Noonan V K, Wolfe D L, Thorogood N P, Park S E, Hsieh J T, Eng J J
1] Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada [2] Rick Hansen Institute, Vancouver, British Columbia, Canada.
1] Program of Aging, Rehabilitation and Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada [2] Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada.
Spinal Cord. 2014 Aug;52(8):578-87. doi: 10.1038/sc.2014.62. Epub 2014 May 6.
To conduct a systematic review examining the effectiveness of knowledge translation (KT) interventions in changing clinical practice and patient outcomes.
MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO were searched for studies published from January 1980 to July 2012 that reported and evaluated an implemented KT intervention in spinal cord injury (SCI) care. We reviewed and summarized results from studies that documented the implemented KT intervention, its impact on changing clinician behavior and patient outcomes as well as the facilitators and barriers encountered during the implementation.
A total of 13 articles featuring 10 studies were selected and abstracted from 4650 identified articles. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders. The methodological quality of studies was mostly poor. Only 3 out of 10 studies evaluated the success of the implementation using statistical analyses, and all 3 reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements. The commonly cited facilitators and barriers were communication and resources, respectively.
The field of KT in SCI is in its infancy with only a few relevant publications. However, there is some evidence that KT interventions may change clinician behavior and improve patient outcomes. Future studies should ensure rigorous study methods are used to evaluate KT interventions.
进行一项系统综述,考察知识转化(KT)干预措施在改变临床实践和患者结局方面的有效性。
检索MEDLINE/PubMed、CINAHL、EMBASE和PsycINFO数据库,查找1980年1月至2012年7月发表的报告并评估在脊髓损伤(SCI)护理中实施的KT干预措施的研究。我们回顾并总结了记录实施的KT干预措施、其对改变临床医生行为和患者结局的影响以及实施过程中遇到的促进因素和障碍的研究结果。
从4650篇已识别的文章中筛选并提取了13篇文章,其中包含10项研究。KT干预措施包括制定和实施患者护理方案、提供临床医生教育以及将结局指标纳入临床实践。促进实施的方法(或驱动因素)包括为临床工作人员组织培训课程、引入计算机化提醒以及让组织领导者参与。研究的方法学质量大多较差。10项研究中只有3项使用统计分析评估了实施的成功情况,且所有3项均报告有显著的行为改变。在10项研究中,6项使用统计分析评估了实施对患者结局的影响,其中4项报告有显著改善。常见的促进因素和障碍分别是沟通和资源。
SCI领域的KT尚处于起步阶段,相关出版物较少。然而,有证据表明KT干预措施可能会改变临床医生行为并改善患者结局。未来的研究应确保使用严格的研究方法来评估KT干预措施。