Implementation Science
Participation is a key determinant of healthy living known to support the development of physical, psychological, and social emotional skills and competencies. Although evidence for sound measures of participation and effective intervention strategies exists in rehabilitation, a knowledge-to-practice gap remains. Members of ASPIRE lab contribute to knowledge translation (KT) initiatives focused on implementing evidence/knowledge into practice.
Leading Evidence to Advance Participation-focused practice (LEAP) Initiative
The figure, inspired by O’Connor et al. (2020) Cultural Cone, the KTA model (Graham et al., 2006) and the Five factors framework (Chaudoir et al, 2013), illustrates working across micro, meso, and macro levels to engage all stakeholders in identifying ways to implement participation-focused practice. The behavioral elements of the Cultural Cone (I don’t, I can’t, I try, I do, We do, use participation-focused practice) show how individuals and organizations can identify ‘where they are now’ and work from there to move towards ideal (blue-sky) participation-focused practice for best outcomes for children and families.
Using this multi-level P-KT framework, eight guiding principles for implementing participation-based innovations are proposed:
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Focus on the essence of participation-based practices
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Talk about participation-Embed the language of participation in communication with families
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Build a “participation team” - Partner with and fully engage stakeholders at all levels
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Understand where the participation-focused innovation sits in relation to your situation
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Leverage existing resources
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Close the practice-research-practice gaps through evidence-based practice
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Connect and share successes and advocate
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Ensure sustainability
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To read the full description of these principles in the context of defining who, what, and how to effect change as well as examples of implementation strategies, refer to Anaby et al., 2021.
See here for full P-KT roadmap booklet.
See here for the detailed table on the eight guiding principles.
See below for additional forms to guide you during the implementation process:
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The LEAP initiative and the P-KT framework will be presented in a Focused Symposia at the BetterTogether2022 conference.
View the recorded presentation here.
Implementing PREP in inclusive schools
This knowledge translation (KT) implementation nation-wide study stemmed from a collaboration with the Israeli ministry of education with the purpose of implementing the PREP approach in inclusive educational settings. In this mixed-methods study, 39 school-based OTs participated in a 30-hour training program over 10 weeks and applied PREP to one student. Students’ mean age was 9.31 years (25 boys, 14 girls). Therapists’ knowledge and their perception on change in practice behaviours following the program were evaluated, and students’ participation was assessed pre- and post-PREP and during follow-up using the Canadian Occupational Performance Measure (COPM).
Our initial analysis revealed that therapists’ knowledge of the PREP approach has increased (especially their ability to analyze environmental characteristics) and a change in practice behaviour was reported in terms of identifying participation issues, using participation-based assessments and setting participation-based goals. In addition, positive improvement in the student’s own participation was observed post-KT intervention.
Previous research/ Completed KT Projects
Clinical Practices for Occupational and Physical Therapists for Children with Cerebral Palsy: Focus and Gaps
A Canada-wide web-based survey completed by 123 occupational (50.4%) and physical therapists (OT/PT) revealed gaps in clinical practice. Clinicians identified problems, assessments, and treatment interventions based on two vignettes of school-aged children with cerebral palsy (CP) and the data was coded and analyzed using the International Classification of Functioning, Disability, and Health (ICF) components.
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Through this study by Anaby et al., 2017, we identified a pressing gap when providing OT/PT services for children with CP as body functions and structures were the main focus of therapy practices. Participation is not well-integrated into practice; even within the “activity and participation” category, attention is mainly given to task-oriented activities rather than social and leisure participation. Interestingly, the largest percentage of problems identified by clinicians (46%) were related to activity and participation however less attention was directed to this area when assessing (36%) and especially when targeting intervention (19%).
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To begin addressing identified gaps in therapy practices, we completed a Knowledge Translation (KT) implementation study.
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Focus on Participation for Children and Youth with Disabilities: Enhancing Therapy Practice Through a Guided Knowledge Translation Process
This KT study by Anaby et al., 2015 tested an intervention to increase clinician’s awareness and to bring about change in practice toward a focus on participation. Fourteen clinicians from two interdisciplinary teams working with youth with physical disabilities participated in six case-based learning sessions facilitated by a knowledge broker. Individual interviews were conducted three months post-intervention and thematically analyzed.
Therapists shared the impact on practice occurred at both the personal and professional levels, validating their current practice/what they know and changing their behaviour and thinking towards an overall intention for change towards participation-based practices. Barriers and facilitators to implementation were also identified (e.g., organizational mandate, reflection on practice).
This strategy was effective in redirecting clinicians’ focus toward the notion of participation and establishing readiness for change.
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