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The contribution of conceptual frameworks to knowledge translation interventions in physical therapy
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS427–eS632
of the Cognitive Ability Screening Instrument (CASI) was 65.8 ± 14.5, without group difference. The RT group completed the exercise program according to protocol with the average adherence rate of 70% and without adverse events. After training, the RT group showed significant groupby-time interactions on 30 s CST (p = .027) and 5-m WT (p = .027). Significant changes during 2 time points were found in many variables with mostly improve or maintain in RT group, but deteriorate in control group. Only 30 s CST (p = .029) showed significant between group effect. Conclusion(s): Three months resistance training program has beneficial effects on many motor performance tests, especially in improving lower extremity endurance and walking speed. Further studies may be needed to know if the training effects different between older adults with normal cognition and with MCI. Implications: Hydraulic circuit progressive resistance training can be implemented in a geriatric rehabilitation setting, which is feasible and effective in improving or maintaining motor performances in older adults with MCI. Keywords: Cognitive impairment; Motor performance; Resistance training Funding acknowledgements: This project was funded by Chang Gung Memorial Hospital Medical Research Fund (CMRPD1B0521). Ethics approval: Ethical approval was obtained from the Chang Gung Medical Foundation Institutional Review Board, Taoyuan, Taiwan. http://dx.doi.org/10.1016/j.physio.2015.03.3437 Special Interest Report Platform Presentation Number: SI-PL-1099 Sunday 3 May 2015 09:03 Room 334–335 THE CONTRIBUTION OF CONCEPTUAL FRAMEWORKS TO KNOWLEDGE TRANSLATION INTERVENTIONS IN PHYSICAL THERAPY A. Hudon 1,2 , M.-J. Gervais 3 , M. Hunt 2,4 1 Université
de Montréal, School of Rehabilitation, Montréal, Canada; 2 Centre for Interdisciplinary Research in Rehabilitation of Greater, Montréal, Canada; 3 Université du Québec à Montréal, Montréal, Canada; 4 McGill University, School of Physical and Occupational Therapy, Montréal, Canada Background: There is growing recognition of the importance of knowledge translation activities in physical therapy to ensure that research findings are integrated in clinical practice. Although various frameworks have been developed to guide and facilitate the process of translating knowledge into practice, these tools have been infrequently used
eS607
in physical therapy knowledge translation interventions and studies to date. Purpose: Knowledge translation in physical therapy implicates multiple stakeholders working in different settings, and involves numerous steps. In light of this complexity, the use of explicit conceptual frameworks by clinicians and researchers conducting knowledge translation interventions is associated with a range of potential benefits. In this presentation, we demonstrate why these frameworks should be considered important resources to promote the uptake of new evidence in physical therapy practice settings. The goal of this analysis is to provide guidance to physical therapists seeking to identify a framework to support the design and implementation of a knowledge translation intervention. Methods: We conducted a literature review in January 2014, using CINAHL, MEDLINE, and EMBASE databases and key words pertaining to knowledge translation and physical therapy, in order to gauge the use of conceptual frameworks for knowledge translation interventions in physical therapy. This review allowed us to identify four key benefits associated with the use of conceptual frameworks in designing and implementing knowledge translation interventions and to consider limits related to their use. Through this review, we also identified diverse knowledge translation conceptual frameworks, which are used in physical therapy and healthcare. We evaluated five prominent conceptual frameworks and whether they address common barriers to knowledge translation in physical therapy. Results: The four advantages of using conceptual frameworks are that they (1) help map knowledge translation interventions to ensure that essential knowledge translation components are addressed; (2) support efforts to evaluate impacts of the intervention and to promote sustainability; (3) promote the establishment of common ground and enhance communication among stakeholders and (4) encourage transparency and clarity about knowledge translation methods. We also identified two important limitations. Concerns remain regarding the difficulty in demonstrating the benefits of conceptual frameworks in knowledge translation interventions. Also, conceptual frameworks can be misapplied or used in a simplistic or mechanistic fashion. Conclusion(s): In sum, knowledge translation conceptual frameworks have the potential to promote systematic and well-planned knowledge translation interventions in physical therapy. It has been argued that guidance is currently lacking to help healthcare researchers, practitioners, or managers make decisions about which implementation strategies to use, in which contexts, and with what groups of stakeholders. Indeed, planning how to integrate research into practice has been described as a “black box”. Conceptual frameworks for physical therapy knowledge translation can help signpost the process of knowledge translation design and implementation,
