KT Plan: Developing and Evidence-based Guideline for Orthotic Prescription in Cerebral Palsy

Erin Bompiani, PT,DPT,PCS

Project Partners / Degree of Partner Engagement / Partner Roles / KT Expertise on Team
Physical therapists (in motion lab and rehab department) / From idea formulation straight through / 1) Various experiences with AFO prescription in different settings
Different departments bring different resources:
Motion lab: expertise in gait and use of objective outcome measures; regularly evaluates need for and effects of AFOs
Rehab: able to provide ongoing intervention and continually monitor AFOs
2) Share in various formats to all departments – grand rounds presentation; webinar to Shriners motion lab network; presentation at local PT conference for input from community therapists / Knowledge broker (motion lab PT)
Other practitioners
·  MDs
·  Orthotists / After idea formulation and straight through / 1) Different background / lens
2) Will help with implementing KT plan to their respective colleagues within the Shriners system / None
Clinical research coordinators / At point of dissemination and project end / 1) Experience with the literature and did 2 well-cited studies with AFOs in CP
2) will help get feedback from research colleagues; will support development of a KT plan within the hospital / Scientists with KT expertise
Patients / families / Beyond the project / 1) Families and patients will give us feedback on what is working and what needs improvement from a real-world perspective
2) Will help with evaluating our process by providing constructive feedback / None
Knowledge Users / Main Messages / KT Goals / KT Strategies
1.  Health practitioners
o  MDs
o  NPs
o  PAs
o  PTs
o  Orthotists
2.  Patients / families
3.  Hospital administrators / ·  Anticipate learning ideal process for AFO prescription in CP
·  Messages
·  Review of current process
·  Summary of evidence
·  Proposed new process informed by evidence / Generate…
·  Awareness (all)
·  Interest (all)
·  Practice change (1,3)
·  Policy action (1,3)
Impart…
·  Knowledge
·  Tools (locally and system wide)
Inform…
·  Research (help guide future direction of research) / Most effective
·  Interactive small group (1,3)
·  Educational outreach (ALL)
·  Combined interventions (ALL)
Mixed effects
·  Conferences (1,3) – Primary care conference, PT conference
·  Educational materials a) table for clinicians; b) evaluation form; c) fact sheet for patients and families
Effects unsupported by synthesis
·  Webinar
·  Communities of practice
KT Process / KT Impact & Evaluation
Integrated iKT – will collaborate to shape the process, involvement in data collection and tool development, assist in interpretation of findings and dissemination of results / a) Would like to have an impact on healthcare / well-being outcomes, clinical practice, policies, research & knowledge
b) Will know if achieved KT by:
·  Usefullness
·  Use indicators
·  Partnership / collaboration indicators
·  Practice change indicators
·  Program or service indicators
·  Policy indicators
·  Knowledge change
·  Attitude change
·  Systems change
Guiding Questions
1.  Similar initiatives: research interest in hospital in 2001 and 2004; did not necessarily change practice based on these studies; other SMALnet members expressed this is an initiative at their hospital – looking for guidance
2.  Who values: PTs, families and patients, researchers, orthotists, some of the MDs
3.  Why evaluate: to know if KT strategies were effective
4.  How will literature inform evaluation: will use current KT literature / frameworks
5.  Which questions are critical: 1) changing outcomes for patients; 2) changing practice / policy
6.  How capture outcomes: could develop quick eval form integrating information from project and capture success of the process with this from; compare patient reported outcomes pre / post implementing new process; evaluate change in practice by surveying other hospitals in the system after KT strategies
7.  Mixed methods of KT evaluation
8.  Perspective needed to achieve eval objectives: utilize feedback from all stakeholders
9.  How engage stakeholders: multiple collaborations throughout the process development an dissemination – feedback from stakeholders on what is important from their perspective
Resources Needed / Budget Items Needed / Implementation
·  Management support – especially for time to develop
·  Human – provider team support / ·  Production /printing
·  Programming
·  Teleconferencing
·  Travel / time: conferences
·  Webinar services / ·  Implement KT strategies first with small group workgroup working into education opportunities beyond the small group – utilize strong network and interest within SMALnet community
·  Goal is change in practice / process – will need to continually update process as evidence changes (search literature regularly and update annually at a minimum)