Publications by authors named "Anita Menon"

21 Publications

  • Page 1 of 1

A mixed-methods approach to understanding partnership experiences and outcomes of projects from an integrated knowledge translation funding model in rehabilitation.

BMC Health Serv Res 2019 Apr 16;19(1):230. Epub 2019 Apr 16.

School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.

Background: Integrated knowledge translation (IKT) can optimize the uptake of research evidence into clinical practice by incorporating knowledge users as equal partners in the entire research process. Although several studies have investigated stakeholder involvement in research, the literature on partnerships between researchers and clinicians in rehabilitation and their impact on clinical practice is scarce. This study described the individual research projects, the outcomes of these projects on clinical practice and the partnership experiences of an initiative that funds IKT projects co-led by a rehabilitation clinician and a researcher.

Methods: This was a sequential explanatory mixed methods study where quantitative data (document reviews and surveys) informed the qualitative phase (focus groups with researchers and interviews with clinicians). Descriptive analysis was completed for the quantitative data and thematic analysis was used for the qualitative data.

Results: 53 projects were classified within multiple steps of the KTA framework. Descriptive information on the projects and outcomes were obtained through the survey for 37 of the 53 funded projects (70%). Half of the respondents (n = 18) were very satisfied or satisfied with their project's impact. Only two (6%) projects reported having measured sustainability of their projects and four (11%) measured long-term impact. A focus group with six researchers and individual interviews with nine clinicians highlighted the benefits (e.g. acquired collaborative skills, stronger networks between clinicians and academia) and challenges (e.g. measuring KT outcomes, lack of planning for sustainability, barriers related to clinician involvement in research) of participating in this initiative. Considerations when partnering on IKT projects included: the importance of having a supportive organization culture and physical proximity between collaborators, sharing motives for participating, leveraging everyone's expertise, grounding projects in KT models, discussing feasibility of projects on a restricted timeline, and incorporating the necessary knowledge users. Clinicians discussed the main outputs (scientific contribution, training and development, increased awareness of best practice, step in a larger effort) as project outcomes, but highlighted the complexity of measuring outcomes on clinical practice.

Conclusion: The study provides a portrait of an IKT funding model, sheds light on past IKT projects' strengths and weaknesses and provides strategies for promoting positive partnership experiences between researchers and rehabilitation clinicians.
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http://dx.doi.org/10.1186/s12913-019-4061-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469130PMC
April 2019

Attributes of evidence-based occupational therapists in stroke rehabilitation.

Can J Occup Ther 2018 Dec 19;85(5):351-364. Epub 2018 Nov 19.

Background.: A better understanding of the features characterizing expert evidence-based occupational therapists in stroke rehabilitation is needed to inform the design of educational and knowledge translation interventions aimed at addressing research-practice gaps.

Purpose.: The study aimed to identify the attributes of evidence-based occupational therapy stroke rehabilitation experts from the perspective of their peers.

Method.: Forty-six occupational therapy clinicians and managers completed an online questionnaire asking them to nominate "outstanding" and "expert evidence-based" occupational therapists in stroke rehabilitation and to explain their choices. A thematic analysis of respondents' statements was conducted.

Findings.: Both outstanding and expert evidence-based occupational therapists were perceived to be motivated self-learners; to have extensive knowledge, skills, and experience; to act as scholarly practitioners; to achieve superior client outcomes; and to work in specialized settings.

Implications.: The development of future strategies supporting occupational therapy students and clinicians to become lifelong learners should take into account key attributes of expertise, such as motivation for continuous learning and professional development.
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http://dx.doi.org/10.1177/0008417418802600DOI Listing
December 2018

The effectiveness of interventions designed to increase the uptake of clinical practice guidelines and best practices among musculoskeletal professionals: a systematic review.

BMC Health Serv Res 2018 06 8;18(1):435. Epub 2018 Jun 8.

School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Hosmer House, 16 Room 205, Montreal, QC, H3G 1Y5, Canada.

Background: The objective of this systematic review was to summarize and evaluate evidence about the effectiveness of knowledge translation (KT) interventions to improve the uptake and application of clinical practice guidelines and best practices for a wide range of musculoskeletal (MSK) disorders and health care professionals.

