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(iKNOW) Lab

Integrating Knowledge Translation (iKNOW) Lab

Integrating Knowledge Translation (iKNOW) Lab located at the University of Michigan-Flint seeks to improve the uptake of rehabilitation research into clinical practice. Rehabilitation evidence generated today may take over 17 years to be implemented into clinical practice. KT is the “process that includes the synthesis, dissemination, exchange, and ethically sound application to improve health, provide more effective health services and products, and strengthen the health care system.”

Objectives

  • Establish highly functioning sustainable partnerships with health care professionals and clinics.
  • Work collaboratively with health care professionals and clinics to improve the uptake of rehabilitation evidence into practice 
  • Add to the body of knowledge translation research.

Presentations

  • Yorke AM, Trojanowski S, Fritz N, Ludwa A, Schroeder M.  iKNOW-PD: Outcomes and lessons learned when implementing standardized outcome assessment battery for patients with Parkinson disease.  Presentation at Research Day at Michigan Physical Therapy Association. Grand Rapids, Michigan. November 1, 2019.
  • Yorke A, Trojanowski S, Sherman E, Carlson J. Rehab Revival 2.0: Building Partnerships to Improve Rehabilitation Care. Poster Presentation:  Healthy Flint Research Coordinating Center Research Symposium. Flint, Michigan. March 15, 2019.

Grant Funding

  • 2019 Smith A, Yorke AM, Lampman A Implementing Evidence into a Student Pro-Bono Physical Therapy Clinic: Neurological Outcome Measures. Awarded $250 the Michigan Physical Therapy Association Institute for Education and Research Small Grant. University of Michigan Flint HIC #HUM00166194
  • 2019  Yorke AM, Trojanowski ST, Fritz N. Integrating Knowledge Translation Tools for OUtcome Measurement in Neurologic Disorders. Awarded $496 the Michigan Physical Therapy Association Institute for Education and Research Large Grant. University of Michigan Flint HIC 
  • 2018 Yorke AM, Trojanowski S, Sherman E, Carlson J.  Rehab Revival 2.0. Awarded $4000.00 from UM-Flint HFRCC Small Grants Research Funding Opportunity 2018 Competitions.  University of Michigan Flint HIC #HUM00151285
  • 2017 Yorke AM, Trojanowski ST, Fritz N. Awarded $500 the Michigan Physical Therapy Association Institute for Education and Research Large Grant. University of Michigan Flint HIC #HUM00137043.

Members

Amy Yorke
National Academy of Practice Distinguished Scholar & Fellow
Welcome to the iKNOW lab team page. As a group of physical therapy clinicians, researchers, and students we are excited to share the impactful work we are doing to decrease the amount of time it takes for research to be implemented into clinical practice. As a Board Certified Neurological Clinical Specialist, I am excited to partner with local clinicians to improve their practice and patient outcomes. Currently, our projects have been focusing on standardizing the use of outcomes measures in neurological physical therapy. As a profession, it is essential that we utilize tools that demonstrate strong psychometric properties and measure the constructs that are important to our patients. We are moving toward implementing knowledge translation projects focused on intervention, including high intensity gait training and implementation of clinical practice guidelines in vestibular rehabilitation. Please reach out to use if you are interested in collaborating with us.

Suzanne Trojanowski, PT, DPT
Board Certified Neurologic Clinical Specialist
As a clinician, I strived to integrate evidence into my practice. This was challenging. I often lacked the tools I needed to implement and sustain this level of practice. As a researcher, I wish to partner with clinicians and clinics to facilitate implementation and sustainability of evidence-based practice.

Nora Fritz, PT, DPT, PhD
Co-team Leader
Wayne State University

Emily VanVeldhuisen
Student
I am a student physical therapist at the University of Michigan-Flint expected to graduate in 2021. I did my undergraduate degree at Calvin University in Grand Rapids and graduated with a Bachelors in Kinesiology in 2018. During my undergraduate career, I had the opportunity to work as a physical therapy tech at Hulst Jepsen. I also spent time working in research as an intern at Emmes Corporation. At Calvin College, I studied abroad in China and Nepal, was involved with Calvin Women’s soccer, and was a member of multiple clubs. I have enjoyed working with this motivated iKNOW team, and I look forward to seeing the impact our work has on knowledge translation in physical therapy clinics. One of our earlier projects, iKNOW PT Heart, has been especially exciting to work on as we get to see the results of this research in our own pro-bono clinic.