eS608
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS427–eS632
thus helping to plan, implement and evaluate effective knowledge translation interventions. Implications: Conceptual frameworks can help structure the design and implementation process in ways that promote successful knowledge translation interventions. Such frameworks are an important resource to advance evidencebased practice in physical therapy and bridging the lingering research-practice gap. Keywords: Physical therapy; Knowledge translation; Conceptual framework Funding acknowledgements: Fonds de recherche du Québec-Santé (FRQ-S), MENTOR program, CJM-IUUQÀM Chair on knowledge translation, Knowledge Translation Canada Student Fellowship. Ethics approval: No ethics approval was required for this project. http://dx.doi.org/10.1016/j.physio.2015.03.3438 Research Report Poster Presentation Number: RR-PO-20-22-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 WHAT ARE THE ETHICAL ISSUES FACED BY PHYSIOTHERAPISTS WORKING IN PRIVATE PRACTICE? RESULTS OF A LITERATURE REVIEW A. Hudon 1,2 , M.-J. Drolet 3 , B. Williams-Jones 4 1 Université
de Montréal, School of Rehabilitation, Montréal, Canada; 2 Centre for Interdisciplinary Research in Rehabilitation of Greater, Montréal, Canada; 3 Université du Québec à Trois-Rivières, Department of Occupational Therapy, Trois-Rivières, Canada; 4 Université de Montréal, Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, Montréal, Canada Background: The for-profit nature of private physiotherapy makes physiotherapy in private practice different from that in a public setting. This workplace reality brings with it a host of ethical issues, some of which may be transversal across public and private practice settings (e.g., maintaining confidentiality, dealing with scarce resources), but others which will necessarily be more specific to private practice (e.g., self-referral, product sales) and that might go against the primary interests of patients. However, the impact of the institutional environment on generating ethical issues and on practitioners’ management of these issues has not yet been systematically investigated, despite the fact that they can affect negatively the quality of physiotherapy services. Purpose: The two objectives of this study were to (1) identify ethical issues encountered by physiotherapists in private practice settings and
(2) identify potential solutions and recommendations to address these issues. Methods: A hermeneutic analysis of texts retrieved by a literature search in eight databases was performed using three broad keyword categories: (1) ethics and professionalism, (2) physiotherapy and rehabilitation, and (3) private practice sector. The texts included had to meet the following inclusion criteria: be a refereed or non-referred text, be published in English or in French and be specifically discussing ethical issues encountered by physiotherapists in private practice. All texts meeting these criteria were included in the sample, regardless of their year of publication. Thirty-nine texts addressing ethical issues in a private practice context were analyzed. Results: Twenty-five ethical issues emerged and were classified in three main categories: (1) Business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time); (2) Professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) Patients’ rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs patient autonomy, informed consent). Particularly interesting and noteworthy are the issues of rights and duties of physiotherapists versus physiotherapy assistants, of physiotherapy care provided by non-physiotherapists, and of competition between colleagues for patients. Issues such as conflicts of interest, self-referral, lack of time affecting quality of care, dual agency and product sales are all weighty ethical issues that can have a major impact on the quality of physiotherapy service, and the profession’s image and public trust. Nonetheless, the literature is also beginning to identify possible remedies to some of these ethical challenges, notably by providing recommendations about how physiotherapists could better manage the issues arising in three main areas: (1) Education/Research and training, (2) Clinical practice and (3) Legal/Governance. Conclusion(s): The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported – through education, research and good governance – in providing the best possible care for patients. Implications: This study demonstrates that ethical issues encountered by physiotherapists vary according to the specific settings in which they work. Further, our findings contribute to ongoing initiatives that seek to better
