November 17, 2020

In 2007, the National Center for the Dissemination of Disability Research (NCDDR) commissioned the report, Knowledge Translation: Introduction to Models, Strategies, and Measures (Sudsawad, 2007) to provide an overview of the field of knowledge translation (KT). The report highlighted KT definitions and characteristics, as well as various models and frameworks prevalent at the time. The past decade has seen significant advancements in KT theory and practice that have led to a new generation of approaches and strategies for sharing evidence and for facilitating and evaluating behavior, policy, and organizational change, including a larger focus on implementation. The resulting magnitude, variety, and complexity of new KT evidence present challenges to many researchers and knowledge users (KUs) in making sense of and choosing approaches that are ideally suited for their needs. The Center on Knowledge Translation for Disability and Rehabilitation Research, as NCDDR is now known, commissioned the present narrative review as an update of the KT literature. We reflect on advancements in KT practice generally, KT’s relationship with implementation science (IS), and its practice in the specific area of disability research. Methods A narrative review is best suited for summarizing knowledge about a topic and for distilling key findings in fields as diverse and broad in scope as KT (Green, Johnson, & Adams, 2006). We have focused on the literature published after 2007 relating to empirically supported definitions, conceptualization, and theories, models, and frameworks (TMFs) of KT and IS. Report Organization This report describes the field of KT and how IS has emerged to provide a focus on implementation. The first sections provide an historical overview of the KT field, highlighting changes in definition and the overall evolution of the concept and related methodologies. The next section describes the importance of stakeholder engagement, followed by a discussion of the advancement of theories, models and frameworks. The following section focuses on the rise of IS. Next, key aspects of the KT process are presented, including defining a KT goal, the fundamentals of KT planning, dissemination, and implementation strategies, and evaluating KT. KT advancements related to disability research are highlighted, followed by a look at future directions in KT.

Sponsorship bias could affect research results to inform decision makers when using the results of these trials. The extent to which sponsorship bias affect results in the field of physical therapy has been unexplored in the literature. Therefore, the main aim of this study was to evaluate the influence of sponsorship bias on the treatment effects of randomized controlled trials in physical therapy area. METHODS: This was a meta-epidemiological study. A random sample of randomized controlled trials included in meta-analyses of physical therapy area were identified. Data extraction including assessments of appropriate influence of funders was conducted independently by two reviewers. To determine the association between biases related to sponsorship biases and effect sizes, a two-level analysis was conducted using a meta-meta-analytic approach. RESULTS: We analyzed 393 trials included in 43 meta-analyses. The most common sources of sponsorship for this sample of physical therapy trials were government (n = 205, 52%), followed by academic (n = 44, 11%) and industry (n = 39, 10%). The funding was not declared in a high percentage of the trials (n = 85, 22%). The influence of the trial sponsor was assessed as being appropriate in 246 trials (63%) and considered inappropriate/unclear in 147 (37%) of them. We have moderate evidence to say that trials with inappropriate/unclear influence of funders tended to have on average a larger effect size than those with appropriate influence of funding (effect size = 0.15; 95% confidence interval = -0.03 to 0.33). CONCLUSIONS: Based on our sample of physical therapy trials, it seems that most of the trials are funded by either government and academia and a small percentage are funded by the industry. Treatment effect size estimates were on average 0.15 larger in trials with lack of appropriate influence of funders as compared with trials with appropriate influence of funding. Contrarily to other fields, industry funding was relatively small and their influence perhaps less marked. All these results could be explained by the relative youth of the field and/or the absence of clear industry interests. In front of the call for action by the World Health Organization to strengthen rehabilitation in health systems, these results raise the issue of the need of public funding in the field.

The widely adopted integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework identifies facilitation as a ‘core ingredient’ for successful implementation. Indeed, most implementation scientists agree that a certain degree of facilitation is required to translate research into clinical practice; that is, there must be some intentional effort to assist the implementation of evidence-based approaches and practices into healthcare. Yet understandings of what constitutes facilitation and how to facilitate effectively remain largely theoretical and, therefore, provide scant practical guidance to ensure facilitator success. Implementation Science theories and frameworks often describe facilitation as an activity accomplished in, and through, formal and informal communication amongst facilitators and those involved in the implementation process (i.e. ‘recipients’). However, the specific communication practices that constitute and enable effective facilitation are currently inadequately understood.

The context of care provided in long-term care homes is changing, as an increasing number of older adults are entering long-term care with advance stages of illness and higher care needs. Long-term care homes are quickly becoming the place of death for an increasing number of older adults, despite recent literature identifying inadequate and suboptimal levels of end-of-life care. Within long-term care, healthcare assistants represent 60%-70% of the unregulated workforce and provide 70%-90% of the direct care to residents. Research indicates that a high level of uncertainty exists surrounding the role of healthcare assistants in end-of-life care, with numerous studies reporting the role of healthcare assistants to be ‘unclear’ with varying levels of responsibilities and autonomy. OBJECTIVE: The purpose of this scoping review was to explore healthcare assistants’ experiences and perspectives of their role in end-of-life care in long-term care. METHODS: We applied Arksey and O’Malley’s methodological framework, with recommendations from Levac and colleagues’ guiding principles. Electronic databases and the grey literature were searched for relevant articles. Search concepts included end-of-life care and healthcare assistants. Articles were included in this review if they explored healthcare assistants’ experiences or perspectives of providing end-of-life care in long-term care. The peaceful end of life theory by Ruland and Moore (1998) was used to organise data extraction and analysis. RESULTS: A total of n = 15 articles met the inclusion criteria. The most predominant role-required behaviours reported by healthcare assistants were as follows: psychosocial support to significant others, knows the resident’s care wishes and physical care with respect and dignity. The most predominant extra-role behaviours reported by healthcare assistants were as follows: becoming emotionally involved, acting as extended family and ensuring residents do not die alone. CONCLUSIONS: Findings from this review expanded the concept of end-of-life care by illustrating the role-required and extra-role behaviours healthcare assistants perform when providing end-of-life care in long-term care. IMPLICATIONS FOR PRACTICE: Findings from this scoping review highlight the numerous behaviours healthcare assistants perform outside their role description in order to provide end-of-life care to dying residents in long-term care. These findings could inform policymakers and managers of long-term care homes.

Previously, AMDA and other organizations have cautioned on the adversarial and punitive tone of federal survey processes, but little has changed.Current survey processes continue to fly in the face of proven principles of internal motivation for promoting performance, instead assigning individual blame, focusing on punishments and impinging on provider autonomy. The updated SNF Requirements of Participation have yet again resulted in a conversation about the survey process, polarizing consumer advocates and providers with diverging opinions.It is important that we take a fresh look at the approach and value of the survey process and how it should be improved.