Making the Case for Knowledge Translation

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Despite the filing cabinets and shelves in my office, I prefer to stay organized by creating tidy little stacks of documents on the floor. It's easy to tell when I'm overworked, as the stacks tend to surround me and inhibit my escape. In one of those stacks is a pile of unread journals, including Journal of Biomechanics, Journal of Prosthetics and Orthotics (JPO), Prosthetics and Orthotics International (POI), and Journal of Rehabilitation Research and Development (JRRD). I rarely have time to read them as soon as they arrive, so off to the stack they go. I must confess that some wind up on the shelf, forever unread.

I thought of this stack when Don Katz, CO, FAAOP, shared a quote with me from Hurwitz et al. in The Journal of Bone and Joint Surgery (JBJS) in 2000: "Guilt accumulates in direct proportion to the growing pile of unread journals."

Why the guilt? Because these journals are my connection to the rest of the O&P world. They describe the current state of knowledge in the field in which I profess to be an expert. They give me new ideas and sometimes squelch my existing ideas, and they often motivate me to try something out in the lab. In these ways, they're not just sources of information, they are catalysts.

As a professor, I need research findings to enhance my subsequent research, but the clinician needs research findings for a more noble and immediate purpose: to best inform the care of an individual patient.

Just as education is an undeniable prerequisite for clinical practice, experience is undeniably beneficial. However, to some extent, experience is automatic. There is a reason it's called practice. Clinical practice begets experience. And while good clinicians are diligent in using that experience to continually improve, such effort often leaves little time for staying current in the research literature and evidence.

Research consumption commonly occurs in two ways: reading a particular issue of one of those journals, or actively searching the entirety of the evidence for a particular topic. The first is broad, time-consuming, and only useful sometimes, accidentally, for justifying an individual's patient care, but it's probably the more pleasurable of the two. Presumably, an O&P practitioner is interested in O&P, and it might not be too much of a stretch to imagine one reading an issue of JPO much as a hobbyist might read Model Airplane News.

The second approach—the active search of the literature for information—has practically become second nature in our Google-enabled world. However, random Internet searches tend to yield a haystack when we're after a needle, particularly when that needle represents a finding that must be reliable and reputable. Searching the evidence for peer-reviewed scientific information, the sort that might hold up in a letter of justification for a patient, is a learned skill, so much so that we devote a sizeable portion of the four-hour course we developed for the American Academy of Orthotists and Prosthetists (the Academy) on evidence-based practice to just that. Even then, literature searches often yield titles and abstracts only; reading the actual article requires a library visit or an online purchase from the publisher. And then there's that temporal issue. Once the article is in hand, reading it consumes that most valuable resource: time.

Wouldn't it be nice if someone could search the literature for a lot of potentially important clinical topics; obtain the articles; read, understand, and even critique them; and then write a concise and comprehensible summary? This very practice is happening. It's loosely termed "knowledge translation," and it's all over allied healthcare these days.

We are learning that no amount of training in, or awareness of, evidence-based practice can add more time to a clinician's day. Consequently, there are major efforts under way with the Academy and others toward knowledge translation. The results—evidence notes, State-of-the-Science conference proceedings, critically appraised topics (CATs), and patient-oriented evidence that matters (POEMs)—are becoming increasingly available in O&P, and that is a very good thing.

I believe this burgeoning trend toward knowledge translation will succeed and ultimately become a fundamental part of clinical practice if two things occur. First, the results need to be readily accessible and easily searched. We must avoid the possibility for scattered bits of knowledge to be hosted on multiple sites with multiple search tools. Otherwise, we'll never develop the critical mass necessary to serve the wide variety of questions for which clinicians need evidence. Second, these secondary knowledge sources must be treated as organic, malleable products, not as snapshot reviews of the literature from a fixed time in our history. New evidence must continually inform them, and mechanisms must be in place for collective updating. The profession has a duty to share this responsibility.

I look forward to the day when O&P has a mature, thriving body of secondary knowledge sources that is accessed, discussed, and, most importantly, utilized to inform and justify patient care. That is the day when we will all be able to look around and say, "Evidence-based practice? Mission accomplished."

Mark Geil, PhD, is an associate professor of biomechanics at Georgia State University, Atlanta. He holds a doctoral degree in biomedical engineering from Ohio State University, Columbus, and has conducted research in locomotion biomechanics with an emphasis in lower-limb prosthetics. An active proponent of advanced education and evidence-based practice in O&P, he recently concluded service as co-principal investigator of the American Academy of Orthotists and Prosthetists U.S. Department of Education grant.

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