connecting with clinicians: opportunities to strengthen rehabilitation research
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CLINICAL COMMENTARY
Connecting with clinicians Opportunities to strengthen rehabilitationresearch
LOUISE DEMERS12 amp LISE POISSANT23
1Research Centre of the Montreal Geriatric University Institute 2School of Rehabilitation Faculty of Medicine Universite de
Montreal and 3Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal Quebec Canada
Accepted March 2007
AbstractPurpose This article examines the distinctive opportunities and challenges involved in connecting with clinicians tostrengthen rehabilitation researchMethod The relevant literature on various factors that link researchers and clinicians is summarized and discussedResults Links between researchers and clinicians are demonstrated by evidence-based practice common conceptualbackground and the development of research capacity Sustainable partnerships can evolve throughout the research processby using various enduring strategies such as expertsrsquo committee as well as novel approaches like communities of practiceConclusion This paper reflects the conviction that reducing the gap between research and clinical practice will be facilitatedby implementing partnerships originating from both researchers and clinicians
Keywords Rehabilitation clinical research research activity ICF
Introduction
Rehabilitation is a quickly expanding field that has
accomplished tremendous progress in achieving a
strong scientific status [1] Rehabilitation research it
should not be forgotten would not exist without its
strong clinical ties [2] In fact studies would be
meaningless if they were not expected to impact on
clinical practice Study results thus need to reach
rehabilitation clinicians in order to improve the way
clinicians interact screen evaluate plan and imple-
ment treatment and organize client-centred rehabi-
litation services [1]
While the importance of research in shaping
clinical practice has been widely acknowledged in
health care [23] so has the lack of appropriate
knowledge transfer approaches [45] This means
that clients are receiving suboptimal treatments at
best and ineffective or even deleterious treatments
at worst [4] Bowen [6] stressed the relevance of
including clinicians early in the research process His
study demonstrated that it is feasible to incorporate
clinical partners in the research process with
successful end results Participatory research in
which clients clinicians and other stakeholders are
engaged in shaping research projects is definitely of
growing interest in rehabilitation [7]
The goal of this discussion paper is to emphasize
the existing relationship between rehabilitation re-
searchers and clinicians and to highlight the various
opportunities offered to both parties in strengthening
the quality and usefulness of research results Our
reflection is based on first-hand experience in
implementing research in rehabilitation settings as
well as inputs from recent literature To accomplish
this goal we will demonstrate how researchers and
clinicians are linked through evidence-based prac-
tice common conceptual background and the
development of research capacity We will then
examine sustainable partnerships throughout the
research process from the early stage of study
conceptualization to the dissemination of results
Correspondence Louise Demers PhD OT(C) Research Centre of the Montreal Geriatric University Institute 4565 Queen Mary Road Montreal (Quebec)
Canada H3W 1W5 Tel thorn1 (514) 340 3540 ext 3010 Fax thorn1 (514) 340 3548 E-mail louisedemersumontrealca
Disability and Rehabilitation 2009 31(2) 152ndash159
ISSN 0963-8288 printISSN 1464-5165 online ordf 2009 Informa Healthcare USA Inc
DOI 10108009638280802037936
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and review various strategies incumbent upon
researchers to promote better interaction with
clinicians Finally challenges in reducing the gap
between research and clinical practice will be
discussed
Linking rehabilitation research and practice
Consider evidence-based practice
Evidence-based practice (EBP) links rehabilitation
research to practice Undoubtedly an important
ingredient for a common vision in rehabilitation
[89] EBP is defined as an approach to health care
practice where the clinician is aware of the evidence
that bears on his or her practice and of the strength
of that evidence (Health Informatics Research Unit
in Law [10]) Of course one key pre-requisite to
EBP is the availability of sound valid reliable useful
and meaningful research Through the use of current
best evidence in treatment EBP at the same time
facilitates recognition for knowledge creation in
certain clinical areas Evidence gaps are powerful
catalysts that lead to research advances or initiatives
ongoing work development and in some cases an
increased interest of clinicians towards research
training Its role in shaping the future of both clinical
practice and research should not be overlooked
[1011] The relationship between research practice
and need for knowledge is illustrated in Figure 1
Implementing EBP in a sustainable way remains
challenging both from research and clinical perspec-
tives Clinicians face several challenges in searching
evaluating evidence and then applying these findings
in a meaningful way especially in a context of lack of
time difficult access to resources and limited critical
appraisal skills [3812] Despite limited effectiveness
in changing clinical practice attending scientific
events and reading scientific journals are commons
means of accessing new knowledge by clinicians yet
these remain unavailable to many of them [13]
Moreover bringing changes into practice is not an
easy task [14] Conversely researchers are pressured
to design obtain financial support measure evaluate
and communicate useful research in a timely
manner
Consider conceptual background
Rehabilitation research rests on scientific methods
and principles [1] That statement being said
characterizing rehabilitation research is quite com-
plex This complexity comes from the fact that
rehabilitation research is a broad-based discipline
including multidisciplinary domains and covering a
wide range of fundamental clinical evaluative and
epidemiological issues [1] An interesting way to
illustrate the diversity of research topics in the area of
rehabilitation is through the use of the International
Classification for Functioning Disability and Health
(ICF) [15] The ICF multi-perspective approach to
the classification of human functioning is frequently
used as a unifying framework to delineate the
inclusive nature of rehabilitation research [16]
Several researchers evoke the ICF to organize and
present research programs and results [1718] For
example Mayo et al [19] mapped several outcome
measures at the item level to the ICF terminology to
characterize stroke survivorsrsquo health-related quality
of life in comparison to community-dwelling survi-
vors Using the ICF as a unifying framework
facilitates interpretation of their results which are
presented with a common international vocabulary
instead of scalesrsquo specific descriptors Unfortunately
because of feasibility funding or methodological
considerations researchers tend to restrict the focus
of their studies one or two components of the ICF
Rehabilitation practice is just as complex as
rehabilitation research Not only does it covers a
wide range of disabling conditions treatment tech-
niques clinical and non-clinical settings and cross-
disciplinary efforts [1] but it rests on humanistic care
requiring from clinicians that they use creative skills
knowledge and emotions to treat and care for
patients [1] As with rehabilitation research the
richness and wide scope of rehabilitation practice is
well illustrated through the ICF More and more
clinicians are adopting the ICF to interconnect the
body functions and structures as well as environ-
mental and personal factors that impact on an
individualrsquos activities and participation In this
regard clinical practice appears to contrast with
rehabilitation research since clinicians look at clients
with a global perspective hence include all of the ICF
components
Consider the development of research capacity
A third way to link rehabilitation research and
clinical practice is in developing research capacityFigure 1 Relationships between research practice and need for
data
Connecting with clinicians 153
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Over the past years the increase in research capacity
has been pushed forward with the involvement of
clinicians Research capacity in rehabilitation was
defined by Frontera and colleagues [20] as a process
of development which leads to higher levels of skills
and greater ability to perform useful research Five
elements that contribute to research capacity were
identified (i) Researchers (ii) funding (iii) research
environment infrastructure and culture (iv) part-
nerships and (v) metrics Metrics is concerned with
the assessment of capacity over time to gauge
progress and will not be further discussed The
other elements however may all be linked to
clinicians
First the development of clinical rehabilitation
research requires a pool of well-qualified researchers
There are many problems to address with respect
to the recruitment and retention of skilled rehabilita-
tion researchers such as the number of existing
programs and the lack of appropriate mentoring
[320] However it is also important to state an
asset in the field namely the opportunity to draw
students with clinical experience in graduate pro-
grams and research labs Because of the under-
graduate professional curriculum graduate students
are in a substantial number of cases registered
professionals with valuable clinical perspectives This
status and experience contributes significantly to
maintain a much alive relationship between clinicians
and researchers especially for those adopting a
clinician-researcher profile
Funding is an inevitable and recurrent problem
with direct repercussions on sustainable research
activities and on supporting individuals [20] Also
indirectly impacting on research capacity is the
precarious economic situation of health sectors
reported by many occidental countries Reduced
funding in clinical services may result in having busy
clinicians struggling with waiting lists and huge
caseloads This stressful context is likely to reduce
the enthusiasm of many clinicians to participate in
research
The research environment and infrastructure
also strongly impact on our rehabilitation research
capacity Quite sadly it has been stated that research
is often unrecognized as a professional core value
[312] In many instances research activities are
not prioritised within established hospital and reha-
bilitation services For instance research labs
may be geographically close yet perceived as dis-
connected from clinical practice Consequently
these structures sometimes fail to promote con-
nections between clinicians and researchers This
situation reduces the participation of clinicians
even if at the individual level these clinicians
voice a strong interest for advancing research Too
often the burden will lie on researchers to make
additional effort to overcome these organizational
barriers
Within the context of research capacity partner-
ship may be considered at different levels such as
with other scientists universities patients and in-
stitutions [20] Within the perspective of this paper
promoting cliniciansrsquo partnership is vital to enhan-
cing capacity to conduct meaningful research to lead
to EBP as was depicted in Figure 1 Considering
that research is not a stand alone activity it offers
through its different stages many opportunities to
activate these partnerships There is no clear limit to
the roles that clinical partners can play over the
course of a research process [7] The next section
highlights different crucial areas in which they can
actively take part
Partnership across the research process
As the research process unfolds [2122] (see
Figure 2) rehabilitation clinicians can be given many
opportunities to participate in research On each and
every occasion the researcher will benefit from their
input through validation of the various research
activities
Partnership at the stage of conceptualizing the research
In the conceptual phase of research inputs from
clinicians are crucial to help framing the problem
and formulating the research question and its
hypotheses To engage in research it is funda-
mental to identify an area that holds clinical
significance In rehabilitation much of the research
is initiated to determine empirically the need for
novel interventions to inform professional practice
or to examine the extent to which an intervention is
efficient in achieving its outcome [32223]
According to DePoy and Gitlin [22] the clinical
arena is perhaps the most immediate and important
Figure 2 Steps in research process Actions close to rehabilitation
clinicians
154 L Demers amp L Poissant
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source from which research questions evolve Many
of the themes or persistent issues that emerge in
case review staff meetings and discussion of
clientsrsquo needs can be readily translated into relevant
research projects Of course rehabilitation research-
ers will also use other sources for topic identifica-
tion such as published research and existing
theory
Testing the relevance of research questions and
hypotheses with clinicians would appear to make a
lot of sense In comparison with the original idea
research questions or hypotheses may be far more
specialized then the topic area initially considered as
relevant and in many ways even sound quite
reductive Discussing those with clinicians may allow
important issues to be raised at the forefront The
feasibility of the study is a good example of an issue
that both researchers and clinicians would want to
address early In this view an iterative and dynamic
discussion between researchers and clinicians is thus
of paramount importance in allowing for expecta-
tions with respect to future research results to be set
correctly and in encouraging the design of a study
that will meet both partiesrsquo requirements or objec-
tives
The second phase of the research process focuses
