Supporting clinical practice behavior change among neurologic physical therapists: a case study in knowledge translation.

BACKGROUND AND PURPOSE: Physical therapists tend to underuse research evidence in clinical practice. Emerging research on knowledge translation activities (KTAs) provides guidance to address this problem. We describe a yearlong effort to promote clinical practice behavior change in neurologic physical therapists. CASE DESCRIPTION: Physical therapy stroke and brain injury teams in an inpatient rehabilitation setting implemented a quality improvement project to encourage use of a novel, evidence-supported gait training method (nonsupported gait training [NSGT]) for patients with hemiparesis. INTERVENTION: The project consisted of multidimensional KTAs, including (1) quarterly staff meetings at which NSGT was introduced, reviewed, and discussed; (2) group and individual dialogue regarding successes, challenges, solutions, and clinical decision-making; (3) ongoing monitoring of and aggregate feedback about appropriate NSGT attempts via chart audit; and (4) ongoing reminders, role modeling, and clinical consultation. Specific staff perceptions about the approach, captured by a mid-year survey, further informed targeted problem-solving and clinical case presentations. OUTCOMES: In the first, second, and fourth quarter, 50%, 60%, and 73% of eligible patients were trained with NSGT, respectively. A mid-year survey showed that 19% of therapists were very/moderately familiar with NSGT before the quality improvement project, versus 78% at the 6-month point. Thirty-three percent stated that they used NSGT almost always/often before the project, versus 66% at the 6-month point. DISCUSSION: Extensive multidimensional KTAs were feasible in inpatient rehabilitation and were accompanied by a moderate increase in documented and self-reported frequency of NSGT attempts. Clinical teams may benefit from adopting KTAs that best support clinical practice change.

Knowledge Translation Task Force for core measures clinical practice guideline: a short report on the process and utilization.

BACKGROUND: As part of the 2018 Clinical Practice Guideline (CPG): A Core Set of Outcome Measures for Adults with Neurologic Conditions Undergoing Rehabilitation, a Knowledge Translation (KT) Task Force was convened. The purpose of this short report was to (1) demonstrate the potential impact of a CPG KT Task Force through a practical example of efforts to implement a CPG into neurologic physical therapy practice and (2) describe the process to convene a KT Task Force and develop products (KT Toolkit) to facilitate implementation of the CPG. METHODS: To describe the process used by the KT Task Force to develop and review a KT Toolkit for implementation of the CPG. RESULTS: Utilizing the Knowledge-To-Action Cycle framework, eight tools were developed as part of the KT Toolkit and are available with open access to the public. Findings indicate that the Core Outcome Measures Homepage, which houses the KT Toolkit, has had greater than 70,000 views since its publication. CONCLUSIONS: This short report serves as an example of the efforts made to implement a CPG into physical therapy practice. The processes to facilitate KT and the tools developed can inform future implementation efforts and underscore the importance of having a KT Task Force to implement a CPG. Moving forward, KT Task Forces should be convened to implement new or revised guidelines. TRIAL REGISTRATION: N/A.

Using feedback on patient health outcomes to improve orthopaedic physical therapist practice: a quality improvement study.

OBJECTIVE: Measuring health outcomes plays an important role in patient-centred healthcare. When aggregated across patients, outcomes can provide data for quality improvement (QI). However, most physical therapists are not familiar with QI methods based on patient outcomes. This mixed-methods study aimed to develop and evaluate a QI programme in outpatient physical therapy care based on routinely collected health outcomes of patients with low-back pain and neck pain. METHODS: The QI programme was conducted by three teams of 5-6 physical therapists from outpatient settings. Plan-do-study-act cycles were used based on team-selected goals. Monthly feedback reports of process and outcomes of care, including pre-post treatment changes in Oswestry Disability Index (ODI) and Neck Disability Index (NDI), guided the QI efforts. Primary outcomes were pre-QI and post-QI changes in knowledge and attitudes towards outcome measures through a survey, and administered and self-reported compliance with using the ODI and NDI. Semistructured interviews and a focus group were conducted to evaluate the perceived value of the programme. RESULTS: Post-QI, the survey showed improvements in two items related to the role of patients and implementation of outcome measures. Registered pre-QI and post-QI completion rates were high at intake (ODI:91% pre, 88% post; NDI:75% pre, 84% post), while completion rates at discharge improved post-QI (ODI:14% pre, 66% post; NDI: 32% pre, 50% post). Perceived benefits of the QI programme included clinician and institutional accountability to processes and strategies aimed at continuous improvement in patient care. An important facilitator for programme participation was autonomy in project selection and development, while a main barrier was the time required to set up the QI project. CONCLUSION: A QI programme based on the feedback of routinely collected health outcomes of patients with low back pain and neck pain was feasible and well accepted by three pilot teams of physical therapists.

Home and Community-Based Physical Therapist Management of Adults With Post-Intensive Care Syndrome.

More than 4 million adults survive a stay in the intensive care unit each year, with many experiencing new or worsening physical disability, mental health problems, and/or cognitive impairments, known as post-intensive care syndrome (PICS). Given the prevalence and magnitude of physical impairments after critical illness, many survivors, including those recovering from COVID-19, could benefit from physical therapist services after hospital discharge. However, due to the relatively recent recognition and characterization of PICS, there may be limited awareness and understanding of PICS among physical therapists practicing in home health care and community-based settings. This lack of awareness may lead to inappropriate and/or inadequate rehabilitation service provision. While this perspective article provides information relevant to all physical therapists, it is aimed toward those providing rehabilitation services outside of the acute and postacute inpatient settings. This article reports the prevalence and clinical presentation of PICS and provides recommendations for physical examination and outcomes measures, plan of care, and intervention strategies. The importance of providing patient and family education, coordinating community resources including referring to other health care team members, and community-based rehabilitation service options is emphasized. Finally, this perspective article discusses current challenges for optimizing outcomes for people with PICS and suggests future directions for research and practice.