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J Neurol Phys Ther. 2014 Apr;38(2):134-43. doi: 10.1097/NPT.0000000000000034.

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

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  • 1Physical Therapy Program, Chatham University, Pittsburgh, Pennsylvania (S.B.P.); and Outpatient Neuro/Vestibular Program (H.Z.) and Stroke Rehabilitation Program, UPMC Centers for Rehab Services, Pittsburgh, Pennsylvania (T.B.).

Abstract

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.

PMID:
24637932
[PubMed - indexed for MEDLINE]
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