on the various components of a study design This is
no simple matter and in many ways it is lsquothersquo part of
a research process that is upheld as requiring definite
scientific training It may also appear to be a bit
daunting for clinicians and even a good reason for
preferring the real world of the clinic Despite all of
this it is the researcherrsquos responsibility to explain the
rationale underlying the methodological aspects
associated with the selected study design For
example clinicians may not be able to appreciate
the need to develop a new measurement instrument
rather than using a modified or home-made
instrument
Partnership at the stage of research actions
The third phase of the research process is quite
crucial with respect to its linkage with rehabilitation
professionals In action research the focus is on the
implementation of the design strategy This would
include among other actions three that are espe-
cially close to clinicians population and sampling
data collection and measurement instruments With
respect to population and sampling it is important
that the target population that is the group of
individuals from which the researcher is able to select
a sample exists in the real world and is accessible
Time and efforts may be saved in defining inclusion
and exclusion criteria that have close correspondence
with the reality of the settings where recruitment
takes place For instance recruiting first-time users
of wheelchairs with no cognitive impairment may
prove to be quite challenging in long term care
settings Clinicians can readily tell researchers
selecting a research site what can be expected
from participants in terms of characteristics and
access to them Feasibility issues as much as science
in many cases will help shape the recruitment
strategy
Measurement instruments are here considered in
relation to pragmatic issues rather than psycho-
metric ones In a study by Auger and colleagues [24]
the importance of using appropriate tools was
emphasized in relation to their applicability ie by
the pragmatic qualities allowing the use of a
measurement tool with a given population or in a
specific context Pragmatic issues will be optimal
when respondent and examiner burden are minimal
score distribution is adequate and format is compa-
tible with respondentsrsquo age culture language and
abilities Considerations such as administration time
simplicity of administration and scoring are crucial to
clinicians and involving them in the selection of
measurement tools in relation to their applicability
is certainly justified
Next data collection and intervention require the
choice of a strategy that will take into consideration
practical aspects associated to study participation
One such issue is the time availability and compet-
ing activities of the study participants For instance
in an emergency department interviews lasting
more than 30 min are bound to be interrupted by
the staff for medical procedures Clinicians can
inform researchers about optimal conditions to
interview patients in specific environments Clin-
icians are best positioned to alert researchers about
tolerance and abilities required for subjectrsquos parti-
cipation The list of relevant clinicians-based
information may also include items such as motiva-
tion toward participation helpful incentives con-
tent and appropriateness of notes and records and
expected collaboration from participants family
members caregivers and staff
It would be a mistake to rely exclusively on
clinicians to recruit collect data and intervene
Unless specific arrangements often financial are
made most clinicians simply do not have time for
these extra tasks They are however good advisors
and can help connecting people together In our
view it is incumbent on the researchers to provide
the additional resources required for achieving
the day-to-day activities inherent to the research
project
Partnership at the stage of disseminating results
The fourth phase of the research process is about
dissemination which is acknowledged to be one
Connecting with clinicians 155
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component of bringing knowledge into action [4]
There are many ways to disseminate research
findings from traditional approaches such as scien-
tific publications oral presentations at scientific
meetings to more innovative approaches such as
computerized evidence-based reviews With respect
to publishing journal articles are probably the most
popular strategies for dissemination of scientific
results Clearly the choice of the journal is of critical
importance and unfortunately researchers and clin-
icians may be completely divergent in their selection
of journal On one hand researchers will target
highly indexed journals which are definitely re-
warded with respect to obtaining grants scholarships
and salary support On the other hand these criteria
may be absolutely meaningless to clinicians who will
select journals on the basis of criteria such as
availability cost and diversity or specificity of its
content But there are others forms of publications
that are potentially very useful with respect to
knowledge dissemination These may include local
newsletter summary articles in professional journals
and local newspapers These other forms should not
be neglected because they are likely to be read by
more people including those who deliver rehabilita-
tion services [12] Although the writing style is
different the basic elements of the research and
most importantly the conclusions are being disse-
minated
Written publications are not the only method for
sharing research results Indeed oral presentations
whether at scientific meeting local events in-
service educational presentations can also be
efficient and have the foremost advantage of
permitting reception of constructive criticism [5]
As for publications the type of audience will
influence the way the study is presented Clinicians
quite rightly may have very pragmatic concerns
about how to implement research results For
researchers it is the ultimate test and challenge
as convinced clinicians are likely to become highly
credible messengers [25] From our experience
getting clinicians excited about study results is the
most rewarding part of the whole process Overall
both clinicians and researchers must ensure they
balance their participation in knowledge dissemina-
tion activities
Novel approaches to push knowledge dissemina-
tion to the stage of action lay within computerized
clinical information systems Order-entry systems
decision support tools reminders are some exam-
ples of innovative approaches that have been
effective in integrating best practices into the
clinical process [26ndash29] Once again establishing a
solid partnership between researchers and clinicians
will optimize adoption of these innovative technolo-
gies [30] and lead to better patient care
Strategies for implementing partnerships
This section describes key strategies that can facil-
itate partnerships between clinicians and researchers
regardless of whether the project originated from the
researcherrsquos perspective or was brought forward by
clinicians
Consider expertsrsquo committees
Being invited as an expert either as a clinician or as a
researcher brings personal satisfaction by valuing
expertise and favouring the perception of contribut-
ing to knowledge Expert committee sessions need
careful preparation and can take different forms such
as focus groups nominal groups or use specific
techniques like the Technique for Research of
Information by Animation of a Group of Experts
(TRIAGE) [31] Regardless of the technique
partnership will be reinforced if the outputs of these
sessions are made available to all clinicians after the
meeting [32]
Consider group discussions and information sessions
Less formal group discussions and information
sessions can be useful means for obtaining feedback
generating ideas and sharing progress Both types of
groups require identification of clear goals and
expectations from respective parties These sessions
must benefit researchers but also clinicians One
advantage of these sessions over the expert groups
may be the opportunity to get spontaneous ideas or
comments Attending weekly clinical meetings may
pay off in ensuring active clinical participation and
involvement in research projects
Consider seeking direct advice
Perhaps one of the most readily available strategies to
clinicians and researchers is to seek direct advice
from each other Discussing on a one-to-one basis is
likely to be perceived as rewarding provided it is
done in a timely manner with utmost respect for
busy schedules From a researchrsquos perspective
this approach may encourage clinicians to become
active collaborators on a research project and may
help removing potential barriers in conducting a
study
Consider undergraduate students
Undergraduate students are future clinicians
Providing opportunities for students to see research
environments discuss projects will make them more
acutely aware of the possibilities constraints and
challenges involved in conducting research Hiring
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undergraduate students during the summer to work
on clinical research projects is a concrete way to
reinforce partnerships between clinicians and re-
searchers
Consider clinicians initiated projects
A second perspective to consider in enhancing
connections with clinicians is to get researchers to
collaborate on clinical research projects If such an
opportunity occurs it would be judicious to take it
As collaborators researchers should modestly assist
the clinicians in moving their project forward It is
important to be constructive and understand the goal
behind the initiative A given project may not lead to
a publication but may lead to improve patient
care and overall this should be recognized by
researchers as a legitimate goal and reason for their
implication
Consider networking
Next it is important to take part in broader events
involving the participation of varied stakeholders
including clinicians and researchers as well as clients
policy-makers and health managers Symposiums
colloquiums and network meetings are exceptional
forums to learn about whatrsquos going on in the field of
rehabilitation to influence decisions to connect with
potential collaborators to understand the struggle
others have to go through and to build research that
is meaningfully grounded Striking differences may
be observed in the way clinicians with different
professional background researchers and managers
consider problems that are raised in these network
gatherings Some may be focussed on training issues
costs data collection and staff turnover Others may
be worried about time constraints and how to let go of
pre-existing approaches to assessment or treatment
Yet others may be centered on theoretical issues
Again the richness of the exchanges between various
points of view is critical in choosing and developing
ultimately the evaluations and interventions that may
best serve patients
Consider developing communities of practice
Communities of practice (CoPs) refer to groups of
individuals who share common ideas goals and
interest and work together in pursuit of these goals
[33] A CoP aimed at strengthening rehabilitation
research through goal-directed activities would in-
corporate clinicians decision-makers and research-
ers The collaborative work and knowledge
exchanges that characterize CoPs have been identi-
fied as an effective way to accelerate knowledge
dissemination and to encourage adoption of
innovations [34] An emergent concept in the
healthcare system CoPs will undoubtedly find
adopters in the rehabilitation field
Conclusion
Gaps and challenges
Over the past few years reducing the gap between
clinicians and researchers has become a priority
Furthermore research is now being conducted to
better understand and identify the best strategies to
increase knowledge uptake by clinicians Interest-
ingly the outcomes of this emerging research
domain around knowledge exchange targets not only
clinicians but also researchers Indeed researchers
will need to take an active role in updating their
dissemination strategies to better match the needs of
clinicians
Throughout this paper we demonstrated the
necessity to create sustainable and dynamic links
between the clinical and research communities to
strengthen rehabilitation research and improve qual-
ity of rehabilitation care and services Clinicians and
researchers have different priorities and concerns
yet we provided concrete approaches to overcome
these differences Accordingly clinicians and re-
searchers move at different speeds While researchers
make small and very slow steps toward the best
possible knowledge clinicians constantly face pro-
blems that require rapid solutions What services are
required What is the level of pain now Can this
person drive safely These decisions bear a lot of
consequences and can hardly wait Not surprisingly
how little can be accomplished in research for
immediate and urgent clinical problem may be seen
as an obstacle in the relationship between clinicians
and researchers and nourish the perception that
these two worlds are incompatible Again through-
out the paper we presented ideas and approaches
that should remove these attitudinal barriers
The reality faced by healthcare professionals and
managers must also be taken into consideration We
acknowledge the fact that the shortage of resources
and constant pressures to be effective and efficient
restrict the latitude of clinicians to participate in
research activities This situation is prone to lead to
frustration unless both parties join their efforts to
ensure that research activities are prioritized within
an organization or health network
Overall each opportunity at hand that favours
connecting clinicians and researchers must be
explored and reinforced An example of such
opportunity which was raised earlier in this paper
is to increase the number of research-trained
clinicians With the imminent move towards a
master-entry level for rehabilitation disciplines in
Connecting with clinicians 157
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occidental countries more classroom time will be
devoted to research and its clinical impacts More-
