1. Knowledge Brokers – getting knowledge from researchers to practitioners Marjolijn Ketelaar Kenniscentrum Revalidatiegeneeskunde Utrecht

2. Clinical practice Research Bridging the gap. HOW?

3. Knowledge Brokers: What are they and how can they help move research into clinical practice? CP 2009 Conference Saturday February 21, 2009

4. Dianne Russell Peter Rosenbaum Jan Willem Gorter CanChild Centre for Childhood Disability Research McMaster University, Hamilton, ON. Canada Johanna Darrah University of Alberta, Edmonton, Alberta, Canada Lori Roxborough Sunnyhill Health Centre for Children, Vancouver, BC Canada Dianne Cameron Centre for Ability, Vancouver, BC Canada Marjolijn Ketelaar RC De Hoogstraat NetChild PERRIN

5. Objectives of the workshop To share our experiences with knowledge translation and Knowledge Brokering

6. What do we mean by knowledge translation anyway? Research transfer Knowledge transfer Knowledge exchange Knowledge mobilization Utilization and diffusion Knowledge transfer and exchange

7. CIHR definition of Knowledge Translation A dynamic, iterative process that includes synthesis, dissemination, exchange, and ethically-sound application of knowledge to improve the health of people, provide more effective health services and products and strengthen the health care system.

8. Do you think there is a gap between knowing and doing? Evidence that research is not being translated into clinical practice 20-25% of patients get care that is not needed or potentially harmful 30-40% of patients do not get treatments of proven effectiveness Schuster, McGlynn, Brook (1998); Grol (2001)

9. Time for you to get to work….

10. Talk to the person on either side of you (3 minutes) and answer this question I’d use evidence from research in my practice but…..

11. Barriers Huge amount of information Lack of time We’re not doing he wrong things Trust all information that is coming up? Changing yourself is not enough Changing attitude

12. Talk to the person on either side of you (3 minutes) and answer this question What are some possible supports to implementing evidence into practice?

13. Supports Way results are presented –Back to earth –Presentations Money –E.g., Buy instruments Good, easy to use instruments Contact to people with experience Leadership – decide what to do Group process

14. Traditional methods of KT have focused on publication of journal articles and conference presentations Suggested reading

15. child* OR pediatric: 3426 hits rehabilitation OR therapy OR intervention: 5113 hits 538!! Pubmed.com Papers published in last 30 days

16. 18 papers each day!

17. A journey with PERRIN

18. PERRIN? What’s that?

19. KinderrevalidatieFonds AdriaanStichting Stichting Bio Kinderrevalidatie A national research program PERRIN PEdiatric Rehabilitation Research In the Netherlands

20. Parents Children, adolescents, young adults Health and care professionals Themes: development prognosis processes of care Questions..... Why PERRIN?

21. Develop instruments Insight in development and determinants Goals of PERRIN Cerebral Palsy Activities and participation

22. Instruments CP 0-5CP 9-16CP 5-9ProCPCP 16-24 PEDI GMFMGMFCSMPOCVABSetc Development and prognosis TP Started in 2001

23. Knowledge Transfer Papers in scientifc journals Papers in professional journals Factsheets www.perrin.nl

24. Heard about Experience with

25. One step further - Workshops Interactive workshops were more successful than more “traditional” other strategies, such as –peer-reviewed publications –presentations –posting information on web sites Phys & Occ Ther in Pediatrics 2008; 28: 191-206 BUT

26. USE GMFM-66

29. What do we know about effective KT strategies? Passive dissemination strategies are useful to increase awareness and knowledge but do not lead to substantial changes in practice

31. Knowledge transfer It involves –Getting the right information –To the right people –In the right form –At the right time –For the right impact (Julie Gilbert, KT manager, The Change Foundation)

32. What works to promote evidence-based practice?....data from 93 studies 1.Ongoing dissemination of information 2.Interaction between research and users 3.Social influence (power of influential people to persuade) 4.Facilitation (provision of technical, financial, organizational and emotional support) 5.Reinforcement (reminders, rewards for collaborative behaviour) Walter, Nutley & Davis. Evidence & Policy 2005; 1: 335-631

33. What do we know about effective KT strategies? Emerging evidence that Knowledge Brokers who are located at each site and understand the local context (supports & barriers) are helpful in moving evidence into practice

34. Knowledge Brokering “bringing people together to help build relationships, uncover needs, and share ideas and evidence that will let them do their jobs better” Canadian Health Services Research Foundation (CHSRF) “Local champions” “Opinion leaders” “Change agents”

35. Talk to the person on either side of you (3 minutes) and answer this question What skills would be important for a Knowledge Broker to have?

36. Researcher competent Meet colleagues – time & money Excited by the subject Communicative Enthusiasm Leader that is supportive Flexible – new ideas – tru out new things Open minded – live with your own past Respect clinicians and researchers – get respect Hold on – be strong! Convincing person – formal and informal leadership!

37. KB-projects Canada Netherlands Clinical practice Research Knowledge Brokers

38. Knowledge Brokers PERRIN Network of “influential” therapists Pilot with: -4 rehabilitation centers -6 instruments (a.o. GMFCS and GMFM) Purpose: From “knowing” to “doing”

39. KB-projects Canada Netherlands Clinical practice Research Researchers Broker to the Brokers Knowledge Brokers Professionals working in clinical practice

40. Knowledge Brokers “Brokers to the Brokers” and Researchers Lessons Learned

41. KB as facilitator (rather than expert) should be: –Reflective and flexible –Able to respond in a timely manner –Able to explain KB-role to others Should have: –Designated time –Resources to support the KB role (responsibility of researchers?)

42. Lessons Learned Crucial aspects: –“Broker to the Broker” (linking researchers with KBs) –Convincing stakeholders Responsibility to children and families – evidence based practice –What knowledge should be brokered and who decides, based on what? (Challenge: Finding enough strong evidence)

43. Great experiences: –Use of instruments increased! –Professionals felt more confident in choosing instruments –KBs enthusiasm – job satisfaction –Network of KBs – creativity, enthusiasm, learn from each other –Spill over to others not “formally” involved Lessons Learned Russell et al, in preparation Rivard et al, in preparation www.canchild.cawww.canchild.ca – Knowledge brokering

44. One of the creative ideas A flyer with measures

45. Take home message Create ways for researchers and research users to get together Create a climate in service delivery organizations conducive to research uptake Multi-faceted strategies to promote use are more likely to be successful than single interventions.

46. Questions?