A strategic initiative to facilitate knowledge translation research in rehabilitation.

BACKGROUND: While there is a growing body of literature supporting clinical decision-making for rehabilitation professionals, suboptimal use of evidence-based practices in that field persists. A strategic initiative that ensures the relevance of the research and its implementation in the context of rehabilitation could 1) help improve the coordination of knowledge translation (KT) research and 2) enhance the delivery of evidence-based rehabilitation services offered to patients with physical disabilities. This paper describes the process and methods used to develop a KT strategic initiative aimed at building capacity and coordinating KT research in physical rehabilitation and its strategic plan; it also reports the initial applications of the strategic plan implementation. METHODS: We used a 3-phase process consisting of an online environmental scan to identify the extent of KT research activities in physical rehabilitation in Quebec, Canada. Data from the environmental scan was used to develop a strategic plan that structures KT research in physical rehabilitation. Seven external KT experts in health science reviewed the strategic plan for consistency and applicability. RESULTS: Sixty-four KT researchers were identified and classified according to the extent of their level of involvement in KT. Ninety-six research projects meeting eligibility criteria were funded by eight of the fourteen agencies and organizations searched. To address the identified gaps, a 5-year strategic plan was developed, containing a mission, a vision, four main goals, nine strategies and forty-two actions. CONCLUSION: Such initiatives can help guide researchers and relevant key stakeholders, to structure, organize and advance KT research in the field of rehabilitation. The strategies are being implemented progressively to meet the strategic initiative's mission and ultimately enhance users' rehabilitation services.

Fostering clinical reasoning in physiotherapy: comparing the effects of concept map study and concept map completion after example study in novice and advanced learners.

BACKGROUND: Health profession learners can foster clinical reasoning by studying worked examples presenting fully worked out solutions to a clinical problem. It is possible to improve the learning effect of these worked examples by combining them with other learning activities based on concept maps. This study investigated which combinaison of activities, worked examples study with concept map completion or worked examples study with concept map study, fosters more meaningful learning of intervention knowledge in physiotherapy students. Moreover, this study compared the learning effects of these learning activity combinations between novice and advanced learners. METHODS: Sixty-one second-year physiotherapy students participated in the study which included a pre-test phase, a 130-min guided-learning phase and a four-week self-study phase. During the guided and self-study learning sessions, participants had to study three written worked examples presenting the clinical reasoning for selecting electrotherapeutic currents to treat patients with motor deficits. After each example, participants engaged in either concept map completion or concept map study depending on which learning condition they were randomly allocated to. Students participated in an immediate post-test at the end of the guided-learning phase and a delayed post-test at the end of the self-study phase. Post-tests assessed the understanding of principles governing the domain of knowledge to be learned (conceptual knowledge) and the ability to solve new problems that have similar (i.e., near transfer) or different (i.e., far transfer) solution rationales as problems previously studied in the examples. RESULTS: Learners engaged in concept map completion outperformed those engaged in concept map study on near transfer (p = .010) and far transfer (p < .001) performance. There was a significant interaction effect of learners' prior ability and learning condition on conceptual knowledge but not on near and far transfer performance. CONCLUSIONS: Worked examples study combined with concept map completion led to greater transfer performance than worked examples study combined with concept map study for both novice and advanced learners. Concept map completion might give learners better insight into what they have and have not yet learned, allowing them to focus on those aspects during subsequent example study.

Example-based learning: comparing the effects of additionally providing three different integrative learning activities on physiotherapy intervention knowledge.

BACKGROUND: Example-based learning using worked examples can foster clinical reasoning. Worked examples are instructional tools that learners can use to study the steps needed to solve a problem. Studying worked examples paired with completion examples promotes acquisition of problem-solving skills more than studying worked examples alone. Completion examples are worked examples in which some of the solution steps remain unsolved for learners to complete. Providing learners engaged in example-based learning with self-explanation prompts has been shown to foster increased meaningful learning compared to providing no self-explanation prompts. Concept mapping and concept map study are other instructional activities known to promote meaningful learning. This study compares the effects of self-explaining, completing a concept map and studying a concept map on conceptual knowledge and problem-solving skills among novice learners engaged in example-based learning. METHODS: Ninety-one physiotherapy students were randomized into three conditions. They performed a pre-test and a post-test to evaluate their gains in conceptual knowledge and problem-solving skills (transfer performance) in intervention selection. They studied three pairs of worked/completion examples in a digital learning environment. Worked examples consisted of a written reasoning process for selecting an optimal physiotherapy intervention for a patient. The completion examples were partially worked out, with the last few problem-solving steps left blank for students to complete. The students then had to engage in additional self-explanation, concept map completion or model concept map study in order to synthesize and deepen their knowledge of the key concepts and problem-solving steps. RESULTS: Pre-test performance did not differ among conditions. Post-test conceptual knowledge was higher (P < .001) in the concept map study condition (68.8 ± 21.8%) compared to the concept map completion (52.8 ± 17.0%) and self-explanation (52.2 ± 21.7%) conditions. Post-test problem-solving performance was higher (P < .05) in the self-explanation (63.2 ± 16.0%) condition compared to the concept map study (53.3 ± 16.4%) and concept map completion (51.0 ± 13.6%) conditions. Students in the self-explanation condition also invested less mental effort in the post-test. CONCLUSIONS: Studying model concept maps led to greater conceptual knowledge, whereas self-explanation led to higher transfer performance. Self-explanation and concept map study can be combined with worked example and completion example strategies to foster intervention selection.