over field work completed as part of the upgraded
curriculum will have a much stronger research
component attached to it These new legal-profes-
sional requirements associated to an increased
number of clinicians accessing graduate programs
and going back to clinical environments will have
major impact on clinical practice Future clinicians
will indeed have the capacity to take on the role of
leaders to improve care and services through the
adoption of best practices
Connecting researchers and clinicians has many
facets all of which may be considered as adding
value to rehabilitation research and clinical practice
The broad scope of topics methods and populations
covered by rehabilitation researchers and clinicians
highlights the need to develop and reinforce this
connection The implementation of traditional and
innovative approaches described in this paper will
encourage both clinicians and researchers to develop
sustainable partnerships which in turn will optimize
rehabilitation care and services
Acknowledgements
The authors are supported by the lsquolsquoFonds de la
recherche en sante du Quebecrsquorsquo An earlier version of
this paper was presented as a keynote presentation by
the first author to the 10th Research Colloquium on
Rehabilitation McGill University Quebec Canada
on May 4 2006
Declaration of interest The authors report no
conflicts of interest The authors alone are respon-
sible for the content and writing of the paper
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1074
3 Ilott I Challenges and strategic solutions for a research
emergent profession Am J Occupat Ther 200458347ndash352
4 Graham ID Logan J Harrison MB Straus SE Tetroe J
Caswell W Robinson N Lost in knowledge translation
Time for a map J Continuing Educ Health Professions 2006
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5 Stratton Johnson L From knowledge transfer to knowledge
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2005711ndash14
6 Bowen S Martens PJ A model for collaborative evaluation of
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7 Taylor RR Suarez-Balcazar Y Forsyth K Kielhofner G
Participatory research in occupational therapy In Kielhofner
G editor Research in occupational therapy Philadelphia
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8 Sudsawad P Definition evolution and implementation
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9 Whalley Hammel K Carpenter C Qualitative research in
evidence-based rehabilitation Edinburgh Churchill Living-
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10 Law M Evidence-based rehabilitation A guide to practice
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11 Baker NA Analyzing evidence for practice In Kielhofner G
editor Research in occupational therapy Philadelphia FA
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12 Egan M Canadian occupational therapy research The little
profession that could Canad J Occupat Ther 200168143ndash
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13 Korner-Bitenski N Wood-Dauphinee S Teasell R Hanley J
Harrison M Kaizer F Kehayia E Menon A Survey of
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14 McCluskey A Managing change and barriers to evidence-
based practice In Kielhofner G editor Research in
occupational therapy Philadelphia FA Davis 2006 pp
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Functioning Disability and Health Geneva World Health
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16 Stucki G International Classification of Functioning Dis-
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classification for rehabilitation medicine Am J Phys Med
Rehabil 200584733ndash740
17 Jette AM Keysor J Coster W Ni P Haley S Beyond
function Predicting participation in a rehabilitation cohort
Arch Phys Med Rehabil 2005862087ndash2094
18 Salter K Jutai JW Teasell R Foley NC Bitensky J Issues for
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Body Functions Disabil Rehabil 200527191ndash207
19 Mayo NE Poissant L Ahmed S Finch L Higgins J Salbach
NM Soicher J Jaglal S Incorporating the International
Classification of Functioning Disability and Health (ICF)
into an electronic health record to create indicators of func-
tion Proof of concept using the SF-12 J Am Med Informatics
Assoc 200411514ndash522
20 Frontera WR Fuhrer MJ Jette AM Chan L Cooper RA
Duncan PW Kemp JD Ottenbacher KJ Peckham PH Roth
EJ et al Rehabilitation medicine summit Building research
capacity (executive summary) Am J Speech Lang Pathol
2006153ndash14
21 Contandriopoulos A-P Champagne F Potvin L Denis J-L
Boyle P Savoir preparer une recherche la definir la
structurer la financer Montreal Les Presses de lrsquoUniversite
de Montreal 1990 193 p
22 DePoy E Gitlin LN Introduction to research understanding
and applying multiple strategies St Louis Elsevier Mosby
2005 346 p
23 Kielhofner G The neccessity of research in a profession In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 1ndash9
24 Auger C Demers L Swaine B Making sense of pragmatic
criteria for the selection of geriatric rehabilitation measure-
ment tools Arch Gerontol Geriatrics 20064365ndash83
25 Reardon R Lavis J Gibson J 2006 May 25 From research to
practice A knowledge transfer planning guide Accessed 25
May 2007 from the website http Institute for Work amp
Health
26 Hunt DL Haynes RB Hanna SE Smith K Effects of
computer-based clinical decision support systems on physi-
cian performance and patient outcomes A systematic review
JAMA 19982801339ndash1346
158 L Demers amp L Poissant
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onal
use
onl
y
27 Patel VL Kushniruk AW Yang S Yale JF Impact of a
computer-based patient record system on data collection
knowledge organization and reasoning J Am Med Infor-
matics Assoc 20007569ndash585
28 Raschke RA Gollihare B Wunderlich TA Guidry JR
Leibowitz AI Peirce JC Lemelson L Heisler MA Susong
C A computer alert system to prevent injury from adverse
drug events Development and evaluation in a community
teaching hospital JAMA 19982801317ndash1320
29 Tamblyn R Huang A Kawasumi Y Bartlett G Grad R
Jacques A Dawes M Abrahamowicz M Perreault R Taylor
L et al The development and evaluation of an integrated
electronic prescribing and drug management system for
primary care J Am Med Informatics Assoc 200613148ndash159
30 Bates DW Kuperman GJ Wang S Gandhi T Kittler A Volk
L Spurr C Khorasani R Tanasijevic M Middleton B Ten
commandments for effective clinical decision support making
the practice of evidence-based medicine a reality J Am Med
Informatics Assoc 200310523ndash530
31 Gervais M Pepin C Carriere M TRIAGE ou comment adapter
une technique de recherche a lrsquointervention en ergotherapie
Revue Quebecoise drsquoErgotherapie 2000911ndash15
32 Morgan DL Scannell AU Planning focus groups Morgan
DL Krueger RA editors Thousand Oaks Sage 1997 139 p
33 Weinger MB Herndon OW Gaba DM The effect of
electronic record keeping and transesophageal echocardio-
graphy on task distribution workload and vigilance during
cardiac anesthesia Anesthesiology 199787144ndash155 discus-
sion 129Andash130A
34 McDermott R 1999 May 25 Nurturing three dimensional
communities of practice How to get the most out of human
works In Knowledge management review Accessed 25
May 2007 from the website http wwwco-i-lcomcoil
knowledge-gardencopdimensional
Connecting with clinicians 159
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and review various strategies incumbent upon
researchers to promote better interaction with
clinicians Finally challenges in reducing the gap
between research and clinical practice will be
discussed
Linking rehabilitation research and practice
Consider evidence-based practice
Evidence-based practice (EBP) links rehabilitation
research to practice Undoubtedly an important
ingredient for a common vision in rehabilitation
[89] EBP is defined as an approach to health care
practice where the clinician is aware of the evidence
that bears on his or her practice and of the strength
of that evidence (Health Informatics Research Unit
in Law [10]) Of course one key pre-requisite to
EBP is the availability of sound valid reliable useful
and meaningful research Through the use of current
best evidence in treatment EBP at the same time
facilitates recognition for knowledge creation in
certain clinical areas Evidence gaps are powerful
catalysts that lead to research advances or initiatives
ongoing work development and in some cases an
increased interest of clinicians towards research
training Its role in shaping the future of both clinical
practice and research should not be overlooked
[1011] The relationship between research practice
and need for knowledge is illustrated in Figure 1
Implementing EBP in a sustainable way remains
challenging both from research and clinical perspec-
tives Clinicians face several challenges in searching
evaluating evidence and then applying these findings
in a meaningful way especially in a context of lack of
time difficult access to resources and limited critical
appraisal skills [3812] Despite limited effectiveness
in changing clinical practice attending scientific
events and reading scientific journals are commons
means of accessing new knowledge by clinicians yet
these remain unavailable to many of them [13]
Moreover bringing changes into practice is not an
easy task [14] Conversely researchers are pressured
to design obtain financial support measure evaluate
and communicate useful research in a timely
manner
Consider conceptual background
Rehabilitation research rests on scientific methods
and principles [1] That statement being said
characterizing rehabilitation research is quite com-
plex This complexity comes from the fact that
rehabilitation research is a broad-based discipline
including multidisciplinary domains and covering a
wide range of fundamental clinical evaluative and
epidemiological issues [1] An interesting way to
illustrate the diversity of research topics in the area of
rehabilitation is through the use of the International
Classification for Functioning Disability and Health
(ICF) [15] The ICF multi-perspective approach to
the classification of human functioning is frequently
used as a unifying framework to delineate the
inclusive nature of rehabilitation research [16]
Several researchers evoke the ICF to organize and
present research programs and results [1718] For
example Mayo et al [19] mapped several outcome
measures at the item level to the ICF terminology to
characterize stroke survivorsrsquo health-related quality
of life in comparison to community-dwelling survi-
vors Using the ICF as a unifying framework
facilitates interpretation of their results which are
presented with a common international vocabulary
instead of scalesrsquo specific descriptors Unfortunately
because of feasibility funding or methodological
considerations researchers tend to restrict the focus
of their studies one or two components of the ICF
Rehabilitation practice is just as complex as
rehabilitation research Not only does it covers a
wide range of disabling conditions treatment tech-
niques clinical and non-clinical settings and cross-
disciplinary efforts [1] but it rests on humanistic care
requiring from clinicians that they use creative skills
knowledge and emotions to treat and care for
patients [1] As with rehabilitation research the
richness and wide scope of rehabilitation practice is
well illustrated through the ICF More and more
clinicians are adopting the ICF to interconnect the
body functions and structures as well as environ-
mental and personal factors that impact on an
individualrsquos activities and participation In this
regard clinical practice appears to contrast with
rehabilitation research since clinicians look at clients
with a global perspective hence include all of the ICF
components
Consider the development of research capacity
A third way to link rehabilitation research and
clinical practice is in developing research capacityFigure 1 Relationships between research practice and need for
data
Connecting with clinicians 153
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Over the past years the increase in research capacity
has been pushed forward with the involvement of
clinicians Research capacity in rehabilitation was
defined by Frontera and colleagues [20] as a process
of development which leads to higher levels of skills
and greater ability to perform useful research Five
elements that contribute to research capacity were
identified (i) Researchers (ii) funding (iii) research
environment infrastructure and culture (iv) part-
nerships and (v) metrics Metrics is concerned with
the assessment of capacity over time to gauge
progress and will not be further discussed The
other elements however may all be linked to
clinicians
First the development of clinical rehabilitation
research requires a pool of well-qualified researchers
There are many problems to address with respect
to the recruitment and retention of skilled rehabilita-
tion researchers such as the number of existing
programs and the lack of appropriate mentoring
[320] However it is also important to state an
asset in the field namely the opportunity to draw
students with clinical experience in graduate pro-
grams and research labs Because of the under-
graduate professional curriculum graduate students
are in a substantial number of cases registered
professionals with valuable clinical perspectives This
status and experience contributes significantly to
maintain a much alive relationship between clinicians
and researchers especially for those adopting a
clinician-researcher profile
Funding is an inevitable and recurrent problem
with direct repercussions on sustainable research
activities and on supporting individuals [20] Also
indirectly impacting on research capacity is the
precarious economic situation of health sectors
reported by many occidental countries Reduced
funding in clinical services may result in having busy
clinicians struggling with waiting lists and huge
caseloads This stressful context is likely to reduce
the enthusiasm of many clinicians to participate in
research
The research environment and infrastructure
also strongly impact on our rehabilitation research
capacity Quite sadly it has been stated that research
is often unrecognized as a professional core value
