1. Translating knowledge and beyond in SCI rehabilitation Janice Eng, PhD, BSc(PT/OT) Dept of Physical Therapy, University of BC, Vancouver, Canada GF Strong Rehab Centre & International Collaboration on Repair Discoveries

2. Lack of knowledge translation in clinical practice Peer reviewed journals are rewarded as the traditional method of knowledge translation Consistent failure to translate research findings into practice Gap between what care people should receive and care they do receive What percent of time are treatments of proven effectiveness not provided? 15% 45% 75%

3. In US: 45% of time, treatments of proven effectiveness not provided McGlynn et al. 2003, N Engl J Med 20% of patients get care that is potentially harmful Schuster et al. 1998, Milbank Quarterly Lack of knowledge translation

4. Knowledge translation in SCI: From the literature to changing practice Knowledge translation is the synthesis, dissemination, exchange and ethically-sound application of research findings among researchers and knowledge users

5. KT requires a body of evidence-based info  Individual studies rarely by themselves provide sufficient evidence for policy or practice changes  Individual studies are often misleading or conflicting

6. Early highly positive results often contradicted 1/3 were contradicted or less effective

7. Why is research not translated to practice?  Lack of time, computing resources, not enough evidence, lack of access; lack of skills for searching, appraising, and interpreting; lack of incentives (Bennett S. et al, 2003. Australian OT Journal)  Relevant literature not compiled all in one place (Closs & Lewin, 1998. Br J of Therapy & Rehab).  Publication bias, indexing issues, language issues, assessing internal validity, access to electronic databases, access to full text, assessing applicability, drawing conclusions (Maher. C. et al. Phys Ther).

8. Knowledge Synthesis Knowledge syntheses are the cornerstone of knowledge translation because they transform vast libraries of scientific literature into knowledge that is reliable, relevant and readable for knowledge users.

9. Knowledge to Action Cycle

10. www.scireproject.com One Solution to Knowledge Synthesis

17. Body-weight Support Treadmill Training What’s the evidence? Does body-weight support treadmill training improve gait outcomes?

18. Level 1a > 1 Rigorous RCTs (PEDro ≥ 6) Level 1b 1 Rigorous RCT Level 2RCTs (PEDro  5), non-randomized prospective controlled studies Level 3Case-control studies Level 4Pre-test/post-test studies, case series Level 5Observational, case reports, expert consensus opinion Levels of Evidence

19. Body-weight Support Treadmill Training There is level 3 evidence (Wernig et al. 1995) using historical controls that BWSTT is effective in improving ambulatory function. However, stronger evidence from two level 2 RCTs (Dobkin et al. 2006; Hornby et al. 2005a) demonstrates that BWSTT has equivalent effects to conventional rehabilitation consisting of an equivalent amount of overground mobility practice for gait outcomes in acute/sub-acute SCI.

20. A new model of knowledge dissemination  Over 1/2 million downloads from 174 countries (US, Canada, UK, Australia, India)  150 presentations  50 peer-reviewed publications

21. Clinician Evaluation (n=92) Item% SCIRE improved their knowledge of SCI evidence 91 % SCIRE helped to inform changes to their clinical practice 81 % SCIRE increased their confidence in treating SCI clients 69 % Can access to knowledge improve practice?

22. Standards of Care Priority Setting SCIRE Knowledge Platform www.scireproject.com  Outcome Measure Standardization (Toolkit)  Practice Guideline Development  Implementation of Best Practice Research & Strategic Funding Priority Setting  Dissemination of evidence  Educational Modules Knowledge Translation