Methods: A search for relevant randomized controlled trials (RCTs) published in English was conducted in MEDLINE (Ovid interface), EMBASE, CINAHL, and CENTRAL (Cochrane library). Two independent reviewers selected studies, assessed risk of bias, and extracted data. All MSK disorders were included except MSK injuries, fractures, trauma, or inflammatory disorders.

Results: A total of 7904 citations yielded 11 eligible RCTs. The targeted MSK disorders included: low back pain (n = 5), neck pain (n = 2), whiplash (1), spinal disorders (n = 1), and osteoarthritis of the hip and knee (n = 2). Studies primarily involved physiotherapists, chiropractors, and a mix of physiotherapists, chiropractors and osteopaths. Results were reported using effect sizes (Cohen's d). Interactive educational meetings were the most commonly used KT strategy. For professional outcomes, 3 studies using single-component interventions had a small effect (d ranges from 0.14 to 0.28) and 7 studies used multifaceted interventions (3 were effective (d ranges from 0.824 to 2.27). For patient outcomes, 4 studies were ineffective (d ranges from 0.06 to 0.31). The majority of the included RCTs had moderate-to-high risk of bias. About half of the studies used theory-based interventions, but the elements of the interventions and theoretical frameworks were often poorly described. Furthermore, there were no comparable outcome measures to evaluate the impact of the interventions on a similar scale.

Conclusions: The findings suggested that multifaceted educational KT interventions appear to be effective for improving professional outcomes, although effects were inconsistent. The KT strategies were generally not effective on patient outcomes. In general, studies were of low quality, interventions were poorly described, and only half had theoretical underpinning. Researchers are encouraged to use validated professional and patient outcomes.
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http://dx.doi.org/10.1186/s12913-018-3253-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994025PMC
June 2018

Stroke rehabilitation and patients with multimorbidity: a scoping review protocol.

J Comorb 2015 17;5:1-10. Epub 2015 Feb 17.

Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada.

Stroke care presents unique challenges for clinicians, as most strokes occur in the context of other medical diagnoses. An assessment of capacity for implementing "best practice" stroke care found clinicians reporting a strong need for training specific to patient/system complexity and multimorbidity. With mounting patient complexity, there is pressure to implement new models of healthcare delivery for both quality and financial sustainability. Policy makers and administrators are turning to clinical practice guidelines to support decision-making and resource allocation. Stroke rehabilitation programs across Canada are being transformed to better align with the Canadian Stroke Strategy's Stroke Best Practice Recommendations. The recommendations provide a framework to facilitate the adoption of evidence-based best practices in stroke across the continuum of care. However, given the increasing and emerging complexity of patients with stroke in terms of multimorbidity, the evidence supporting clinical practice guidelines may not align with the current patient population. To evaluate this, electronic databases and gray literature will be searched, including published or unpublished studies of quantitative, qualitative or mixed-methods research designs. Team members will screen the literature and abstract the data. Results will present a numerical account of the amount, type, and distribution of the studies included and a thematic analysis and concept map of the results. This review represents the first attempt to map the available literature on stroke rehabilitation and multimorbidity, and identify gaps in the existing research. The results will be relevant for knowledge users concerned with stroke rehabilitation by expanding the understanding of the current evidence.
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http://dx.doi.org/10.15256/joc.2015.5.47DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5636031PMC
February 2015

Determining the barriers and facilitators to adopting best practices in the management of poststroke unilateral spatial neglect: results of a qualitative study.

Top Stroke Rehabil 2014 May-Jun;21(3):228-36

Montreal Neurological Institute, Montreal University Health Center, Montreal, Canada.

Background: A gap exists between best and actual management of poststroke unilateral spatial neglect (USN). Given the negative impact of USN on poststroke recovery, knowledge translation efforts are needed to optimize USN management. To date, no study has investigated the specific barriers and facilitators affecting USN management during the acute care process.

Objective: To identify the facilitators and barriers that affect evidence-based practice use by occupational therapists (the primary discipline managing USN) when treating individuals with acute poststroke USN.

Methods: Focus group methodology elicited information from 9 acute care occupational therapists.