[312] In many instances research activities are
not prioritised within established hospital and reha-
bilitation services For instance research labs
may be geographically close yet perceived as dis-
connected from clinical practice Consequently
these structures sometimes fail to promote con-
nections between clinicians and researchers This
situation reduces the participation of clinicians
even if at the individual level these clinicians
voice a strong interest for advancing research Too
often the burden will lie on researchers to make
additional effort to overcome these organizational
barriers
Within the context of research capacity partner-
ship may be considered at different levels such as
with other scientists universities patients and in-
stitutions [20] Within the perspective of this paper
promoting cliniciansrsquo partnership is vital to enhan-
cing capacity to conduct meaningful research to lead
to EBP as was depicted in Figure 1 Considering
that research is not a stand alone activity it offers
through its different stages many opportunities to
activate these partnerships There is no clear limit to
the roles that clinical partners can play over the
course of a research process [7] The next section
highlights different crucial areas in which they can
actively take part
Partnership across the research process
As the research process unfolds [2122] (see
Figure 2) rehabilitation clinicians can be given many
opportunities to participate in research On each and
every occasion the researcher will benefit from their
input through validation of the various research
activities
Partnership at the stage of conceptualizing the research
In the conceptual phase of research inputs from
clinicians are crucial to help framing the problem
and formulating the research question and its
hypotheses To engage in research it is funda-
mental to identify an area that holds clinical
significance In rehabilitation much of the research
is initiated to determine empirically the need for
novel interventions to inform professional practice
or to examine the extent to which an intervention is
efficient in achieving its outcome [32223]
According to DePoy and Gitlin [22] the clinical
arena is perhaps the most immediate and important
Figure 2 Steps in research process Actions close to rehabilitation
clinicians
154 L Demers amp L Poissant
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source from which research questions evolve Many
of the themes or persistent issues that emerge in
case review staff meetings and discussion of
clientsrsquo needs can be readily translated into relevant
research projects Of course rehabilitation research-
ers will also use other sources for topic identifica-
tion such as published research and existing
theory
Testing the relevance of research questions and
hypotheses with clinicians would appear to make a
lot of sense In comparison with the original idea
research questions or hypotheses may be far more
specialized then the topic area initially considered as
relevant and in many ways even sound quite
reductive Discussing those with clinicians may allow
important issues to be raised at the forefront The
feasibility of the study is a good example of an issue
that both researchers and clinicians would want to
address early In this view an iterative and dynamic
discussion between researchers and clinicians is thus
of paramount importance in allowing for expecta-
tions with respect to future research results to be set
correctly and in encouraging the design of a study
that will meet both partiesrsquo requirements or objec-
tives
The second phase of the research process focuses
on the various components of a study design This is
no simple matter and in many ways it is lsquothersquo part of
a research process that is upheld as requiring definite
scientific training It may also appear to be a bit
daunting for clinicians and even a good reason for
preferring the real world of the clinic Despite all of
this it is the researcherrsquos responsibility to explain the
rationale underlying the methodological aspects
associated with the selected study design For
example clinicians may not be able to appreciate
the need to develop a new measurement instrument
rather than using a modified or home-made
instrument
Partnership at the stage of research actions
The third phase of the research process is quite
crucial with respect to its linkage with rehabilitation
professionals In action research the focus is on the
implementation of the design strategy This would
include among other actions three that are espe-
cially close to clinicians population and sampling
data collection and measurement instruments With
respect to population and sampling it is important
that the target population that is the group of
individuals from which the researcher is able to select
a sample exists in the real world and is accessible
Time and efforts may be saved in defining inclusion
and exclusion criteria that have close correspondence
with the reality of the settings where recruitment
takes place For instance recruiting first-time users
of wheelchairs with no cognitive impairment may
prove to be quite challenging in long term care
settings Clinicians can readily tell researchers
selecting a research site what can be expected
from participants in terms of characteristics and
access to them Feasibility issues as much as science
in many cases will help shape the recruitment
strategy
Measurement instruments are here considered in
relation to pragmatic issues rather than psycho-
metric ones In a study by Auger and colleagues [24]
the importance of using appropriate tools was
emphasized in relation to their applicability ie by
the pragmatic qualities allowing the use of a
measurement tool with a given population or in a
specific context Pragmatic issues will be optimal
when respondent and examiner burden are minimal
score distribution is adequate and format is compa-
tible with respondentsrsquo age culture language and
abilities Considerations such as administration time
simplicity of administration and scoring are crucial to
clinicians and involving them in the selection of
measurement tools in relation to their applicability
is certainly justified
Next data collection and intervention require the
choice of a strategy that will take into consideration
practical aspects associated to study participation
One such issue is the time availability and compet-
ing activities of the study participants For instance
in an emergency department interviews lasting
more than 30 min are bound to be interrupted by
the staff for medical procedures Clinicians can
inform researchers about optimal conditions to
interview patients in specific environments Clin-
icians are best positioned to alert researchers about
tolerance and abilities required for subjectrsquos parti-
cipation The list of relevant clinicians-based
information may also include items such as motiva-
tion toward participation helpful incentives con-
tent and appropriateness of notes and records and
expected collaboration from participants family
members caregivers and staff
It would be a mistake to rely exclusively on
clinicians to recruit collect data and intervene
Unless specific arrangements often financial are
made most clinicians simply do not have time for
these extra tasks They are however good advisors
and can help connecting people together In our
view it is incumbent on the researchers to provide
the additional resources required for achieving
the day-to-day activities inherent to the research
project
Partnership at the stage of disseminating results
The fourth phase of the research process is about
dissemination which is acknowledged to be one
Connecting with clinicians 155
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component of bringing knowledge into action [4]
There are many ways to disseminate research
findings from traditional approaches such as scien-
tific publications oral presentations at scientific
meetings to more innovative approaches such as
computerized evidence-based reviews With respect
to publishing journal articles are probably the most
popular strategies for dissemination of scientific
results Clearly the choice of the journal is of critical
importance and unfortunately researchers and clin-
icians may be completely divergent in their selection
of journal On one hand researchers will target
highly indexed journals which are definitely re-
warded with respect to obtaining grants scholarships
and salary support On the other hand these criteria
may be absolutely meaningless to clinicians who will
select journals on the basis of criteria such as
availability cost and diversity or specificity of its
content But there are others forms of publications
that are potentially very useful with respect to
knowledge dissemination These may include local
newsletter summary articles in professional journals
and local newspapers These other forms should not
be neglected because they are likely to be read by
more people including those who deliver rehabilita-
tion services [12] Although the writing style is
different the basic elements of the research and
most importantly the conclusions are being disse-
minated
Written publications are not the only method for
sharing research results Indeed oral presentations
whether at scientific meeting local events in-
service educational presentations can also be
efficient and have the foremost advantage of
permitting reception of constructive criticism [5]
As for publications the type of audience will
influence the way the study is presented Clinicians
quite rightly may have very pragmatic concerns
about how to implement research results For
researchers it is the ultimate test and challenge
as convinced clinicians are likely to become highly
credible messengers [25] From our experience
getting clinicians excited about study results is the
most rewarding part of the whole process Overall
both clinicians and researchers must ensure they
balance their participation in knowledge dissemina-
tion activities
Novel approaches to push knowledge dissemina-
tion to the stage of action lay within computerized
clinical information systems Order-entry systems
decision support tools reminders are some exam-
ples of innovative approaches that have been
effective in integrating best practices into the
clinical process [26ndash29] Once again establishing a
solid partnership between researchers and clinicians
will optimize adoption of these innovative technolo-
gies [30] and lead to better patient care
Strategies for implementing partnerships
This section describes key strategies that can facil-
itate partnerships between clinicians and researchers
regardless of whether the project originated from the
researcherrsquos perspective or was brought forward by
clinicians
Consider expertsrsquo committees
Being invited as an expert either as a clinician or as a
researcher brings personal satisfaction by valuing
expertise and favouring the perception of contribut-
ing to knowledge Expert committee sessions need
careful preparation and can take different forms such
as focus groups nominal groups or use specific
techniques like the Technique for Research of
Information by Animation of a Group of Experts
(TRIAGE) [31] Regardless of the technique
partnership will be reinforced if the outputs of these
sessions are made available to all clinicians after the
meeting [32]
Consider group discussions and information sessions
Less formal group discussions and information
sessions can be useful means for obtaining feedback
generating ideas and sharing progress Both types of
groups require identification of clear goals and
expectations from respective parties These sessions
must benefit researchers but also clinicians One
advantage of these sessions over the expert groups
may be the opportunity to get spontaneous ideas or
comments Attending weekly clinical meetings may
pay off in ensuring active clinical participation and
involvement in research projects
Consider seeking direct advice
Perhaps one of the most readily available strategies to
clinicians and researchers is to seek direct advice
from each other Discussing on a one-to-one basis is
likely to be perceived as rewarding provided it is
done in a timely manner with utmost respect for
busy schedules From a researchrsquos perspective
this approach may encourage clinicians to become
active collaborators on a research project and may
help removing potential barriers in conducting a
study
Consider undergraduate students
Undergraduate students are future clinicians
Providing opportunities for students to see research
environments discuss projects will make them more
acutely aware of the possibilities constraints and
challenges involved in conducting research Hiring
156 L Demers amp L Poissant
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undergraduate students during the summer to work
on clinical research projects is a concrete way to
reinforce partnerships between clinicians and re-
searchers
Consider clinicians initiated projects
A second perspective to consider in enhancing
connections with clinicians is to get researchers to
collaborate on clinical research projects If such an
opportunity occurs it would be judicious to take it
As collaborators researchers should modestly assist
the clinicians in moving their project forward It is
important to be constructive and understand the goal
behind the initiative A given project may not lead to
a publication but may lead to improve patient
care and overall this should be recognized by
researchers as a legitimate goal and reason for their
implication
Consider networking
Next it is important to take part in broader events
involving the participation of varied stakeholders
including clinicians and researchers as well as clients
policy-makers and health managers Symposiums
colloquiums and network meetings are exceptional
forums to learn about whatrsquos going on in the field of
rehabilitation to influence decisions to connect with
potential collaborators to understand the struggle
others have to go through and to build research that
is meaningfully grounded Striking differences may
be observed in the way clinicians with different
professional background researchers and managers
consider problems that are raised in these network
gatherings Some may be focussed on training issues