Amy Smith
Student
I am a student in the DPT class of 2021 at the University of Michigan-Flint and thoroughly enjoy working with this diligent iKnow team. I received my Bachelors in Biomedical Science from Western Michigan University in 1991 and was first introduced to research through my internship at Upjohn. Throughout my career, I have had the privilege of working at both Airway Oxygen and National Heritage Academies in various roles. I have also enjoyed volunteering in the community and serving on boards for several organizations. I recently decided to pursue my doctorate in physical therapy and was delighted to learn about the dual DPT/PhD opportunity at U of M Flint. I have found knowledge translation to be a wonderful combination of research, education, and clinical practice that blends well with my background and my goals. I am excited about the impact knowledge translation can have in clinical practice and how positively it can affect patient outcomes. Currently, I enjoy working on a project with iKNOW PT Heart implementing neurological CPGs into our student-run pro-bono clinic. My hope is that we, as students, will utilize this knowledge throughout our careers and, in turn, further impact practice.

Amanda Woodruff
Student
I am a student physical therapist at the University of Michigan-Flint and will be graduating in 2022. I earned my Bachelors of Science in Clinical Exercise Science at Grand Valley State University in 2016. While at Grand Valley, I had the privilege to assist my professors in conducting their research as well as conducting and publishing research of my own. I also volunteered and worked for Mary Free Bed Rehabilitation Hospital and Hope Network of Grand Rapids in assisting with the treatment of patients with TBIs and other spinal cord injuries as a rehab tech. Before starting school, I spent time being a physical therapy tech with Athletico. I’ve enjoyed my new role as a part of the iKNOW team and can’t wait to see how the brilliant minds of this team are going to impact the clinics we are partnered with to improve outcomes through the use of knowledge translation.

Current Research

Study Title: Knowledge Translation Intervention to Improve the use of Standardized Parkinson’s Disease Assessments by Physical Therapists Working in Outpatient Rehabilitation: iKNOW PD (HUM00137043)
Measuring outcomes is an important component of physical therapists practice. Outcome measures (OMs) are important indirect patient care as well as the opportunity they provide the profession in collectively comparing care and determining effectiveness. (APTA, 2017)   The use of standardized tests and measures early in an episode of care establishes the baseline status of the patient, providing a means to measure the change in the patient’s functional abilities. Outcome measures, along with other standardized tests and measures used throughout the episode of care, provide information about the functional progression of the patient and whether predicted outcomes are being met. (APTA, 2017)  Despite the need for using OMs in professional practice, physical therapists do not demonstrate consistent adherence. Forty-seven percent of physical therapists (Jette, 2009) reported using outcome measures. In another study (Kirkness & Korner-Bitensky, 2002), only 31% of therapists used outcome measures as determined by a chart audit. When interviewed, physical therapists admit to over-estimating the use of OMs.

The purpose of this study is to use a theoretically based, multi-modal, tailed knowledge translation (KT) intervention to increase the documented and self-reported use of Parkinson’s disease OMs in physical therapists who work in outpatient rehabilitation. The Knowledge to Action (KTA) framework (Graham, 2006) will be the theory used to implement this KT intervention. The KTA framework consists of six key steps: identify problem, adapt knowledge to local context, select, tailor, and implement intervention, monitor knowledge use, and evaluate outcomes.