of the Cognitive Ability Screening Instrument (CASI) was 65.8 ± 14.5, without group difference. The RT group completed the exercise program according to protocol with the average adherence rate of 70% and without adverse events. After training, the RT group showed significant groupby-time interactions on 30 s CST (p = .027) and 5-m WT (p = .027). Significant changes during 2 time points were found in many variables with mostly improve or maintain in RT group, but deteriorate in control group. Only 30 s CST (p = .029) showed significant between group effect. Conclusion(s): Three months resistance training program has beneficial effects on many motor performance tests, especially in improving lower extremity endurance and walking speed. Further studies may be needed to know if the training effects different between older adults with normal cognition and with MCI. Implications: Hydraulic circuit progressive resistance training can be implemented in a geriatric rehabilitation setting, which is feasible and effective in improving or maintaining motor performances in older adults with MCI. Keywords: Cognitive impairment; Motor performance; Resistance training Funding acknowledgements: This project was funded by Chang Gung Memorial Hospital Medical Research Fund (CMRPD1B0521). Ethics approval: Ethical approval was obtained from the Chang Gung Medical Foundation Institutional Review Board, Taoyuan, Taiwan. http://dx.doi.org/10.1016/j.physio.2015.03.3437 Special Interest Report Platform Presentation Number: SI-PL-1099 Sunday 3 May 2015 09:03 Room 334–335 THE CONTRIBUTION OF CONCEPTUAL FRAMEWORKS TO KNOWLEDGE TRANSLATION INTERVENTIONS IN PHYSICAL THERAPY A. Hudon 1,2 , M.-J. Gervais 3 , M. Hunt 2,4 1 Université
de Montréal, School of Rehabilitation, Montréal, Canada; 2 Centre for Interdisciplinary Research in Rehabilitation of Greater, Montréal, Canada; 3 Université du Québec à Montréal, Montréal, Canada; 4 McGill University, School of Physical and Occupational Therapy, Montréal, Canada Background: There is growing recognition of the importance of knowledge translation activities in physical therapy to ensure that research findings are integrated in clinical practice. Although various frameworks have been developed to guide and facilitate the process of translating knowledge into practice, these tools have been infrequently used
eS607
in physical therapy knowledge translation interventions and studies to date. Purpose: Knowledge translation in physical therapy implicates multiple stakeholders working in different settings, and involves numerous steps. In light of this complexity, the use of explicit conceptual frameworks by clinicians and researchers conducting knowledge translation interventions is associated with a range of potential benefits. In this presentation, we demonstrate why these frameworks should be considered important resources to promote the uptake of new evidence in physical therapy practice settings. The goal of this analysis is to provide guidance to physical therapists seeking to identify a framework to support the design and implementation of a knowledge translation intervention. Methods: We conducted a literature review in January 2014, using CINAHL, MEDLINE, and EMBASE databases and key words pertaining to knowledge translation and physical therapy, in order to gauge the use of conceptual frameworks for knowledge translation interventions in physical therapy. This review allowed us to identify four key benefits associated with the use of conceptual frameworks in designing and implementing knowledge translation interventions and to consider limits related to their use. Through this review, we also identified diverse knowledge translation conceptual frameworks, which are used in physical therapy and healthcare. We evaluated five prominent conceptual frameworks and whether they address common barriers to knowledge translation in physical therapy. Results: The four advantages of using conceptual frameworks are that they (1) help map knowledge translation interventions to ensure that essential knowledge translation components are addressed; (2) support efforts to evaluate impacts of the intervention and to promote sustainability; (3) promote the establishment of common ground and enhance communication among stakeholders and (4) encourage transparency and clarity about knowledge translation methods. We also identified two important limitations. Concerns remain regarding the difficulty in demonstrating the benefits of conceptual frameworks in knowledge translation interventions. Also, conceptual frameworks can be misapplied or used in a simplistic or mechanistic fashion. Conclusion(s): In sum, knowledge translation conceptual frameworks have the potential to promote systematic and well-planned knowledge translation interventions in physical therapy. It has been argued that guidance is currently lacking to help healthcare researchers, practitioners, or managers make decisions about which implementation strategies to use, in which contexts, and with what groups of stakeholders. Indeed, planning how to integrate research into practice has been described as a “black box”. Conceptual frameworks for physical therapy knowledge translation can help signpost the process of knowledge translation design and implementation,