costs data collection and staff turnover Others may
be worried about time constraints and how to let go of
pre-existing approaches to assessment or treatment
Yet others may be centered on theoretical issues
Again the richness of the exchanges between various
points of view is critical in choosing and developing
ultimately the evaluations and interventions that may
best serve patients
Consider developing communities of practice
Communities of practice (CoPs) refer to groups of
individuals who share common ideas goals and
interest and work together in pursuit of these goals
[33] A CoP aimed at strengthening rehabilitation
research through goal-directed activities would in-
corporate clinicians decision-makers and research-
ers The collaborative work and knowledge
exchanges that characterize CoPs have been identi-
fied as an effective way to accelerate knowledge
dissemination and to encourage adoption of
innovations [34] An emergent concept in the
healthcare system CoPs will undoubtedly find
adopters in the rehabilitation field
Conclusion
Gaps and challenges
Over the past few years reducing the gap between
clinicians and researchers has become a priority
Furthermore research is now being conducted to
better understand and identify the best strategies to
increase knowledge uptake by clinicians Interest-
ingly the outcomes of this emerging research
domain around knowledge exchange targets not only
clinicians but also researchers Indeed researchers
will need to take an active role in updating their
dissemination strategies to better match the needs of
clinicians
Throughout this paper we demonstrated the
necessity to create sustainable and dynamic links
between the clinical and research communities to
strengthen rehabilitation research and improve qual-
ity of rehabilitation care and services Clinicians and
researchers have different priorities and concerns
yet we provided concrete approaches to overcome
these differences Accordingly clinicians and re-
searchers move at different speeds While researchers
make small and very slow steps toward the best
possible knowledge clinicians constantly face pro-
blems that require rapid solutions What services are
required What is the level of pain now Can this
person drive safely These decisions bear a lot of
consequences and can hardly wait Not surprisingly
how little can be accomplished in research for
immediate and urgent clinical problem may be seen
as an obstacle in the relationship between clinicians
and researchers and nourish the perception that
these two worlds are incompatible Again through-
out the paper we presented ideas and approaches
that should remove these attitudinal barriers
The reality faced by healthcare professionals and
managers must also be taken into consideration We
acknowledge the fact that the shortage of resources
and constant pressures to be effective and efficient
restrict the latitude of clinicians to participate in
research activities This situation is prone to lead to
frustration unless both parties join their efforts to
ensure that research activities are prioritized within
an organization or health network
Overall each opportunity at hand that favours
connecting clinicians and researchers must be
explored and reinforced An example of such
opportunity which was raised earlier in this paper
is to increase the number of research-trained
clinicians With the imminent move towards a
master-entry level for rehabilitation disciplines in
Connecting with clinicians 157
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occidental countries more classroom time will be
devoted to research and its clinical impacts More-
over field work completed as part of the upgraded
curriculum will have a much stronger research
component attached to it These new legal-profes-
sional requirements associated to an increased
number of clinicians accessing graduate programs
and going back to clinical environments will have
major impact on clinical practice Future clinicians
will indeed have the capacity to take on the role of
leaders to improve care and services through the
adoption of best practices
Connecting researchers and clinicians has many
facets all of which may be considered as adding
value to rehabilitation research and clinical practice
The broad scope of topics methods and populations
covered by rehabilitation researchers and clinicians
highlights the need to develop and reinforce this
connection The implementation of traditional and
innovative approaches described in this paper will
encourage both clinicians and researchers to develop
sustainable partnerships which in turn will optimize
rehabilitation care and services
Acknowledgements
The authors are supported by the lsquolsquoFonds de la
recherche en sante du Quebecrsquorsquo An earlier version of
this paper was presented as a keynote presentation by
the first author to the 10th Research Colloquium on
Rehabilitation McGill University Quebec Canada
on May 4 2006
Declaration of interest The authors report no
conflicts of interest The authors alone are respon-
sible for the content and writing of the paper
References
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Arch Phys Med Rehabil 200687160ndash166
2 Cicerone KD Evidence-based practice and the limits of
rational rehabilitation Arch Phys Med Rehabil 2005861073ndash
1074
3 Ilott I Challenges and strategic solutions for a research
emergent profession Am J Occupat Ther 200458347ndash352
4 Graham ID Logan J Harrison MB Straus SE Tetroe J
Caswell W Robinson N Lost in knowledge translation
Time for a map J Continuing Educ Health Professions 2006
2613ndash24
5 Stratton Johnson L From knowledge transfer to knowledge
translation Applying research to practice Occupat Ther Now
2005711ndash14
6 Bowen S Martens PJ A model for collaborative evaluation of
university-community partnerships Epidemiol Community
Health 200660902ndash907
7 Taylor RR Suarez-Balcazar Y Forsyth K Kielhofner G
Participatory research in occupational therapy In Kielhofner
G editor Research in occupational therapy Philadelphia
FA Davis 2006 pp 620ndash631
8 Sudsawad P Definition evolution and implementation
of evidence-based practice in occupational therapy In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 656ndash662
9 Whalley Hammel K Carpenter C Qualitative research in
evidence-based rehabilitation Edinburgh Churchill Living-
stone 2004 148 p
10 Law M Evidence-based rehabilitation A guide to practice
Thorofare Slack 2002 364 p
11 Baker NA Analyzing evidence for practice In Kielhofner G
editor Research in occupational therapy Philadelphia FA
Davis 2006 pp 663ndash684
12 Egan M Canadian occupational therapy research The little
profession that could Canad J Occupat Ther 200168143ndash
148
13 Korner-Bitenski N Wood-Dauphinee S Teasell R Hanley J
Harrison M Kaizer F Kehayia E Menon A Survey of
occupational therapy practices for stroke Canad J Occupat
Ther 2005(Suppl 1)33
14 McCluskey A Managing change and barriers to evidence-
based practice In Kielhofner G editor Research in
occupational therapy Philadelphia FA Davis 2006 pp
685ndash696
15 World Health Organization International Classification of
Functioning Disability and Health Geneva World Health
Organization 2001 306 p
16 Stucki G International Classification of Functioning Dis-
ability and Health (ICF) A promising framework and
classification for rehabilitation medicine Am J Phys Med
Rehabil 200584733ndash740
17 Jette AM Keysor J Coster W Ni P Haley S Beyond
function Predicting participation in a rehabilitation cohort
Arch Phys Med Rehabil 2005862087ndash2094
18 Salter K Jutai JW Teasell R Foley NC Bitensky J Issues for
selection of outcome measures in stroke rehabilitation ICF
Body Functions Disabil Rehabil 200527191ndash207
19 Mayo NE Poissant L Ahmed S Finch L Higgins J Salbach
NM Soicher J Jaglal S Incorporating the International
Classification of Functioning Disability and Health (ICF)
into an electronic health record to create indicators of func-
tion Proof of concept using the SF-12 J Am Med Informatics
Assoc 200411514ndash522
20 Frontera WR Fuhrer MJ Jette AM Chan L Cooper RA
Duncan PW Kemp JD Ottenbacher KJ Peckham PH Roth
EJ et al Rehabilitation medicine summit Building research
capacity (executive summary) Am J Speech Lang Pathol
2006153ndash14
21 Contandriopoulos A-P Champagne F Potvin L Denis J-L
Boyle P Savoir preparer une recherche la definir la
structurer la financer Montreal Les Presses de lrsquoUniversite
de Montreal 1990 193 p
22 DePoy E Gitlin LN Introduction to research understanding
and applying multiple strategies St Louis Elsevier Mosby
2005 346 p
23 Kielhofner G The neccessity of research in a profession In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 1ndash9
24 Auger C Demers L Swaine B Making sense of pragmatic
criteria for the selection of geriatric rehabilitation measure-
ment tools Arch Gerontol Geriatrics 20064365ndash83
25 Reardon R Lavis J Gibson J 2006 May 25 From research to
practice A knowledge transfer planning guide Accessed 25
May 2007 from the website http Institute for Work amp
Health
26 Hunt DL Haynes RB Hanna SE Smith K Effects of
computer-based clinical decision support systems on physi-
cian performance and patient outcomes A systematic review
JAMA 19982801339ndash1346
158 L Demers amp L Poissant
Dis
abil
Reh
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ded
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ealth
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com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
27 Patel VL Kushniruk AW Yang S Yale JF Impact of a
computer-based patient record system on data collection
knowledge organization and reasoning J Am Med Infor-
matics Assoc 20007569ndash585
28 Raschke RA Gollihare B Wunderlich TA Guidry JR
Leibowitz AI Peirce JC Lemelson L Heisler MA Susong
C A computer alert system to prevent injury from adverse
drug events Development and evaluation in a community
teaching hospital JAMA 19982801317ndash1320
29 Tamblyn R Huang A Kawasumi Y Bartlett G Grad R
Jacques A Dawes M Abrahamowicz M Perreault R Taylor
L et al The development and evaluation of an integrated
electronic prescribing and drug management system for
primary care J Am Med Informatics Assoc 200613148ndash159
30 Bates DW Kuperman GJ Wang S Gandhi T Kittler A Volk
L Spurr C Khorasani R Tanasijevic M Middleton B Ten
commandments for effective clinical decision support making
the practice of evidence-based medicine a reality J Am Med
Informatics Assoc 200310523ndash530
31 Gervais M Pepin C Carriere M TRIAGE ou comment adapter
une technique de recherche a lrsquointervention en ergotherapie
Revue Quebecoise drsquoErgotherapie 2000911ndash15
32 Morgan DL Scannell AU Planning focus groups Morgan
DL Krueger RA editors Thousand Oaks Sage 1997 139 p
33 Weinger MB Herndon OW Gaba DM The effect of
electronic record keeping and transesophageal echocardio-
graphy on task distribution workload and vigilance during
cardiac anesthesia Anesthesiology 199787144ndash155 discus-
sion 129Andash130A
34 McDermott R 1999 May 25 Nurturing three dimensional
communities of practice How to get the most out of human
works In Knowledge management review Accessed 25
May 2007 from the website http wwwco-i-lcomcoil
knowledge-gardencopdimensional
Connecting with clinicians 159
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For
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onal
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onl
y
Over the past years the increase in research capacity
has been pushed forward with the involvement of
clinicians Research capacity in rehabilitation was
defined by Frontera and colleagues [20] as a process
of development which leads to higher levels of skills
and greater ability to perform useful research Five
elements that contribute to research capacity were
identified (i) Researchers (ii) funding (iii) research
environment infrastructure and culture (iv) part-
nerships and (v) metrics Metrics is concerned with
the assessment of capacity over time to gauge
progress and will not be further discussed The
other elements however may all be linked to
clinicians
First the development of clinical rehabilitation
research requires a pool of well-qualified researchers
There are many problems to address with respect
to the recruitment and retention of skilled rehabilita-
tion researchers such as the number of existing
programs and the lack of appropriate mentoring
[320] However it is also important to state an
asset in the field namely the opportunity to draw
students with clinical experience in graduate pro-
grams and research labs Because of the under-
graduate professional curriculum graduate students
are in a substantial number of cases registered
professionals with valuable clinical perspectives This
status and experience contributes significantly to
maintain a much alive relationship between clinicians
and researchers especially for those adopting a
clinician-researcher profile
Funding is an inevitable and recurrent problem
with direct repercussions on sustainable research
activities and on supporting individuals [20] Also
indirectly impacting on research capacity is the
precarious economic situation of health sectors
reported by many occidental countries Reduced
funding in clinical services may result in having busy
clinicians struggling with waiting lists and huge
caseloads This stressful context is likely to reduce
the enthusiasm of many clinicians to participate in
research
The research environment and infrastructure
also strongly impact on our rehabilitation research
capacity Quite sadly it has been stated that research
is often unrecognized as a professional core value
[312] In many instances research activities are
not prioritised within established hospital and reha-
bilitation services For instance research labs
may be geographically close yet perceived as dis-
connected from clinical practice Consequently
these structures sometimes fail to promote con-
nections between clinicians and researchers This
situation reduces the participation of clinicians
even if at the individual level these clinicians
voice a strong interest for advancing research Too
often the burden will lie on researchers to make
additional effort to overcome these organizational
barriers
Within the context of research capacity partner-
ship may be considered at different levels such as
