Knowledge mobilization regarding activity and exercise after spinal cord injury: a Canadian undergraduate curriculum scan

Purpose: The purpose of this study was to conduct a curriculum scan of Canadian undergraduate university programs to determine the relative emphasis placed on the activity and exercise after spinal cord injury (SCI), in the context of physical disability studies. Method: Eighty-three Canadian Universities were evaluated for courses discussing: (i) general information about SCI, (ii) physical activity and exercise after SCI, (iii) general information about other physical disabilities and (iv) physical activity and exercise for such disabilities. Online course calendars (2009) were scanned, and their accuracy was verified by instructors or administrative assistants. Results: The curriculum scan revealed 113 courses that discuss physical disability. Seventy-four of these courses cover information regarding SCI, 47 of which include content relating to activity and exercise. In comparison, 104 courses discuss other physical disabilities, 76 of which cover material related to activity and exercise. Further, the 47 courses that cover activity and exercise after SCI are only offered in 22 Canadian Universities, and only 31 are mandatory for a degree. Conclusions: A substantial number of future healthcare professionals lack exposure to material regarding activity and exercise after SCI during their undergraduate education. This curricular oversight likely contributes to ineffective exercise strategies and the relative inactivity of the SCI population.

Implications for Rehabilitation

• Individuals with spinal cord injury are relatively inactive due to the many physical, psychological and social barriers they face regarding activity and exercise participation.

• Effective knowledge mobilization regarding activity and exercise after SCI to future healthcare providers is an essential step in promoting participation.

• This undergraduate curriculum scan showed that students lack exposure to issues regarding the activity and exercise after SCI in Canadian Universities.

• The lack of effective knowledge mobilization in this area likely contributes to the low levels of activity and exercise participation in the SCI population.

     

Developing applications of the ICF in education systems: addressing issues of knowledge creation,management and transfer

Purpose: Since its endorsement, the International Classification of Functioning, Disability and Health (ICF) has been applied in many policy contexts, including education. While so far the focus has been on showing ways in which it can be used to describe functioning and disability, this article seeks to focus on its value to represent knowledge. Methods: Two applications of the ICF and ICF-CY in the context of the Swiss education system highlight ways in which the classification can be used to assist multidisciplinary teams in acquiring and mapping existing knowledge, in creating new knowledge and in applying it for specific purposes. Results: The conceptual analysis illustrates that “disability in education” is a hybrid conceptual world that needs to bridge disability-related information with information relevant for learning and education. The ICF can be used to adequately map such knowledge in complex social settings. Conclusion: More attention needs to be paid to the ICF as an information system to help negotiate between different views on reality and different areas of expertise. The selection of content and ways of representing it need to be considered in the light of the specific purposes during collaborative knowledge creation processes.

Implications for Rehabilitation

• A sound understanding of the linkage between knowledge, information and data helps to clarify problems with the application of the ICF in everyday practice.

• Tool development needs to be responsive to the different information requirements across the knowledge creation cycle.

• Planning and decision-making can be improved if relevant information is represented in ways that facilitate adequate information processing.

     

Evaluation of a knowledge translation initiative for physical therapists treating patients with work disability

Purpose. We evaluated a knowledge translation and exchange (KTE) initiative aimed at providing physical therapists with best practice information regarding work disability prevention.

Method. The KTE initiative involved dissemination of a best practice resource guide for work disability prevention, creation of a network of peer-selected educationally influential clinicians, province-wide seminars for practicing clinicians, and use of the resources in an academic training curriculum. Evaluation included email surveys of clinician practice patterns and exposure to the KTE initiative. We also evaluated the impact of the KTE on community physical therapy workers' compensation outcomes.

Results. 241 and 164 clinicians responded to the baseline and follow-up email surveys, respectively. Clinicians reported a wide range of years in practice (0–30+ years) and practice settings although the majority worked in private clinics (～61%). Approximately 80% of the follow-up sample reported some exposure to the KTE initiative. Few differences were observed in reported practice patterns between survey periods. Compensation outcomes improved slightly after KTE (68 versus 70% off benefits) however, this effect was confounded by proportion of claimants with sprain/strain injury.

Conclusions. Implementation of a KTE initiative appears to have had little impact on the clinical practice or outcomes. Future interventions for rehabilitation professionals should consider the organisational culture of the settings in which they practice, which may be a barrier or facilitator of research uptake.     

Knowledge Translation at the Macro Level: Legal and Ethical Considerations

Macro-level legal and ethical issues play a significant role in the successful translation of knowledge into practice. The medicolegal milieu, in particular, can promote clinical inertia and stifle innovation. Embracing new clinical practice guidelines and best practice models has not protected physicians from superfluous torts; in some cases, emerging evidence has been used as the dagger of trial lawyers rather than the scalpel of physicians. Beyond the legal challenges are overarching justice issues that frame the broad goals of knowledge translation (KT) and technology diffusion. Optimal implementation of the latest evidence requires attention to be paid to the context of the candidate community and the key opinion leaders therein, characterized by the "8Ps" (public, patients, press, physicians, policy makers, private sector, payers, and public health). Ethical and equitable KT also accounts for the global burdens and benefits of implementing innovation such that disparities and gaps in health experienced by the least advantaged are prioritized. Researchers and thought leaders must attend to questions of fairness, economics, and legal risk when investigating ways to promote equity-oriented KT.     

A comparison of the nutritional beliefs of human immunodeficiency virus (HIV) seropositive and seronegative homosexual men

One-hundred and eighty-eight HIV-seropositive (index cases) and 45 HIV-seronegative (controls) homosexual men completed a questionnaire to assess their nutritional beliefs and practices, their psychosocial characteristics and information sources. Most individuals, irrespective of their HIV serological status, perceived the need to change their diet. Dietary changes were those which would be perceived as healthy by the general population, for example, a low-fat, high-fibre diet. Most HIV-seropositive individuals believed that vitamin and mineral supplements were especially important for their health and this was mirrored in their relative increased use of these substances compared to controls. Dietetic advice was not effective in terms of reported changes in dietary practice.
This work shows that although dietetic advice could be important in the management of HIV infection, in terms of altering dietary intake to promote weight gain, current practice needs to be reviewed in an attempt to improve efficacy. These results highlight the need to consider psychological characteristics when monitoring dietary compliance.