Human behavior flows from three main sources: desire, emotion and knowledge. —Plato
We've got to put a lot of money into changing behavior. —Bill Gates
*Mr. Ketterman's Case
I have the sense that I'm not making use of current knowledge about Alzheimer's disease as I treat Mr. Ketterman. What's holding me back? (See Appendix for Mr. Ketterman's health history.)
The previous sections have presented a foundational introduction to the three main components of evidence-based practice (EBP). Clinicians will find that most decisions required of them can benefit from the integration of sound clinical reasoning, patient-focused preferences, and critically appraised evidence. Whether you are selecting a diagnostic test or an intervention, your odds of having the best patient outcomes are enhanced when you ground your decisions in EBP. We are finding increasing evidence to support this assumption.1,2 But knowing and doing can be miles apart when it comes to human behavior, and clinicians are susceptible to barriers that make acceptance of EBP more difficult. Understanding the slow pace of change in the health care system makes it important to identify strategies to quicken our abilities to get the right care to the right patient at the right time. Increasing the rate of change to best physical therapy practice would result in significant improvements in our patient outcomes. Evensen et al3 refers to this as closing the evidence-practice gaps. Although most authors believe this is an appropriate goal, it will require the removal of barriers at several levels of health care, including the patient, the practitioner, and the health care organization.
Researchers and clinicians who identify problems with adherence to best practice, and who design and test interventions to decrease these barriers, are participating in what is called knowledge translation research or implementation science. The Canadian Institutes of Health Research define knowledge translation as:
the exchange, synthesis and ethically sound application of knowledge—within a complex system of interactions among researchers and users—to accelerate the capture of the benefits of research for society through improved health, more effective services and products, and a strengthened health care system.4
Evensen et al3 have described a disappointingly low amount of high-quality evidence in the past decade for guiding our understanding of how to implement the changes we hope will close the evidence-practice gap. The literature in medicine reports a preponderance of observational studies or simply papers that restate the practice guidelines or treatment recommendations.
In this chapter we will discuss three elements that can affect, in either a positive or negative manner, the process of getting evidence into practice: dissemination, practitioner acceptance, and organizational support for EBP (Fig. 17-1). We will draw from the best available evidence in physical therapy to identify barriers and recommend interventions that have been effective. For some knowledge translation, the path to the desired change ...