with other scientists universities patients and in-
stitutions [20] Within the perspective of this paper
promoting cliniciansrsquo partnership is vital to enhan-
cing capacity to conduct meaningful research to lead
to EBP as was depicted in Figure 1 Considering
that research is not a stand alone activity it offers
through its different stages many opportunities to
activate these partnerships There is no clear limit to
the roles that clinical partners can play over the
course of a research process [7] The next section
highlights different crucial areas in which they can
actively take part
Partnership across the research process
As the research process unfolds [2122] (see
Figure 2) rehabilitation clinicians can be given many
opportunities to participate in research On each and
every occasion the researcher will benefit from their
input through validation of the various research
activities
Partnership at the stage of conceptualizing the research
In the conceptual phase of research inputs from
clinicians are crucial to help framing the problem
and formulating the research question and its
hypotheses To engage in research it is funda-
mental to identify an area that holds clinical
significance In rehabilitation much of the research
is initiated to determine empirically the need for
novel interventions to inform professional practice
or to examine the extent to which an intervention is
efficient in achieving its outcome [32223]
According to DePoy and Gitlin [22] the clinical
arena is perhaps the most immediate and important
Figure 2 Steps in research process Actions close to rehabilitation
clinicians
154 L Demers amp L Poissant
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111
014
For
pers
onal
use
onl
y
source from which research questions evolve Many
of the themes or persistent issues that emerge in
case review staff meetings and discussion of
clientsrsquo needs can be readily translated into relevant
research projects Of course rehabilitation research-
ers will also use other sources for topic identifica-
tion such as published research and existing
theory
Testing the relevance of research questions and
hypotheses with clinicians would appear to make a
lot of sense In comparison with the original idea
research questions or hypotheses may be far more
specialized then the topic area initially considered as
relevant and in many ways even sound quite
reductive Discussing those with clinicians may allow
important issues to be raised at the forefront The
feasibility of the study is a good example of an issue
that both researchers and clinicians would want to
address early In this view an iterative and dynamic
discussion between researchers and clinicians is thus
of paramount importance in allowing for expecta-
tions with respect to future research results to be set
correctly and in encouraging the design of a study
that will meet both partiesrsquo requirements or objec-
tives
The second phase of the research process focuses
on the various components of a study design This is
no simple matter and in many ways it is lsquothersquo part of
a research process that is upheld as requiring definite
scientific training It may also appear to be a bit
daunting for clinicians and even a good reason for
preferring the real world of the clinic Despite all of
this it is the researcherrsquos responsibility to explain the
rationale underlying the methodological aspects
associated with the selected study design For
example clinicians may not be able to appreciate
the need to develop a new measurement instrument
rather than using a modified or home-made
instrument
Partnership at the stage of research actions
The third phase of the research process is quite
crucial with respect to its linkage with rehabilitation
professionals In action research the focus is on the
implementation of the design strategy This would
include among other actions three that are espe-
cially close to clinicians population and sampling
data collection and measurement instruments With
respect to population and sampling it is important
that the target population that is the group of
individuals from which the researcher is able to select
a sample exists in the real world and is accessible
Time and efforts may be saved in defining inclusion
and exclusion criteria that have close correspondence
with the reality of the settings where recruitment
takes place For instance recruiting first-time users
of wheelchairs with no cognitive impairment may
prove to be quite challenging in long term care
settings Clinicians can readily tell researchers
selecting a research site what can be expected
from participants in terms of characteristics and
access to them Feasibility issues as much as science
in many cases will help shape the recruitment
strategy
Measurement instruments are here considered in
relation to pragmatic issues rather than psycho-
metric ones In a study by Auger and colleagues [24]
the importance of using appropriate tools was
emphasized in relation to their applicability ie by
the pragmatic qualities allowing the use of a
measurement tool with a given population or in a
specific context Pragmatic issues will be optimal
when respondent and examiner burden are minimal
score distribution is adequate and format is compa-
tible with respondentsrsquo age culture language and
abilities Considerations such as administration time
simplicity of administration and scoring are crucial to
clinicians and involving them in the selection of
measurement tools in relation to their applicability
is certainly justified
Next data collection and intervention require the
choice of a strategy that will take into consideration
practical aspects associated to study participation
One such issue is the time availability and compet-
ing activities of the study participants For instance
in an emergency department interviews lasting
more than 30 min are bound to be interrupted by
the staff for medical procedures Clinicians can
inform researchers about optimal conditions to
interview patients in specific environments Clin-
icians are best positioned to alert researchers about
tolerance and abilities required for subjectrsquos parti-
cipation The list of relevant clinicians-based
information may also include items such as motiva-
tion toward participation helpful incentives con-
tent and appropriateness of notes and records and
expected collaboration from participants family
members caregivers and staff
It would be a mistake to rely exclusively on
clinicians to recruit collect data and intervene
Unless specific arrangements often financial are
made most clinicians simply do not have time for
these extra tasks They are however good advisors
and can help connecting people together In our
view it is incumbent on the researchers to provide
the additional resources required for achieving
the day-to-day activities inherent to the research
project
Partnership at the stage of disseminating results
The fourth phase of the research process is about
dissemination which is acknowledged to be one
Connecting with clinicians 155
Dis
abil
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nive
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111
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For
pers
onal
use
onl
y
component of bringing knowledge into action [4]
There are many ways to disseminate research
findings from traditional approaches such as scien-
tific publications oral presentations at scientific
meetings to more innovative approaches such as
computerized evidence-based reviews With respect
to publishing journal articles are probably the most
popular strategies for dissemination of scientific
results Clearly the choice of the journal is of critical
importance and unfortunately researchers and clin-
icians may be completely divergent in their selection
of journal On one hand researchers will target
highly indexed journals which are definitely re-
warded with respect to obtaining grants scholarships
and salary support On the other hand these criteria
may be absolutely meaningless to clinicians who will
select journals on the basis of criteria such as
availability cost and diversity or specificity of its
content But there are others forms of publications
that are potentially very useful with respect to
knowledge dissemination These may include local
newsletter summary articles in professional journals
and local newspapers These other forms should not
be neglected because they are likely to be read by
more people including those who deliver rehabilita-
tion services [12] Although the writing style is
different the basic elements of the research and
most importantly the conclusions are being disse-
minated
Written publications are not the only method for
sharing research results Indeed oral presentations
whether at scientific meeting local events in-
service educational presentations can also be
efficient and have the foremost advantage of
permitting reception of constructive criticism [5]
As for publications the type of audience will
influence the way the study is presented Clinicians
quite rightly may have very pragmatic concerns
about how to implement research results For
researchers it is the ultimate test and challenge
as convinced clinicians are likely to become highly
credible messengers [25] From our experience
getting clinicians excited about study results is the
most rewarding part of the whole process Overall
both clinicians and researchers must ensure they
balance their participation in knowledge dissemina-
tion activities
Novel approaches to push knowledge dissemina-
tion to the stage of action lay within computerized
clinical information systems Order-entry systems
decision support tools reminders are some exam-
ples of innovative approaches that have been
effective in integrating best practices into the
clinical process [26ndash29] Once again establishing a
solid partnership between researchers and clinicians
will optimize adoption of these innovative technolo-
gies [30] and lead to better patient care
Strategies for implementing partnerships
This section describes key strategies that can facil-
itate partnerships between clinicians and researchers
regardless of whether the project originated from the
researcherrsquos perspective or was brought forward by
clinicians
Consider expertsrsquo committees
Being invited as an expert either as a clinician or as a
researcher brings personal satisfaction by valuing
expertise and favouring the perception of contribut-
ing to knowledge Expert committee sessions need
careful preparation and can take different forms such
as focus groups nominal groups or use specific
techniques like the Technique for Research of
Information by Animation of a Group of Experts
(TRIAGE) [31] Regardless of the technique
partnership will be reinforced if the outputs of these
sessions are made available to all clinicians after the
meeting [32]
Consider group discussions and information sessions
Less formal group discussions and information
sessions can be useful means for obtaining feedback
generating ideas and sharing progress Both types of
groups require identification of clear goals and
expectations from respective parties These sessions
must benefit researchers but also clinicians One
advantage of these sessions over the expert groups
may be the opportunity to get spontaneous ideas or
comments Attending weekly clinical meetings may
pay off in ensuring active clinical participation and
involvement in research projects
Consider seeking direct advice
Perhaps one of the most readily available strategies to
clinicians and researchers is to seek direct advice
from each other Discussing on a one-to-one basis is
likely to be perceived as rewarding provided it is
done in a timely manner with utmost respect for
busy schedules From a researchrsquos perspective
this approach may encourage clinicians to become
active collaborators on a research project and may
help removing potential barriers in conducting a
study
Consider undergraduate students
Undergraduate students are future clinicians
Providing opportunities for students to see research
environments discuss projects will make them more
acutely aware of the possibilities constraints and
challenges involved in conducting research Hiring
156 L Demers amp L Poissant
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ded
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014
For
pers
onal
use
onl
y
undergraduate students during the summer to work
on clinical research projects is a concrete way to
reinforce partnerships between clinicians and re-
searchers
Consider clinicians initiated projects
A second perspective to consider in enhancing
connections with clinicians is to get researchers to
collaborate on clinical research projects If such an
opportunity occurs it would be judicious to take it
As collaborators researchers should modestly assist
the clinicians in moving their project forward It is
important to be constructive and understand the goal
behind the initiative A given project may not lead to
a publication but may lead to improve patient
care and overall this should be recognized by
researchers as a legitimate goal and reason for their
implication
Consider networking
Next it is important to take part in broader events
involving the participation of varied stakeholders
including clinicians and researchers as well as clients
policy-makers and health managers Symposiums
colloquiums and network meetings are exceptional
forums to learn about whatrsquos going on in the field of
rehabilitation to influence decisions to connect with
potential collaborators to understand the struggle
others have to go through and to build research that
is meaningfully grounded Striking differences may
be observed in the way clinicians with different
professional background researchers and managers
consider problems that are raised in these network
gatherings Some may be focussed on training issues
costs data collection and staff turnover Others may
be worried about time constraints and how to let go of
pre-existing approaches to assessment or treatment
Yet others may be centered on theoretical issues
Again the richness of the exchanges between various
points of view is critical in choosing and developing
ultimately the evaluations and interventions that may
best serve patients
Consider developing communities of practice
