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INTRODUCTIONPhysical therapists (PTs) and other health care providers are expected to integrate new knowledge into clinical practice. This knowledge-to-action process is known as knowledge translation (KT) and is defined as the exchange, synthesis, and ethically sound application of knowledge within a complex system of interactions among researchers and users.1"3 Knowledge translation can also be considered as a multidimensional, active process aimed at ensuring that new knowledge gained through the course of research ultimately improves the lives of people with disabilities and furthers their participation in society.4Numerous barriers to the application of new knowledge from scientific evidence into health care practice have been identified. These include insufficient time to read articles and implement changes, limited self-efficacy for interpreting research results, lack of awareness of the evidence, disagreement with practice guideline recommendations, and the presence of economic, administrative, and interprofessional constraints.5"8 Additionally, entrenchment of existing practice behaviors or habits may also limit practice change despite the presence of new knowledge.9"11Continuing education courses (CECs) are a means to build knowledge and maintain and improve professional skill.7,12"14 Evidence suggests that PTs prefer to use CECs rather than information from primary research to inform clinical decisions.7,15 However, although CECs can improve knowledge, it is not clear that traditional CECs alone are effective at changing practitioner behavior or improving patient outcomes.7,8,14,16"19 It appears that participation in interactive, multicomponent education strategies is more effective than passive dissemination for enhancing evidence-based knowledge and practice behaviors in health care providers.20,21Several recent studies examined efforts to integrate KT activities into CECs as an alternative to traditional lecture- and labbased CECs.22,23 In 2 projects, attendees were coached on how to develop KT plans for themselves as practitioners and for their coworkers. Drafting actual plans required reflection on how to customize the KT process based on local resources and barriers, and readiness to change. Attendees also interacted with course instructors in an ongoing online discussion group on course content and implementation of KT plans. One of the studies included 3 separate sessions for the CEC, which further facilitated interaction regarding application of content.23 Results from both projects indicated significant improvement in self-reported knowledge compared with baseline. Self-reported frequency of content application was more variable across individual attendees, with some reporting a marked increase and others no change.22,23Brennan et al compared clinical outcomes from 34 therapists who attended a 2-day CEC on the management of neck pain with outcomes from 11 therapists who additionally participated in an ongoing clinical improvement project after the 2-day course was completed.14 The improvement project consisted of monthly review and discussion of manual therapy techniques, and one 4-hour session of hands-on instruction from the CEC instructor 5 months after the CEC. No differences in patient outcomes (ie, Neck Disability Index scores) were found based on attendance at the 2-day CEC alone. However, therapists who participated in the improvement project demonstrated improved clinical outcomes and significantly lower median physical therapy charges compared with nonparticipant therapists. Similarly, a randomized controlled trial compared the effect of a 2-day CEC with and without an ongoing small-group discussion on improving patient outcomes with neck pain.12 Patients of therapists in the ongoing education group experienced less disability in fewer visits compared with the CEC-only group.Newer perspectives on CECs based on adult and professional education propose that learning meant to improve professional practice must take into account the contingencies of the workplace and use the challenges presented by day-to-day practice to solidify learning. … |
