned from this study can inform future clinical and implementation research using commercial videogames and social media platforms. The capacity to track compensatory movements, clinical considerations in game selection, the provision of kinematic and treatment progress reports to participants, and effective communication and training for therapists and participants may enhance research success, system usability, and adoption.

Virtual Rehabilitation with Children: Challenges for Clinical Adoption [From the Field].

Virtual, augmented, and mixed reality environments are increasingly being developed and used to address functional rehabilitation goals related to physical, cognitive, social, and psychological impairments. For example, a child with an acquired brain injury may participate in virtual rehabilitation to address impairments in balance, attention, turn taking, and engagement in therapy. The trend toward virtual rehabilitation first gained momentum with the adoption of commercial off-the-shelf active video gaming consoles (e.g., Nintendo Wii and XBox). Now, we are seeing the rapid emergence of customized rehabilitation-specific systems that integrate technological advances in virtual reality, visual effects, motion tracking, physiological monitoring, and robotics.