eS608
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS427–eS632
thus helping to plan, implement and evaluate effective knowledge translation interventions. Implications: Conceptual frameworks can help structure the design and implementation process in ways that promote successful knowledge translation interventions. Such frameworks are an important resource to advance evidencebased practice in physical therapy and bridging the lingering research-practice gap. Keywords: Physical therapy; Knowledge translation; Conceptual framework Funding acknowledgements: Fonds de recherche du Québec-Santé (FRQ-S), MENTOR program, CJM-IUUQÀM Chair on knowledge translation, Knowledge Translation Canada Student Fellowship. Ethics approval: No ethics approval was required for this project. http://dx.doi.org/10.1016/j.physio.2015.03.3438 Research Report Poster Presentation Number: RR-PO-20-22-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 WHAT ARE THE ETHICAL ISSUES FACED BY PHYSIOTHERAPISTS WORKING IN PRIVATE PRACTICE? RESULTS OF A LITERATURE REVIEW A. Hudon 1,2 , M.-J. Drolet 3 , B. Williams-Jones 4 1 Université
de Montréal, School of Rehabilitation, Montréal, Canada; 2 Centre for Interdisciplinary Research in Rehabilitation of Greater, Montréal, Canada; 3 Université du Québec à Trois-Rivières, Department of Occupational Therapy, Trois-Rivières, Canada; 4 Université de Montréal, Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, Montréal, Canada Background: The for-profit nature of private physiotherapy makes physiotherapy in private practice different from that in a public setting. This workplace reality brings with it a host of ethical issues, some of which may be transversal across public and private practice settings (e.g., maintaining confidentiality, dealing with scarce resources), but others which will necessarily be more specific to private practice (e.g., self-referral, product sales) and that might go against the primary interests of patients. However, the impact of the institutional environment on generating ethical issues and on practitioners’ management of these issues has not yet been systematically investigated, despite the fact that they can affect negatively the quality of physiotherapy services. Purpose: The two objectives of this study were to (1) identify ethical issues encountered by physiotherapists in private practice settings and
(2) identify potential solutions and recommendations to address these issues. Methods: A hermeneutic analysis of texts retrieved by a literature search in eight databases was performed using three broad keyword categories: (1) ethics and professionalism, (2) physiotherapy and rehabilitation, and (3) private practice sector. The texts included had to meet the following inclusion criteria: be a refereed or non-referred text, be published in English or in French and be specifically discussing ethical issues encountered by physiotherapists in private practice. All texts meeting these criteria were included in the sample, regardless of their year of publication. Thirty-nine texts addressing ethical issues in a private practice context were analyzed. Results: Twenty-five ethical issues emerged and were classified in three main categories: (1) Business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time); (2) Professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) Patients’ rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs patient autonomy, informed consent). Particularly interesting and noteworthy are the issues of rights and duties of physiotherapists versus physiotherapy assistants, of physiotherapy care provided by non-physiotherapists, and of competition between colleagues for patients. Issues such as conflicts of interest, self-referral, lack of time affecting quality of care, dual agency and product sales are all weighty ethical issues that can have a major impact on the quality of physiotherapy service, and the profession’s image and public trust. Nonetheless, the literature is also beginning to identify possible remedies to some of these ethical challenges, notably by providing recommendations about how physiotherapists could better manage the issues arising in three main areas: (1) Education/Research and training, (2) Clinical practice and (3) Legal/Governance. Conclusion(s): The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported – through education, research and good governance – in providing the best possible care for patients. Implications: This study demonstrates that ethical issues encountered by physiotherapists vary according to the specific settings in which they work. Further, our findings contribute to ongoing initiatives that seek to better