Communities of practice (CoPs) refer to groups of
individuals who share common ideas goals and
interest and work together in pursuit of these goals
[33] A CoP aimed at strengthening rehabilitation
research through goal-directed activities would in-
corporate clinicians decision-makers and research-
ers The collaborative work and knowledge
exchanges that characterize CoPs have been identi-
fied as an effective way to accelerate knowledge
dissemination and to encourage adoption of
innovations [34] An emergent concept in the
healthcare system CoPs will undoubtedly find
adopters in the rehabilitation field
Conclusion
Gaps and challenges
Over the past few years reducing the gap between
clinicians and researchers has become a priority
Furthermore research is now being conducted to
better understand and identify the best strategies to
increase knowledge uptake by clinicians Interest-
ingly the outcomes of this emerging research
domain around knowledge exchange targets not only
clinicians but also researchers Indeed researchers
will need to take an active role in updating their
dissemination strategies to better match the needs of
clinicians
Throughout this paper we demonstrated the
necessity to create sustainable and dynamic links
between the clinical and research communities to
strengthen rehabilitation research and improve qual-
ity of rehabilitation care and services Clinicians and
researchers have different priorities and concerns
yet we provided concrete approaches to overcome
these differences Accordingly clinicians and re-
searchers move at different speeds While researchers
make small and very slow steps toward the best
possible knowledge clinicians constantly face pro-
blems that require rapid solutions What services are
required What is the level of pain now Can this
person drive safely These decisions bear a lot of
consequences and can hardly wait Not surprisingly
how little can be accomplished in research for
immediate and urgent clinical problem may be seen
as an obstacle in the relationship between clinicians
and researchers and nourish the perception that
these two worlds are incompatible Again through-
out the paper we presented ideas and approaches
that should remove these attitudinal barriers
The reality faced by healthcare professionals and
managers must also be taken into consideration We
acknowledge the fact that the shortage of resources
and constant pressures to be effective and efficient
restrict the latitude of clinicians to participate in
research activities This situation is prone to lead to
frustration unless both parties join their efforts to
ensure that research activities are prioritized within
an organization or health network
Overall each opportunity at hand that favours
connecting clinicians and researchers must be
explored and reinforced An example of such
opportunity which was raised earlier in this paper
is to increase the number of research-trained
clinicians With the imminent move towards a
master-entry level for rehabilitation disciplines in
Connecting with clinicians 157
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For
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onal
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onl
y
occidental countries more classroom time will be
devoted to research and its clinical impacts More-
over field work completed as part of the upgraded
curriculum will have a much stronger research
component attached to it These new legal-profes-
sional requirements associated to an increased
number of clinicians accessing graduate programs
and going back to clinical environments will have
major impact on clinical practice Future clinicians
will indeed have the capacity to take on the role of
leaders to improve care and services through the
adoption of best practices
Connecting researchers and clinicians has many
facets all of which may be considered as adding
value to rehabilitation research and clinical practice
The broad scope of topics methods and populations
covered by rehabilitation researchers and clinicians
highlights the need to develop and reinforce this
connection The implementation of traditional and
innovative approaches described in this paper will
encourage both clinicians and researchers to develop
sustainable partnerships which in turn will optimize
rehabilitation care and services
Acknowledgements
The authors are supported by the lsquolsquoFonds de la
recherche en sante du Quebecrsquorsquo An earlier version of
this paper was presented as a keynote presentation by
the first author to the 10th Research Colloquium on
Rehabilitation McGill University Quebec Canada
on May 4 2006
Declaration of interest The authors report no
conflicts of interest The authors alone are respon-
sible for the content and writing of the paper
References
1 Tate DG The state of rehabilitation research Art or science
Arch Phys Med Rehabil 200687160ndash166
2 Cicerone KD Evidence-based practice and the limits of
rational rehabilitation Arch Phys Med Rehabil 2005861073ndash
1074
3 Ilott I Challenges and strategic solutions for a research
emergent profession Am J Occupat Ther 200458347ndash352
4 Graham ID Logan J Harrison MB Straus SE Tetroe J
Caswell W Robinson N Lost in knowledge translation
Time for a map J Continuing Educ Health Professions 2006
2613ndash24
5 Stratton Johnson L From knowledge transfer to knowledge
translation Applying research to practice Occupat Ther Now
2005711ndash14
6 Bowen S Martens PJ A model for collaborative evaluation of
university-community partnerships Epidemiol Community
Health 200660902ndash907
7 Taylor RR Suarez-Balcazar Y Forsyth K Kielhofner G
Participatory research in occupational therapy In Kielhofner
G editor Research in occupational therapy Philadelphia
FA Davis 2006 pp 620ndash631
8 Sudsawad P Definition evolution and implementation
of evidence-based practice in occupational therapy In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 656ndash662
9 Whalley Hammel K Carpenter C Qualitative research in
evidence-based rehabilitation Edinburgh Churchill Living-
stone 2004 148 p
10 Law M Evidence-based rehabilitation A guide to practice
Thorofare Slack 2002 364 p
11 Baker NA Analyzing evidence for practice In Kielhofner G
editor Research in occupational therapy Philadelphia FA
Davis 2006 pp 663ndash684
12 Egan M Canadian occupational therapy research The little
profession that could Canad J Occupat Ther 200168143ndash
148
13 Korner-Bitenski N Wood-Dauphinee S Teasell R Hanley J
Harrison M Kaizer F Kehayia E Menon A Survey of
occupational therapy practices for stroke Canad J Occupat
Ther 2005(Suppl 1)33
14 McCluskey A Managing change and barriers to evidence-
based practice In Kielhofner G editor Research in
occupational therapy Philadelphia FA Davis 2006 pp
685ndash696
15 World Health Organization International Classification of
Functioning Disability and Health Geneva World Health
Organization 2001 306 p
16 Stucki G International Classification of Functioning Dis-
ability and Health (ICF) A promising framework and
classification for rehabilitation medicine Am J Phys Med
Rehabil 200584733ndash740
17 Jette AM Keysor J Coster W Ni P Haley S Beyond
function Predicting participation in a rehabilitation cohort
Arch Phys Med Rehabil 2005862087ndash2094
18 Salter K Jutai JW Teasell R Foley NC Bitensky J Issues for
selection of outcome measures in stroke rehabilitation ICF
Body Functions Disabil Rehabil 200527191ndash207
19 Mayo NE Poissant L Ahmed S Finch L Higgins J Salbach
NM Soicher J Jaglal S Incorporating the International
Classification of Functioning Disability and Health (ICF)
into an electronic health record to create indicators of func-
tion Proof of concept using the SF-12 J Am Med Informatics
Assoc 200411514ndash522
20 Frontera WR Fuhrer MJ Jette AM Chan L Cooper RA
Duncan PW Kemp JD Ottenbacher KJ Peckham PH Roth
EJ et al Rehabilitation medicine summit Building research
capacity (executive summary) Am J Speech Lang Pathol
2006153ndash14
21 Contandriopoulos A-P Champagne F Potvin L Denis J-L
Boyle P Savoir preparer une recherche la definir la
structurer la financer Montreal Les Presses de lrsquoUniversite
de Montreal 1990 193 p
22 DePoy E Gitlin LN Introduction to research understanding
and applying multiple strategies St Louis Elsevier Mosby
2005 346 p
23 Kielhofner G The neccessity of research in a profession In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 1ndash9
24 Auger C Demers L Swaine B Making sense of pragmatic
criteria for the selection of geriatric rehabilitation measure-
ment tools Arch Gerontol Geriatrics 20064365ndash83
25 Reardon R Lavis J Gibson J 2006 May 25 From research to
practice A knowledge transfer planning guide Accessed 25
May 2007 from the website http Institute for Work amp
Health
26 Hunt DL Haynes RB Hanna SE Smith K Effects of
computer-based clinical decision support systems on physi-
cian performance and patient outcomes A systematic review
JAMA 19982801339ndash1346
158 L Demers amp L Poissant
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abil
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abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
27 Patel VL Kushniruk AW Yang S Yale JF Impact of a
computer-based patient record system on data collection
knowledge organization and reasoning J Am Med Infor-
matics Assoc 20007569ndash585
28 Raschke RA Gollihare B Wunderlich TA Guidry JR
Leibowitz AI Peirce JC Lemelson L Heisler MA Susong
C A computer alert system to prevent injury from adverse
drug events Development and evaluation in a community
teaching hospital JAMA 19982801317ndash1320
29 Tamblyn R Huang A Kawasumi Y Bartlett G Grad R
Jacques A Dawes M Abrahamowicz M Perreault R Taylor
L et al The development and evaluation of an integrated
electronic prescribing and drug management system for
primary care J Am Med Informatics Assoc 200613148ndash159
30 Bates DW Kuperman GJ Wang S Gandhi T Kittler A Volk
L Spurr C Khorasani R Tanasijevic M Middleton B Ten
commandments for effective clinical decision support making
the practice of evidence-based medicine a reality J Am Med
Informatics Assoc 200310523ndash530
31 Gervais M Pepin C Carriere M TRIAGE ou comment adapter
une technique de recherche a lrsquointervention en ergotherapie
Revue Quebecoise drsquoErgotherapie 2000911ndash15
32 Morgan DL Scannell AU Planning focus groups Morgan
DL Krueger RA editors Thousand Oaks Sage 1997 139 p
33 Weinger MB Herndon OW Gaba DM The effect of
electronic record keeping and transesophageal echocardio-
graphy on task distribution workload and vigilance during
cardiac anesthesia Anesthesiology 199787144ndash155 discus-
sion 129Andash130A
34 McDermott R 1999 May 25 Nurturing three dimensional
communities of practice How to get the most out of human
works In Knowledge management review Accessed 25
May 2007 from the website http wwwco-i-lcomcoil
knowledge-gardencopdimensional
Connecting with clinicians 159
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
source from which research questions evolve Many
of the themes or persistent issues that emerge in
case review staff meetings and discussion of
clientsrsquo needs can be readily translated into relevant
research projects Of course rehabilitation research-
ers will also use other sources for topic identifica-
tion such as published research and existing
theory
Testing the relevance of research questions and
hypotheses with clinicians would appear to make a
lot of sense In comparison with the original idea
research questions or hypotheses may be far more
specialized then the topic area initially considered as
relevant and in many ways even sound quite
reductive Discussing those with clinicians may allow
important issues to be raised at the forefront The
feasibility of the study is a good example of an issue
that both researchers and clinicians would want to
address early In this view an iterative and dynamic
discussion between researchers and clinicians is thus
of paramount importance in allowing for expecta-
tions with respect to future research results to be set
correctly and in encouraging the design of a study
that will meet both partiesrsquo requirements or objec-
tives
The second phase of the research process focuses
on the various components of a study design This is
no simple matter and in many ways it is lsquothersquo part of
a research process that is upheld as requiring definite
scientific training It may also appear to be a bit
daunting for clinicians and even a good reason for
preferring the real world of the clinic Despite all of
this it is the researcherrsquos responsibility to explain the
rationale underlying the methodological aspects
associated with the selected study design For
example clinicians may not be able to appreciate
the need to develop a new measurement instrument
rather than using a modified or home-made
instrument
Partnership at the stage of research actions
The third phase of the research process is quite
crucial with respect to its linkage with rehabilitation
professionals In action research the focus is on the
implementation of the design strategy This would
include among other actions three that are espe-
cially close to clinicians population and sampling
data collection and measurement instruments With
respect to population and sampling it is important
that the target population that is the group of
individuals from which the researcher is able to select
a sample exists in the real world and is accessible
Time and efforts may be saved in defining inclusion
and exclusion criteria that have close correspondence
with the reality of the settings where recruitment
takes place For instance recruiting first-time users
of wheelchairs with no cognitive impairment may
prove to be quite challenging in long term care
settings Clinicians can readily tell researchers
selecting a research site what can be expected
from participants in terms of characteristics and
access to them Feasibility issues as much as science
in many cases will help shape the recruitment
strategy
Measurement instruments are here considered in
relation to pragmatic issues rather than psycho-
metric ones In a study by Auger and colleagues [24]
the importance of using appropriate tools was
emphasized in relation to their applicability ie by
the pragmatic qualities allowing the use of a
measurement tool with a given population or in a