Engaging patients through education: a modified-Delphi consultation to develop recommendations for patient education interventions in the management of subacromial pain syndrome in physical therapy.

PURPOSE: To develop recommendations to support the range of patient education interventions relevant in the management of patients with subacromial pain syndrome (SAPS) in physical therapy. MATERIALS AND METHODS: A 3-round modified Delphi consultation was used to obtain consensus agreement on the relevance of 12 preliminary recommendations. These were developed from a literature review and an expert consultation on general educational strategies and specific patient education interventions for the management of SAPS. The analysis assessed the rate of consensus on the relevance of these recommendations. Delphi panelists were rehabilitation professionals including physical (n = 21) and occupational therapists (n = 1) with SAPS experience, and patient-partners (n = 2) presenting shoulder pain. RESULTS: The Delphi consultation resulted in 13 revised consensus recommendations. Six consensus recommendations addressed general educational strategies to facilitate patient education, including teaching methods and materials, and seven addressed specific educational interventions, including teaching symptom self-management and tailoring activities and participation. These recommendations were incorporated into a clinical decision-making tool to support the selection of the most relevant patient education interventions. CONCLUSION: The recommendations developed in this study are relevant to guide physical therapist's clinical decisions making regarding interventions using patient education for SAPS. They promote active engagement and empowerment of individuals with SAPS.

Patient education, as a strategy to promote self-management of the condition, can help empower individuals with subacromial pain syndrome.Patient education may be relevant to addressing psychosocial factors that are often not adequately addressed in subacromial pain syndrome.Consensus and comprehensive patient education recommendations are relevant to support physical therapists' decision making in the management of subacromial pain syndrome.Such recommendations and a decision-support tool based on a scoping review of the literature, expert opinion and consensus are now available.

The Black Box of Patient Education: An Expert Consultation on Patient Education Interventions and Strategies for the Management of Subacromial Pain Syndrome.

Purpose: To identify patient education, interventions, and strategies to optimize the management of subacromial pain syndrome (SAPS) in physical therapy, based on the experiential knowledge of patient-partners and caregivers involved in the rehabilitation of this condition. Method: Using a semi-deductive approach building on the evidence extracted from the literature, an expert consultation using focus groups was conducted. The experts were physical therapists (n = 5) and an occupational therapist with extensive clinical experience, as well as a patient-partner. Analysis followed the Framework method. Results: Two main themes emerged: (1) interventions directly related to patient education, consisting of nine sub-themes, including symptom self-management and pain phenomenon, and (2) patient education strategies to broadly frame the interventions, consisting of 10 sub-themes, including educational materials and clinical teaching approaches. Conclusion: The consultation confirmed and expanded the knowledge from the literature by adding knowledge that emerged from the experts' practical experience. It resulted in the development of preliminary statements on structured patient education interventions and management strategies for SAPS. These emerging statements are, to our knowledge, the first to inform patient education specifically as it relates to the management of SAPS taking into account psychosocial and contextual factors.

Objectif: déterminer les mesures d'éducation des patients, les interventions et les stratégies à utiliser pour optimiser la prise en charge du conflit sous-acromial (CSA) en physiothérapie, d'après les connaissances expérientielles de patients-partenaires et de soignants qui participent à la réadaptation de cette affection. Méthodologie: au moyen d'une approche semi-déductive s'appuyant sur les données probantes tirées de publications scientifiques, les chercheurs ont réalisé une consultation d'experts au sein de groupes de travail. Ces experts étaient des physiothérapeutes (n = 5) et un ergothérapeute possédant une vaste expérience clinique, de même qu'un patient-partenaire. L'analyse a fait appel à la méthode du cadre logique. Résultats: deux grands thèmes ont émergé : 1) les interventions directement liées à l'éducation des patients, composées de neuf sous-thèmes, incluant l'autogestion des symptômes et le phénomène de la douleur, et 2) les stratégies d'éducation des patients pour encadrer sommairement les interventions, composées de dix sous-thèmes, y compris le matériel pédagogique et les méthodes d'enseignement clinique. Conclusion: la consultation a confirmé et élargi les connaissances tirées des publications scientifiques, car elle a permis d'ajouter le savoir issu de l'expérience pratique des experts. Elle a entraîné la préparation de déclarations préliminaires sur des interventions structurées d'éducation des patients et sur des stratégies de prise en charge du CSA. À notre connaissance, ces déclarations préliminaires sont les premières à éclairer les mesures d'éducation des patients, plus particulièrement à l'égard de la prise en charge du CSA, en tenant compte des facteurs psychosociaux et contextuels.