It is most definitely a buzz-word in the health arena, but what exactly does it mean?

The Canadian Institutes of Health Research (CIHR) has referred to knowledge translation as “a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. The very fact that this term has gained visibility in health research represents a major shift in our priorities. In the past, considerable amounts of money have been spent on clinical research while relatively little attention has been paid to ensuring that the findings of research were captured by its potential beneficiaries. The biomedical and applied research enterprise represents an annual investment of $55 billion US worldwide (Haines, A and Hayes, B., 1998)!”

The loose connection between this buzzing activity in research and that of clinical practice has revealed itself in recent years, demanding that strategies that accelerate the use of research findings run alongside knowledge creation agendas. As we acknowledge the behavioral, financial, and political barriers in disseminating high quality evidence we also look to research in providing the strategies to overcome them. To achieve evidence based health care means to also pursue 'evidence-based implementation' (Grimshaw, 1998).

This is exemplified through the mandate of CIHR that was recently established by an act of parliament. Bill C-13 defines the objective of the CIHR as "to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system".

CIHR recognizes that this must be enacted through a complex system of researchers and users. This includes traditional audiences such as 'health care providers, policy makers in various sectors, managers, industry, voluntary agencies, patients, and the general public. This also includes less commonly targeted groups such as the research community itself, rural communities, and school-age children'.

Return to top

Health care professionals and research: the daily struggle to keep up-to-date

Timely, useful evidence from the biomedical literature should be an integral component of clinical decision-making. Health care professionals have a responsibility to keep up with research findings to ensure that their practice is effective, but this is often at odds with the limited time they have to devote to educational activities. It is therefore imperative that professionals identify effective and efficient strategies for staying well informed of new, high-quality research findings.

You are perhaps very aware that traditional methods of reading printed educational materials and attending didactic educational meetings are often not very effective in changing behavior (Grimshaw, 1998). In addition to time constraints, you may sometimes find the conclusions of individual articles conflicting or confusing, and feel uncomfortable changing your practice based on this literature.

Pre-appraised, synthesized evidence can help health care professionals keep abreast of medical literature by summarizing large bodies of evidence and explaining the differences among studies on the same topic. However helpful systematic reviews may be, integrating the Cochrane Library into the routine of health care professionals does present a challenge! A recent study in New Zealand, for example, found that 42% of GPs were aware of the Cochrane Library but only 15% had used it (Kerse et al, 2001).

Questions persist as to how best to acquaint health care professionals with the basic methodology of high-quality systematic reviews and demonstrate their value as an unbiased report of evidence obtained using rigorous methods. This type of 'knowledge translation research' will help make clear what steps must be taken to effectively change clinical practice for the better. As Cochrane reviews are used increasingly to inform clinical decision-making, plan future research agendas, and establish clinical policy, they may help bridge the gap between best research evidence and optimal health care.

Return to top

CMSG's role in promoting change in clinical practice

Over the past years, there has been exponential growth in the use of Cochrane reviews in user-friendly products targeted at changing the behavior of clinicians, policy-makers and consumers, such as Clinical Evidence, the British Medical Journal (BMJ) evidence-based book series, clinical guidelines and patient/clinician decision aids. The Cochrane Collaboration collects evidence of its impact .

The CMSG is a leader in creating a 'friendly front end' that facilitates these changes. We were most recently involved in developing guidelines for rehabilitation interventions in musculoskeletal pain, using the information from Cochrane reviews. In a survey of 300 clinicians, we found that over 80% of clinicians agreed with the guidelines and would change their practice based on them. Dr. Peter Tugwell, the CMSG coordinating editor, has coordinated the publication of a British Medical Journal book on Evidence-based Rheumatology, using Cochrane reviews. Results from the CMSG reviews are included in guidelines for both consumers and clinicians - for example, CMSG osteoporosis reviews are now being used as the basis for a patient-clinician decision aid.

The CMSG is very proactive about increasing both Canadian and international clinician awareness of the Cochrane Collaboration. Members of CMSG presented to clinician audiences in Canada at the Canadian Rheumatology Association, Canadian Physiotherapy conference and local health science faculties. Internationally the CMSG has presented at the American College of Rheumatology, Outcome Measures in Rheumatology (OMERACT), the American Society of Bone and Mineral Research, the International Society of Health Technology Assessment and the American Physical Therapy Association.

The Australian Editorial Base has been working hard to increase dissemination of the evidence from Cochrane reviews through presentations and workshops to health professionals and consumer groups. Members have presented to rheumatology trainees at the annual Australian Rheumatology Association conference and to interested consumers from the Ankylosing Spondylitis Group of Victoria, Australia.