Results: Key barriers identified included lack of basic evidence-based practice skills specific to USN treatment and personal motivation to change current practices and engrained habits. Key facilitators included the presence of a multidisciplinary stroke team, recent graduation, and an environment with access to learning time and resources. Synthesized Web-based learning was also seen as important to uptake of best practices.

Conclusion: It is estimated that upwards of 40% of patients experience poststroke USN in the acute phase, and we have evidence of poor early management. This study identified several modifiable factors that prepare the ground for the creation and testing of a multimodal knowledge translation intervention aimed at improving clinicians' best practice management of poststroke USN.
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http://dx.doi.org/10.1310/tsr2103-228DOI Listing
July 2014

Applications of social constructivist learning theories in knowledge translation for healthcare professionals: a scoping review.

Implement Sci 2014 May 6;9:54. Epub 2014 May 6.

School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.

Background: Use of theory is essential for advancing the science of knowledge translation (KT) and for increasing the likelihood that KT interventions will be successful in reducing existing research-practice gaps in health care. As a sociological theory of knowledge, social constructivist theory may be useful for informing the design and evaluation of KT interventions. As such, this scoping review explored the extent to which social constructivist theory has been applied in the KT literature for healthcare professionals.

Methods: Searches were conducted in six databases: Ovid MEDLINE (1948 - May 16, 2011), Ovid EMBASE, CINAHL, ERIC, PsycInfo, and AMED. Inclusion criteria were: publications from all health professions, research methodologies, as well as conceptual and theoretical papers related to KT. To be included in the review, key words such as constructivism, social constructivism, or social constructivist theories had to be included within the title or abstract. Papers that discussed the use of social constructivist theories in the context of undergraduate learning in academic settings were excluded from the review. An analytical framework of quantitative (numerical) and thematic analysis was used to examine and combine study findings.

Results: Of the 514 articles screened, 35 papers published between 1992 and 2011 were deemed eligible and included in the review. This review indicated that use of social constructivist theory in the KT literature was limited and haphazard. The lack of justification for the use of theory continues to represent a shortcoming of the papers reviewed. Potential applications and relevance of social constructivist theory in KT in general and in the specific studies were not made explicit in most papers. For the acquisition, expression and application of knowledge in practice, there was emphasis on how the social constructivist theory supports clinicians in expressing this knowledge in their professional interactions.

Conclusions: This scoping review was the first to examine use of social constructivism in KT studies. While the links between social constructivism and KT have not been fully explored, the Knowledge to Action framework has strong constructivist underpinnings that can be used in moving forward within the broader KT enterprise.
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http://dx.doi.org/10.1186/1748-5908-9-54DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040365PMC
May 2014

What do letters to the editor publish about randomized controlled trials? A cross-sectional study.

BMC Res Notes 2013 Oct 14;6:414. Epub 2013 Oct 14.

Li Ka Shing Knowledge Institute (LKSKI) of St, Michael's Hospital, Toronto, ON, Canada.

Background: To identify published letters to the editor (LTE) written in response to randomized controlled trials (RCTs), determine the topics addressed in the letters, and to examine if these topics were affected by the characteristics and results of the RCTs.

Methods: Comparative cross-sectional study of a representative sample of RCTs from a set of high-impact medical journals (BMJ, Lancet, NEJM, JAMA, and Annals of Internal Medicine). RCTs and their published LTE were searched from these 5 journals in 2007. Data were collected on RCTs and their characteristics (author affiliation, funding source, intervention, and effect on the primary outcome) and the topics addressed in published LTE related to these RCTs. Analysis included chi-square and regression analysis (RCT characteristics) and thematic analysis (LTE topics).

Results: Of 334 identified RCTs, 175 trials had at least one LTE. Of these, 381 published LTE were identified. Most RCTs, tested drug interventions (68%), were funded by government (54%) or industry (33%), and described an intervention that had a positive impact on the primary outcome (62%). RCT authors were primarily affiliated with an academic centre (78%). Ninety percent of the 623 LTE topics concerned methodological issues regarding the analysis, intervention, and population in the RCT. There was a significant association between funding source and impact on outcomes (p = 0.002) or type of intervention tested (p = 0.001) in these trials. Clinical and "Other" LTE topics were more likely to be published in response to a government funded RCT (p = 0.005 and p = 0.033, respectively); no other comparisons were significant.

