In the last issue of Rehabilitation Oncology, I noted in my Presidential column that the work of the Section's EDGE taskforce on lymphedema (Kimberly Levenhagen, Claire Davies, Marisa Perdomo, Kathy Ryan, and Laura Gilchrist) has generated a clinical practice guideline (CPG) that has been copublished in the Section's journal and Physical Therapy Journal. The publication of this CPG is the penultimate step in the EDGE process. The ultimate step in this process remains to be completed, namely, the transfer and implementation of the recommendations contained in this CPG into clinical practice. My earlier column decried the lengthy amount of time required to transfer clinically valuable knowledge into clinical practice itself and left the story there. Recently, I had reason to revisit this issue and realized that I had left my story unfinished and incomplete. My previous comments spoke only cryptically to the processes by which published information is translated into clinical practice. I imagined that knowledge translation (KT) was simple and straightforward; if the work was good, the results and conclusions would simply flow off from the journal pages and into clinical practice. I have subsequently learned that I was wrong, so allow me to make a few comments to tell “the rest of the story,” as Paul Harvey would say.
In 2005, the National Center for the Dissemination of Disability Research defined KT as “The collaborative and systematic review, assessment, identification, aggregation, and practical application of high-quality disability and rehabilitation research by key stakeholders (i.e., consumers, researchers, practitioners, and policymakers) for the purpose of improving the lives of individuals with disabilities.”1 The expectations arising from KT are unique for each stakeholder and can range from the identification of useful and appropriate clinical outcome measures creating better alignment between administrative policy and clinical reality.
The challenges and barriers successful KT must overcome also vary across the different stakeholders. But, regardless of these differences, the end point for each stakeholder is to make informed decisions based on available evidence that will improve patient care directly or indirectly. For the physical therapist, the knowledge base that underlies informed decision-making incorporates different types of knowledge that is multidimensional.2 More specifically, physical therapists must combine technical knowledge with insight into patient-client and patient-family relationships. Physical therapists also draw on knowledge generated both quantitatively and qualitatively and integrate this knowledge with insights gleaned from clinical judgment. Increasingly, barriers to KT are being recognized but they appear to vary even within the same general clinical setting.2 To add to this complexity, successful KT requires behavioral changes, changes that have proven to be extremely difficult for most, if not all, health care professions including physical therapy.3,4
Physical therapists appreciate the need for incorporating evidence into their practice, but KT remains challenging for our profession.5,6 Conceptual frameworks are available that can provide physical therapists with guidance into the design and implementation of processes that can facilitate KT in a physical therapy setting.2,6 The authors of the lymphedema CPG have created a plan that will help to transfer their recommendations into clinical practice, and perhaps they would share their insights into this process with the membership of the Section. Have the other EDGE task writing groups consider doing something similar? Does anyone in the Section have experience and expertise in the area of KT? If so, would you share that knowledge? There are several opportunities within the Section to do just that. Should the Program Committee consider KT as a topic for a session at a future Combined Sections Meeting? KT is on the minds of every member of the Section, as we each move into the era of evidence-based medicine. How can the Section assist with this process?
Now, I would like to abruptly change gears and share some of my “take-home messages” from the House of Delegates (HoD) held in Boston in June 2017. First, the word that permeated the House from start to end was “change.” Both Dr Sharon Dunn, President of the APTA, and Justin Moore, CEO of the organization, spoke frequently of creating a unified brand for the Association, putting systems and infrastructure into place within the APTA that will create operational excellence, increasing diversity and inclusion within the organization, making it easier to be a member of the APTA, and preparing physical therapy education for the 21st century. Plans for upgrading the infrastructure of the Association include a move from its current location to a new building that will be specifically designed to meet the needs of the Association and its staff and volunteers.
Both leaders stated a desire to improve and expand existing relationships the APTA has with other groups while developing new relationships with groups and organizations that share common goals and interests with the APTA. These particular goals will be achieved, in part, by building on existing relationships that individual members or groups within the APTA may already have with other groups. The current involvement of the Section with the American College of Sports Medicine in the revision of the frequently cited manuscript outlining exercise guidelines for the cancer survivor was singled out as a model for this approach to building new and lasting relationships. Finally, the 18 Sections of the APTA will again seek full voting status in the HoD. The group will submit a HoD motion in 2018 that seeks 2 votes for each Section and is in the process of developing a campaign for garnering sufficient support for this motion to get it passed. The goal of this action is to end the long-standing disenfranchisement of the Sections and their members in matters related to the governance of the APTA. Success in this effort will expand the role and responsibilities of the Sections within the HoD from one of advisor to one of advisor and active participant in the management of the APTA.
G. Stephen Morris, PT, PhD, FACSM
2. Hudon A, Mathieu-Joel G, Hunt M. The contribution of conceptual frameworks to knowledge translation interventions in physical therapy. Phys Ther. 2015;95:630–639.
3. Grimshaw J, Thomas R, MacLennan G, et al Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8:iii–72.
4. Dijkers MP, Murphy SL, Krellman J. Evidence-based practice for rehabilitation professionals: concepts and controversies. Arch Phys Med Rehabil. 2012;93:S164–S176.
5. Jette DU, Bacon K, Batty C, et al Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83:786–805.
6. Bernhardsson S, Lynch E, Dizon JM, et al Advancing evidence-based practice in physical therapy settings: multinational perspectives on implementation strategies and interventions. Phys Ther. 2017;97:51–60.