Knowledge Translation Issues: Clinical applications, pre-service curriculum development, and research applications

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1 Knowledge Translation Issues: Clinical applications, pre-service curriculum development, and research applications Kurt Johnson University of Washington

2 Start at the beginning KT is thoroughly integrated in the NIDRR mission Pimjai observes that KT is a process, not an outcome She notes that outcomes measurement is the underlying foundation of evidence Critical to understanding impact of treatment and programs KT begins at the beginning and is an iterative process Involve stakeholders at all stages Usability, versatility, incremental validity, cost of outcome measures As speakers yesterday noted in discussion of measuring participation, it is critical to know what those being measured value! What should be measured. Pain intensity vs pain interference. Isolated symptoms vs. global issues

Involve stakeholders at all stages Usability, versatility, incremental validity, cost of outcome measures As speakers yesterday noted in discussion of measuring

3 Pre-service Marieke notes that RT students are often at BS level and do not have advanced research training and inconsistent introduction to outcomes measurement home made assessment, Interventions linked to assessment What about OT, PT, Speech, Rehab Counseling, Medicine, etc.? How to translate research to practice and update Ken observes that there are a number of opportunities for OT and PT to access information about EBP, but is that evidence relevant or do they really have ready access?

PT, Speech, Rehab Counseling, Medicine, etc.

4 Models of EBP Ken describes the prevailing models of EBP grounded in the medical model with the RCT Pyramid and the limitations of using those in rehab research, education, clinical care Traditional EBT links intervention to Dx and outcomes are conceived in terms of mitigating impairment Alternative models that actively engage consumers of measurement and research in all stages. Collaborative engagement with evidence between clinicians and patients may result in changes in the behavior of both including use of outcome measures

of mitigating impairment Alternative models that actively engage consumers of measurement and research in all stages.

5 Agricultural Extension Model Well established model of KT Ground up from members of the community and farmers Top down from USDA and science Intermediates from land grant universities Grounded in the community with county extension agents Increasing use of technology e.g. uploading crop loads

Intermediates from land grant universities Grounded in the community with

6 Increasing use of evidence by students and practitioners Engaging students in an organic process of discovery Encouraging a dialog with people with disabilities, family members about what are important outcomes to them Encouraging a process of scientific inquiry as part of clinical practice using an empirical strategy to formulate hypotheses about barriers and solutions conducting experiments to achieve goals and evaluating outcomes, and refining the process Math.com

Encouraging a process of scientific inquiry as part of clinical practice using an empirical strategy to formulate

7 Barriers to EBP for students and clinicians Students have a lock step curriculum Limited opportunity to engage with future patients Limited opportunities to understand interventions in an ecological context where should we intervene to achieve what outcomes for which consumers For clinicians, an enormous systems barrier associated with operating under fee for service medical model including collecting outcomes data EMR, burden of setting specific data collection Barriers to collaborative problem solving, lack of access to Pub Med And for clinicians, lack of access to just in time, ready to consume, high quality evidence

barrier associated with operating under fee for service medical model including collecting outcomes data EMR, burden of setting specific data collection

8 Multiple service providers Rehabilitation is multidisciplinary Multiple providers working toward multiple outcomes Different providers are often in different locations with different EMR Difficult to close the outcome measurement loop

multiple outcomes Different providers are often in

9 Discussion From Pimjai Are outcome measures suitable for research also suitable for clinical practice? Is the expectation for practitioners to use research tools for everyday practice realistic? Clinically meaningful differences? Would having outcome measures with characteristics that facilitate KT also help with the adoption an use of intervention studies findings, as to making the result more relevant and meaningful to the stakeholders interests and needs? How can the incentives be created for adoption and use of standardized outcome measures? How can we increase use of outcome measures in clinical settings through pre-service education, post-graduate support, and systems change What about CDE for clinical practice PROMIS in EPIC

Would having outcome measures with characteristics that facilitate KT also help with the adoption an use of intervention studies findings, as to making the result more relevant and

Improving Employment Outcomes for Adolescents and Adults with Neuro-Cognitive-Behavioral Deficits

Improving Employment Outcomes for Adolescents and Adults with Neuro-Cognitive-Behavioral Deficits Kurt L. Johnson, Ph.D. Professor Department of Rehabilitation Medicine kjohnson@uw.edu http://rehab.washington.edu