Conclusions: This study showed that most LTE are about methodological topics, but found little evidence to support that these topics are affected by the characteristics or results of the RCTs. The lack of association may be explained by editorial censorship as a small proportion of LTE that are submitted are actually published.
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http://dx.doi.org/10.1186/1756-0500-6-414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3852599PMC
October 2013

Risk Factors for Complicated Influenza A (H1N1) 2009 Disease in Children.

Ann Acad Med Singap 2013 May;42(5):232-6

Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.

Introduction: Singapore had its first case of pandemic influenza A (H1N1) 2009 on 26 May 2009. As of 3 August 2009, 440 children with confirmed H1N1were admitted to KK Women's and Children's Hospital (KKH).

Materials And Methods: This is a retrospective case control study of children admitted from 26 May 2009 to 19 July 2009 with H1N1infection. Cases and controls were first differentiated by whether they were complicated or non-complicated in nature, and subsequently analysed with regards to possible independent risk factors.

Results: We analysed 143 admitted children; 48 cases and 95 controls (1: 2 ratio). Significant comorbidity was found in 20.3% (n = 29) of patients with the majority having asthma (n = 18, 12.6 %) followed by obesity (n = 7, 4.9%). Binary logistic regression analysis showed risk factors for complicated disease were comorbidity (adjusted OR 6.0, 95% CI, 2.5 to 14.6, P < 0.0001) and age <2 years (adjusted OR 9.8, 95% CI, 2.4 to 40, P = 0.001). Age less than 5 years was not found to be a risk factor.

Conclusion: In the early stages of an evolving influenza epidemic when oseltamivir stocks are low, oseltamivir treatment for influenza can be streamlined and offered to those at highest risk who are under 2 years old or have significant comorbidity to prevent complicated disease.
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May 2013

Usability testing of two e-learning resources: methods to maximize potential for clinician use.

J Rehabil Med 2012 Apr;44(4):338-45

Department of Health Policy, Management and Evaluation, University of Toronto, Canada.

Rationale And Objectives: Rigorous usability testing of e-learn-ing resources is an important prerequisite to their wide-spread use among clinicians. This study demonstrates the application of an evidence-based approach to usability testing of two stroke-related e-learning resources (StrokEngine).

Methods: 14 stroke rehabilitation clinicians (occupational therapists and physiotherapists) from Ontario, Canada participated in a 1.5 h in-person testing session. Clinicians navigated StrokEngine in search of information to answer questions on stroke assessment/intervention. Their search patterns were observed and clinicians provided verbal/written feedback about StrokEngine. Content analysis was used to generate themes and categorize them under two broad categories: facilitators and barriers to use.

Results: Five key facilitators and three key barriers to Strok-Engine use were identified and related to screen format, layout/organization, ease of navigation, quality of content, likelihood of using StrokEngine in the future, and system dysfunctions. All 14 clinicians were very or extremely satisfied with the layout/organization, quality and clinical relevance of the content, stating that they were likely to use StrokEngine in the future.

Conclusion: All identified barriers from this study were addressed with website modifications in order to maximize the usability and navigability of StrokEngine. This rigorous methodology for usability testing can be applied during the design process of any e-learning resource.
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http://dx.doi.org/10.2340/16501977-0952DOI Listing
April 2012

Increasing knowledge of best practices for occupational therapists treating post-stroke unilateral spatial neglect: results of a knowledge-translation intervention study.

J Rehabil Med 2012 Feb;44(2):118-24

Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.

Objective: The aim of this study was to investigate: (i) the feasibility of delivering a multi-modal knowledge translation intervention specific to the management of acute post-stroke unilateral spatial neglect; and (ii) the impact of the knowledge translation intervention on occupational therapists' knowledge of evidence-based unilateral spatial neglect problem identification, assessment and treatment, and self-efficacy related to evidence-based practice implementation.

Design: A 3-period (pre-post) repeated measures design.

Subjects: Acute care occupational therapists treating patients with post-stroke unilateral spatial neglect were recruited from two major Canadian cities.

