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. Cochrane wrote an editorial about the evidence of its impact.
The CMSG is a leader in creating a 'friendly front end' that facilitates these changes. In 2009, the American College of Rheumatology (ACR) referred to several Cochrane reviews for the development of its Osteoarthritis Treatment Guidelines. The CMSG was also 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 former 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 have presented to clinician audiences in Canada at the Canadian Rheumatology Association, the 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.
CMSG collaborated with the Institute for Musculoskeletal Health of CIHR on a workshop that brought together knowledge translation experts, clinicians, and consumers to examine the obstacles to allowing consumers and clinicians to fully benefit from the results of Cochrane Systematic Reviews. The ideas that developed here formed the terms of reference for a CIHR 'Request for Application (RFA)", and this RFA initiated new knowledge transfer research with CIHR funding. More importantly, the workshop affirmed the position of knowledge transfer as a priority area for CIHR, CMSG, and Cochrane as a whole.
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It is most definitely a buzz-word in the health arena, but what exactly does knowledge translation 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 (Haynes B and Haines A, 1998)!”
The loose connection between this buzzing activity in research and that of clinical practice has revealed itself in recent years, demanding that strategies accelerating 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-aged children.
Grimshaw, JM, What have new efforts to change professional practice achieved? Journal of the Royal Society of Medicine. 1998; 91(35): 20-25.
Haynes B & Haines A. Getting research findings into practice: Barriers and bridges to evidence based clinical practice. BMJ. 1998; 317: 273-6.