Study Title: Integrating Knowledge Translation Tools for Outcome Measurement in Neurologic Disorders (iKNOW-Neuro) (HUM00170494)
The American Physical Therapy Association supports the use of Clinical Practice Guidelines (CPGs) to guide clinical decision making in practice. The process of knowledge translation facilitates the implementation of CPGs into clinical practice. Based on a call to standardize measurement data in clinical practice to improve care delivery, strengthen public health, link clinicians’ performance to patient outcomes, and generate knowledge, a CPG was recently published to standardize the use of a core set of outcome measures for adults with neurologic conditions (i.e., stroke, multiple sclerosis, Parkinson disease, traumatic brain injury, spinal cord injury, and vestibular dysfunction). These measures are suitable for all rehabilitation professionals. Unfortunately, these recommendations have not been widely adopted in a standardized way. The use of standardized outcome measurement is critical for monitoring improvements and declines over time in adults with neurologic conditions.

In this knowledge translation project, we propose to capitalize on our existing partnership with Genesys Integrated Physical Therapy, who has expressed an interest in standardizing the outcome assessments used in individuals with adults with neurologic conditions across their seven sites (Burton, Fenton, Flint, Grand Blanc Health Park, Grand Blanc Holly Road, Lapeer, and Mt. Morris). We hypothesize that a targeted plan of education that overcomes barriers within the Genesys system will result in improved therapist adherence to standardized outcome measures and improved therapist knowledge of the benefits of using standardized outcome measures.

Study Title: Rehab Revival 2.0/iKNOW AMPAC (HUM00163891)
Rehabilitation services are healthcare services that help a person regain physical, mental, and/or cognitive abilities that have been lost or impaired as a result of disease, injury, or treatment. Rehabilitation services help people reintegrate into daily life and include physical therapy, occupational therapy, and speech therapy. Hurley Medical Center Inpatient Therapy Services (HMC-ITS) and the University of Michigan Flint’s Physical Therapy Department (UMF-PTD) are located in the city of Flint and are seeking a formal partnership to improve communication and information sharing while increasing patient access to rehabilitation and improving patient care. This new partnership, titled “Rehab Revival 2.0” would lead to structured information sharing with a goal to increase access to high quality rehabilitative care based on evidence. The mission statement of HMC is “Clinical Excellence. Service to People.” In order to improve access to care and promote clinical excellence at HMC-ITS, a type of community-engaged research known as knowledge translation (KT) would be implemented as the guiding theory. Numerous barriers, including lack of access to evidence and the inability to critically evaluate the literature, exist to incorporate evidence into practice. Rehabilitation research evidence generated today may take over 17 years to be implemented into clinical practice. KT is the “process that includes the synthesis, dissemination, exchange, and ethically sound application of knowledge to improve health, provide more effective health services and products, and strengthen the health care system.” The use of a KT process may help promote earlier implementation of the evidence in rehabilitation services. HMC-ITS provides a clinical environment with provider knowledge of opportunities for improving access to high-quality care which will improve patient outcomes, while UMF-PTD will offer the expertise and research support to facilitate KT and novel research projects. The leadership of both institutions are committed to increasing access to and advancing health care for the aging citizens of Flint who require rehabilitation services. Building this partnership between our two institutions will create a best practice environment that would improve access to care and patient outcomes.

Objectives of the project: Over the course of six months, the collaborative project will 1) Establish a high functioning sustainable partnership, 2) Collaboratively identify areas for enhancement of clinical practices based on community and facility need, 3) Develop Rehab Revival 2.0 in order to improve access to evidence-based inpatient rehabilitation care at HMC in areas jointly identified, 4) Enhance the patient experience at HMC-ITS, 5) Add to the body of community-engaged research in rehabilitation.

Study Title:  Implementing Evidence into a Student Pro-Bono Physical Therapy Clinic: Neurological Outcome Measures (HUM00166194)
The purpose of this study is to use a theoretically based, multi-modal, tailored knowledge translation intervention to incorporate the use of the neuro outcome measure clinical practice guidelines in a student-led pro-bono physical therapy clinic. The Knowledge to Action (KTA) framework (Graham, 2006) will be the theory used to implement this KT intervention. The KTA framework consists of six key steps: identify problems, adapt knowledge to local context, select, tailor, and implement intervention, monitor knowledge use, and evaluate outcomes.