Methods: Participants completed two pre-intervention assessments, took part in a day-long interactive multi-modal knowledge translation intervention and a subsequent 8-week follow-up, and completed a post-intervention assessment. Knowledge of evidence-based problem identification, assessment and treatment of unilateral spatial neglect, and self-efficacy to perform evidence-based practice activities were measured using standard scales.

Results: The intervention was tested on 20 occupational therapists. Results indicate a significant improvement in knowledge of best practice unilateral spatial neglect management (p < 0.000) and evidence-based practice self-efficacy in carrying out evidence-based practice activities (p < 0.045) post-intervention.

Conclusion: Use of a multi-modal knowledge translation intervention is feasible and can significantly improve occupational therapists' knowledge of unilateral spatial neglect best practices and self-efficacy. The findings should help advance best practices specific to the management of post-stroke unilateral spatial neglect as well as informing knowledge translation studies in other areas of practice.
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http://dx.doi.org/10.2340/16501977-0910DOI Listing
February 2012

Using problem-based case studies to learn about knowledge translation interventions: an inside perspective.

J Contin Educ Health Prof 2011 ;31(4):268-75

Health Information Management, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, New Brunswick, Canada E1C 6C4.

Knowledge translation (KT) interventions can facilitate the successful implementation of best practices by engaging and actively involving various stakeholders in the change process. However, for novices, the design of KT interventions can be overwhelming. In this article, we describe our experience as participants in a problem-based case study on planning a KT intervention and reflect on the use of problem-based learning (PBL) to develop knowledge and skills relevant to the KT process. Participants were six fellows and two faculty members attending the 2009 Canadian Institutes of Health Research KT Summer Institute. Participants received a case study asking them to develop a KT intervention with the goal of implementing a stroke response protocol for hospital inpatients. The group was given 5 hours spread over 2 days to complete the learning task. As the members of the small group reflected on their experience with the case study, 4 themes emerged: (1) balancing engaging stakeholders with moving forward; (2) exploring the research gaps and role of the Knowledge-to-Action Framework; (3) investigating methodological approaches for KT research; and (4) experiencing a supportive training environment. Participation in the problem-based case study allowed participants to expand their individual understanding of KT, while fostering the learning experiences of other group members. In a supportive learning environment, participants were able to identify influential stakeholders for the stroke response protocol implementation, discuss potential barriers by stakeholder group, and consider effective KT interventions. Future training initiatives focusing on strengthening KT capacity and knowledge should consider using small-group problem-based case study to facilitate learning.
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http://dx.doi.org/10.1002/chp.20140DOI Listing
May 2012

Using the knowledge to action process model to incite clinical change.

J Contin Educ Health Prof 2010 ;30(3):167-71

McGill University, Montreal, Quebec, Canada.

Introduction: Knowledge translation (KT) has only recently emerged in the field of rehabilitation with attention on creating effective KT interventions to increase clinicians' knowledge and use of evidence-based practice (EBP). The uptake of EBP is a complex process that can be facilitated by the use of the Knowledge to Action Process model. This model provides a sequence of phases for researchers and clinicians to follow in order to optimize KT across various fields of practice.

Methods: In this article we use an example from a series of national studies in stroke rehabilitation to demonstrate how the Knowledge to Action Process model is being used to increase the use of best practices in the management of a very prevalent poststroke impairment, unilateral spatial neglect.

Results: The series of research projects and actions described herein each address a specific phase of the model. The reader is introduced to a specific example with the goal of generalizing the process to his or her own domain of interest. Gaps in our research agenda are also highlighted and future initiatives to complete the process are described.

Discussion: It is important that KT is maximized in health care to improve patient outcomes. As demonstrated here, the Knowledge to Action Process model provides an excellent guide for clinicians, managers, and researchers who wish to incite change in patient care.
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http://dx.doi.org/10.1002/chp.20077DOI Listing
November 2010

Creation and validation of the PERFECT: a critical incident tool for evaluating change in the practices of health professionals.

J Eval Clin Pract 2010 Dec;16(6):1170-5

Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Rationale: The critical incident technique provides a means to better understand the reasons behind clinicians' practices and changes in practice. No standardized tool exists to elicit information using this technique.

Objectives: To create and validate a standardized tool that explores change and reasons for change in professional practice.

Method: Item generation was based on expert consultation and a review of the clinical practice and knowledge translation literature. The draft tool was pilot-tested with a convenience sample of 10 rehabilitation clinicians to receive feedback on its content, clarity, optimal cueing, omissions and ease of recall of critical incidents.

Results: The tool was progressively refined and validated according to feedback from both the clinicians and expert reviewers. The final version of the tool includes 33 questions designed to elicit information on change and reasons for change in four areas: problem identification, assessment, treatment and referral practices. In addition, it elicits information on factors that facilitate or hinder change in practice. Cues are included when necessary to clarify questions and facilitate responses. Regarding ease of recall, all clinicians confirmed that beginning with a 6-month recall of practice change and working back to 1 year was a facilitator. All clinicians mentioned that the tool encouraged them to reflect about changes they made in their practice or lack thereof.

Conclusion: The newly created standardized critical incident tool, named the PERFECT (Professional Evaluation & Reflection on Change Tool) provides an opportunity for widespread applicability to explore change, reasons for change, as well as facilitators and barriers to change in the practices of health professionals.
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http://dx.doi.org/10.1111/j.1365-2753.2009.01288.xDOI Listing
December 2010

Occupational therapists' capacity-building needs related to older driver screening, assessment, and intervention: a Canadawide survey.

Am J Occup Ther 2010 Mar-Apr;64(2):316-24

Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3630 Promenades Sir-William-Osler, Montreal, Quebec H3G 1Y5, Canada.

Background: Older driver safety is a growing concern. We identified capacity-building needs of occupational therapists related to older driver screening, assessment, and intervention.

Method: A Canadawide survey was undertaken involving 133 occupational therapists working with an older clientele. A standardized questionnaire elicited information regarding (1) actual practices related to older driver screening, assessment, and intervention; (2) perceived competence; and (3) need for continuing education.

Results: Occupational therapists were twice as likely to use screening tools rather than in-depth assessments (n = 79 vs. n = 37). Only 25 occupational therapists offered on-road assessment, and even fewer offered retraining (n = 11). Occupational therapists more often felt very competent in domains related to screening as opposed to assessment, and most were interested in continuing education.

Conclusion: Driving services offered were primarily related to screening compared with assessment or intervention. Occupational therapists would benefit from driving-related professional training aimed at enhancing professional capacity in this arena.
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http://dx.doi.org/10.5014/ajot.64.2.316DOI Listing
May 2010

Cost-effectiveness analysis of implantable venous access device insertion using interventional radiologic versus conventional operating room methods in pediatric patients with cancer.

J Vasc Interv Radiol 2010 May 27;21(5):677-84. Epub 2010 Mar 27.

Institute of Medical Science, University of Toronto, Toronto, ON, Canada.

Purpose: Percutaneous image-guided techniques are associated with less tissue trauma and morbidity than open surgical techniques. Interventional radiology has received significant health care investment. The purpose was to determine the cost effectiveness of inserting implantable venous access devices (IVADs) by interventional radiologic means versus conventional operating room surgery in pediatric patients with cancer.

Materials And Methods: In a retrospective cohort analysis, patients presenting with a new tumor diagnosis and receiving a first-time IVAD in January to June 2000 (operative group; n = 30) and January to June 2004 (interventional group; n = 30) were included. A societal costing perspective was adopted. Costs included labor, materials, equipment, inpatient wards, parent travel, and parental productivity losses for 30 days after insertion. Severe complications related to IVAD insertion were microcosted. Costs related to cancer therapy were not included. Incremental cost-effectiveness analysis and sensitivity analysis were performed.

Results: Interventional patients were older (7.3 years vs 4.1 years; P = .01). There were no significant differences between groups in sex, American Society of Anesthesiologists score, or length of hospital stay. Interventional radiologic procedures were shorter (84.9 minutes vs 112.8 minutes; P = 0.01). Interventional radiologic insertion was slightly less costly than operative insertion (Can$622,860 and Can$627,005 per 30-patient group, respectively) and more effective in reducing the complication rate (two vs eight complications per group, respectively; P = .039). The results were sensitive to the cost of operating the operating room.

Conclusions: Interventional radiology was slightly less costly than operative IVAD insertion and resulted in fewer serious complications. It should be considered for IVAD insertions in pediatric patients with cancer.
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http://dx.doi.org/10.1016/j.jvir.2010.01.014DOI Listing
May 2010

Best practise use in stroke rehabilitation: from trials and tribulations to solutions!

Disabil Rehabil 2010 ;32(8):646-9

Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M6 Canada.

Purpose: This article explores the use of best practises among stroke rehabilitation professionals, salient barriers that influence their knowledge uptake/application and effective knowledge translation (KT) strategies that meet the needs of this clinician group.

Method: Relevant literature on evidence-based practise in stroke rehabilitation and the use of KT strategies among rehabilitation professionals is summarised and discussed.

Results: Although adherence to rehabilitation guidelines translates into improved patient outcomes, best practises are not routinely applied by clinicians when treating individuals with a stroke. Lack of protected work time to search and appraise the research literature is by far the largest organisational barrier to knowledge uptake/application. Personal barriers, such as the lack of confidence and skills to interpret, synthesise and apply research findings, also limit clinicians' uptake of best practises. Studies involving rehabilitation professionals found that active KT strategies were more effective than passive strategies to produce change in their evidence-based knowledge and practise behaviours. As such, interactive e-learning resources are likely to be a relevant KT solution to meet rehabilitation professionals' specific learning needs, guide their clinical decision-making and ultimately increase their best practise behaviours.

Conclusion: We have the knowledge of best practises in stroke rehabilitation, a means to disseminate that knowledge internationally through interactive e-learning resources, and information about effective KT interventions. With these opportunities in place, rehabilitation professionals can expand their capacity by adopting stroke best practises and producing better outcomes for patients.
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http://dx.doi.org/10.3109/09638280903214640DOI Listing
May 2010

Strategies for rehabilitation professionals to move evidence-based knowledge into practice: a systematic review.

J Rehabil Med 2009 Nov;41(13):1024-32

Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.

Rationale: Rehabilitation clinicians need to stay current regarding best practices, especially since adherence to clinical guidelines can significantly improve patient outcomes. However, little is known about the benefits of knowledge translation interventions for these professionals.

Objectives: To examine the effectiveness of single or multi-component knowledge translation interventions for improving knowledge, attitudes, and practice behaviors of rehabilitation clinicians.

Methods: Systematic review of 7 databases conducted to identify studies evaluating knowledge translation interventions specific to occupational therapists and physical therapists.

Results: 12 studies met the eligibility criteria. For physical therapists, participation in an active multi-component knowledge translation intervention resulted in improved evidence-based knowledge and practice behaviors compared with passive dissemination strategies. These gains did not translate into change in clinicians' attitudes towards best practices. For occupational therapists, no studies have examined the use of multi-component interventions; studies of single interventions suggest limited evidence of effectiveness for all outcomes measured.

Conclusion: While this review suggests the use of active, multi-component knowledge translation interventions to enhance knowledge and practice behaviors of physical therapists, additional research is needed to understand the impact of these strategies on occupational therapists. Serious research gaps remain regarding which knowledge translation strategies impact positively on patient outcomes.
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http://dx.doi.org/10.2340/16501977-0451DOI Listing
November 2009

Practice style traits of student occupational therapists and physical therapists.

Can J Occup Ther 2009 Apr;76(2):98-106

School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec.

Background: Intensive efforts are aimed at understanding student attributes in anticipation that this will lead to effective knowledge translation (KT) strategies. One attribute of interest is practice style trait: four have been identified ranging from the seeker, who is driven by scientific evidence, to the pragmatist, who is driven by practicality.

Purpose: To identify the prevalence of the four traits among student clinicians and explore associations between these traits, clinician characteristics and practice behaviours.

Methods: Ninety-two occupational therapy and 86 physical therapy students completed a survey that elicited information on traits, clinician characteristics, and practice behaviours.

Findings: The most prevalent trait was pragmatic, the least, seeker at <1%. The most prevalent reason for choosing an intervention was "it was used by my clinical supervisor".

Implications: Educators should carefully reconsider the implication of using KT strategies that cater primarily to seekers. Research is warranted to explore the impact of matching educational strategies to traits.
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http://dx.doi.org/10.1177/000841740907600207DOI Listing
April 2009

Creation and pilot testing of StrokEngine: a stroke rehabilitation intervention website for clinicians and families.

J Rehabil Med 2008 May;40(5):329-33

Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3630 Promenades Sir-William-Osler, Montreal, Quebec, Canada.

Objective: There is a gap in the translation of knowledge about stroke between researchers and clinicians. This paper describes the creation and pilot testing of an evidence-based stroke rehabilitation intervention website, StrokEngine (http://www.strokengine.org), which was designed to close this gap.

Design: A within-subject design was used to compare the usability and navigability of StrokEngine vs other search strategies/sites. Each participant searched a well-known stroke website, searched StrokEngine, and performed a free search, with the order of search randomized. A standard questionnaire was used to elicit information on usability and navigability across the 3 searches.

Subjects: A purposive sample of 19 rehabilitation clinicians from Montreal, Quebec, with varied stroke-related treatment experience.

Results: All 19 clinicians gave the highest usability score to StrokEngine (p<0.05): StrokEngine usability score (mean 43, SD 4) vs the Cochrane Library (mean 26, SD 8), the Royal College of Physicians website (mean 20, SD 5) and a general Internet search (mean 26, SD 7).

Conclusion: This preliminary study on StrokEngine's usability and navigability suggests that it has the potential to be an asset for clinicians who wish to keep abreast of information on intervention effectiveness.
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http://dx.doi.org/10.2340/16501977-0177DOI Listing
May 2008

Clinical presentation of type 1 diabetes.

Pediatr Diabetes 2005 Jun;6(2):75-8

The National Children's Hospital, AMNCH, Tallaght, Dublin 24, Ireland.

Objective: To identify the presenting features of type 1 diabetes in a national incident cohort aged under 15 yr, the duration of symptoms, the occurrence of diabetic ketoacidosis (DKA) at presentation, and the frequency of a family history of diabetes.

Methods: A prospective study was undertaken of incident cases of type 1 diabetes using an active monthly reporting card system from January 1, 1997 to December 31, 1998 in the Republic of Ireland. Follow-up questionnaires were distributed to pediatricians nationally.

Results: Two hundred and eighty-three incident cases were identified. Polyuria, polydipsia and weight loss were the main presenting symptoms in all age categories. Nocturnal enuresis was reported in 19% under 5 yr and in 31% aged 5-9.99 yr. Constipation was noted in five patients and in 10.4% under 5 yr of age. The median duration of symptoms was highest in the youngest (under 2 yr) and oldest (10-14.99 yr) age categories. Presentation in moderate/severe DKA occurred in 25% overall and six of nine of those aged under 2 yr. A family history of type 1 diabetes in a first-degree relative was found in 10.2%.

Conclusions: This study confirms the abrupt onset of type 1 diabetes, the absence of a family history, and the importance of the classical symptoms of polyuria, polydipsia, and weight loss in the majority of cases. It reveals secondary enuresis as an important symptom, especially in those under 10 yr, and constipation in the under 5 yr age group. The very young (under 2 yr) are more difficult to diagnose, have more variability of symptom duration, and are more likely to present in moderate/severe DKA. A high index of suspicion aids early diagnosis.
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http://dx.doi.org/10.1111/j.1399-543X.2005.00110.xDOI Listing
June 2005

Evaluating unilateral spatial neglect post stroke: working your way through the maze of assessment choices.

Top Stroke Rehabil 2004 ;11(3):41-66

School of Physical and Occupational Therapy, McGill University, Montreal, Quebec.

This study identified, using a comprehensive review of the literature, 62 standardized and nonstandardized assessment tools that exist to evaluate unilateral spatial neglect (USN). Each standardized tool was critically appraised according to its purpose (hemispace assessed), psychometric properties, and client appropriateness. The findings on the 28 standardized tools were compiled into a USN Assessment Summary Guide to facilitate clinical decision-making regarding the standardized USN assessments that are appropriate for specific clients at different phases of their recovery post stroke.
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http://dx.doi.org/10.1310/KQWL-3HQL-4KNM-5F4UDOI Listing
December 2004