specific context Pragmatic issues will be optimal
when respondent and examiner burden are minimal
score distribution is adequate and format is compa-
tible with respondentsrsquo age culture language and
abilities Considerations such as administration time
simplicity of administration and scoring are crucial to
clinicians and involving them in the selection of
measurement tools in relation to their applicability
is certainly justified
Next data collection and intervention require the
choice of a strategy that will take into consideration
practical aspects associated to study participation
One such issue is the time availability and compet-
ing activities of the study participants For instance
in an emergency department interviews lasting
more than 30 min are bound to be interrupted by
the staff for medical procedures Clinicians can
inform researchers about optimal conditions to
interview patients in specific environments Clin-
icians are best positioned to alert researchers about
tolerance and abilities required for subjectrsquos parti-
cipation The list of relevant clinicians-based
information may also include items such as motiva-
tion toward participation helpful incentives con-
tent and appropriateness of notes and records and
expected collaboration from participants family
members caregivers and staff
It would be a mistake to rely exclusively on
clinicians to recruit collect data and intervene
Unless specific arrangements often financial are
made most clinicians simply do not have time for
these extra tasks They are however good advisors
and can help connecting people together In our
view it is incumbent on the researchers to provide
the additional resources required for achieving
the day-to-day activities inherent to the research
project
Partnership at the stage of disseminating results
The fourth phase of the research process is about
dissemination which is acknowledged to be one
Connecting with clinicians 155
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
component of bringing knowledge into action [4]
There are many ways to disseminate research
findings from traditional approaches such as scien-
tific publications oral presentations at scientific
meetings to more innovative approaches such as
computerized evidence-based reviews With respect
to publishing journal articles are probably the most
popular strategies for dissemination of scientific
results Clearly the choice of the journal is of critical
importance and unfortunately researchers and clin-
icians may be completely divergent in their selection
of journal On one hand researchers will target
highly indexed journals which are definitely re-
warded with respect to obtaining grants scholarships
and salary support On the other hand these criteria
may be absolutely meaningless to clinicians who will
select journals on the basis of criteria such as
availability cost and diversity or specificity of its
content But there are others forms of publications
that are potentially very useful with respect to
knowledge dissemination These may include local
newsletter summary articles in professional journals
and local newspapers These other forms should not
be neglected because they are likely to be read by
more people including those who deliver rehabilita-
tion services [12] Although the writing style is
different the basic elements of the research and
most importantly the conclusions are being disse-
minated
Written publications are not the only method for
sharing research results Indeed oral presentations
whether at scientific meeting local events in-
service educational presentations can also be
efficient and have the foremost advantage of
permitting reception of constructive criticism [5]
As for publications the type of audience will
influence the way the study is presented Clinicians
quite rightly may have very pragmatic concerns
about how to implement research results For
researchers it is the ultimate test and challenge
as convinced clinicians are likely to become highly
credible messengers [25] From our experience
getting clinicians excited about study results is the
most rewarding part of the whole process Overall
both clinicians and researchers must ensure they
balance their participation in knowledge dissemina-
tion activities
Novel approaches to push knowledge dissemina-
tion to the stage of action lay within computerized
clinical information systems Order-entry systems
decision support tools reminders are some exam-
ples of innovative approaches that have been
effective in integrating best practices into the
clinical process [26ndash29] Once again establishing a
solid partnership between researchers and clinicians
will optimize adoption of these innovative technolo-
gies [30] and lead to better patient care
Strategies for implementing partnerships
This section describes key strategies that can facil-
itate partnerships between clinicians and researchers
regardless of whether the project originated from the
researcherrsquos perspective or was brought forward by
clinicians
Consider expertsrsquo committees
Being invited as an expert either as a clinician or as a
researcher brings personal satisfaction by valuing
expertise and favouring the perception of contribut-
ing to knowledge Expert committee sessions need
careful preparation and can take different forms such
as focus groups nominal groups or use specific
techniques like the Technique for Research of
Information by Animation of a Group of Experts
(TRIAGE) [31] Regardless of the technique
partnership will be reinforced if the outputs of these
sessions are made available to all clinicians after the
meeting [32]
Consider group discussions and information sessions
Less formal group discussions and information
sessions can be useful means for obtaining feedback
generating ideas and sharing progress Both types of
groups require identification of clear goals and
expectations from respective parties These sessions
must benefit researchers but also clinicians One
advantage of these sessions over the expert groups
may be the opportunity to get spontaneous ideas or
comments Attending weekly clinical meetings may
pay off in ensuring active clinical participation and
involvement in research projects
Consider seeking direct advice
Perhaps one of the most readily available strategies to
clinicians and researchers is to seek direct advice
from each other Discussing on a one-to-one basis is
likely to be perceived as rewarding provided it is
done in a timely manner with utmost respect for
busy schedules From a researchrsquos perspective
this approach may encourage clinicians to become
active collaborators on a research project and may
help removing potential barriers in conducting a
study
Consider undergraduate students
Undergraduate students are future clinicians
Providing opportunities for students to see research
environments discuss projects will make them more
acutely aware of the possibilities constraints and
challenges involved in conducting research Hiring
156 L Demers amp L Poissant
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
undergraduate students during the summer to work
on clinical research projects is a concrete way to
reinforce partnerships between clinicians and re-
searchers
Consider clinicians initiated projects
A second perspective to consider in enhancing
connections with clinicians is to get researchers to
collaborate on clinical research projects If such an
opportunity occurs it would be judicious to take it
As collaborators researchers should modestly assist
the clinicians in moving their project forward It is
important to be constructive and understand the goal
behind the initiative A given project may not lead to
a publication but may lead to improve patient
care and overall this should be recognized by
researchers as a legitimate goal and reason for their
implication
Consider networking
Next it is important to take part in broader events
involving the participation of varied stakeholders
including clinicians and researchers as well as clients
policy-makers and health managers Symposiums
colloquiums and network meetings are exceptional
forums to learn about whatrsquos going on in the field of
rehabilitation to influence decisions to connect with
potential collaborators to understand the struggle
others have to go through and to build research that
is meaningfully grounded Striking differences may
be observed in the way clinicians with different
professional background researchers and managers
consider problems that are raised in these network
gatherings Some may be focussed on training issues
costs data collection and staff turnover Others may
be worried about time constraints and how to let go of
pre-existing approaches to assessment or treatment
Yet others may be centered on theoretical issues
Again the richness of the exchanges between various
points of view is critical in choosing and developing
ultimately the evaluations and interventions that may
best serve patients
Consider developing communities of practice
Communities of practice (CoPs) refer to groups of
individuals who share common ideas goals and
interest and work together in pursuit of these goals
[33] A CoP aimed at strengthening rehabilitation
research through goal-directed activities would in-
corporate clinicians decision-makers and research-
ers The collaborative work and knowledge
exchanges that characterize CoPs have been identi-
fied as an effective way to accelerate knowledge
dissemination and to encourage adoption of
innovations [34] An emergent concept in the
healthcare system CoPs will undoubtedly find
adopters in the rehabilitation field
Conclusion
Gaps and challenges
Over the past few years reducing the gap between
clinicians and researchers has become a priority
Furthermore research is now being conducted to
better understand and identify the best strategies to
increase knowledge uptake by clinicians Interest-
ingly the outcomes of this emerging research
domain around knowledge exchange targets not only
clinicians but also researchers Indeed researchers
will need to take an active role in updating their
dissemination strategies to better match the needs of
clinicians
Throughout this paper we demonstrated the
necessity to create sustainable and dynamic links
between the clinical and research communities to
strengthen rehabilitation research and improve qual-
ity of rehabilitation care and services Clinicians and
researchers have different priorities and concerns
yet we provided concrete approaches to overcome
these differences Accordingly clinicians and re-
searchers move at different speeds While researchers
make small and very slow steps toward the best
possible knowledge clinicians constantly face pro-
blems that require rapid solutions What services are
required What is the level of pain now Can this
person drive safely These decisions bear a lot of
consequences and can hardly wait Not surprisingly
how little can be accomplished in research for
immediate and urgent clinical problem may be seen
as an obstacle in the relationship between clinicians
and researchers and nourish the perception that
these two worlds are incompatible Again through-
out the paper we presented ideas and approaches
that should remove these attitudinal barriers
The reality faced by healthcare professionals and
managers must also be taken into consideration We
acknowledge the fact that the shortage of resources
and constant pressures to be effective and efficient
restrict the latitude of clinicians to participate in
research activities This situation is prone to lead to
frustration unless both parties join their efforts to
ensure that research activities are prioritized within
an organization or health network
Overall each opportunity at hand that favours
connecting clinicians and researchers must be
explored and reinforced An example of such
opportunity which was raised earlier in this paper
is to increase the number of research-trained
clinicians With the imminent move towards a
master-entry level for rehabilitation disciplines in
Connecting with clinicians 157
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
occidental countries more classroom time will be
devoted to research and its clinical impacts More-
over field work completed as part of the upgraded
curriculum will have a much stronger research
component attached to it These new legal-profes-
sional requirements associated to an increased
number of clinicians accessing graduate programs
and going back to clinical environments will have
major impact on clinical practice Future clinicians
will indeed have the capacity to take on the role of
leaders to improve care and services through the
adoption of best practices
Connecting researchers and clinicians has many
facets all of which may be considered as adding
value to rehabilitation research and clinical practice
The broad scope of topics methods and populations
covered by rehabilitation researchers and clinicians
highlights the need to develop and reinforce this
connection The implementation of traditional and
innovative approaches described in this paper will
encourage both clinicians and researchers to develop
sustainable partnerships which in turn will optimize
rehabilitation care and services
Acknowledgements
The authors are supported by the lsquolsquoFonds de la
recherche en sante du Quebecrsquorsquo An earlier version of
this paper was presented as a keynote presentation by
the first author to the 10th Research Colloquium on
Rehabilitation McGill University Quebec Canada
on May 4 2006
Declaration of interest The authors report no
conflicts of interest The authors alone are respon-
sible for the content and writing of the paper
References
1 Tate DG The state of rehabilitation research Art or science
Arch Phys Med Rehabil 200687160ndash166
2 Cicerone KD Evidence-based practice and the limits of
rational rehabilitation Arch Phys Med Rehabil 2005861073ndash
1074
3 Ilott I Challenges and strategic solutions for a research
emergent profession Am J Occupat Ther 200458347ndash352
4 Graham ID Logan J Harrison MB Straus SE Tetroe J
Caswell W Robinson N Lost in knowledge translation
Time for a map J Continuing Educ Health Professions 2006
2613ndash24
5 Stratton Johnson L From knowledge transfer to knowledge
translation Applying research to practice Occupat Ther Now
2005711ndash14
6 Bowen S Martens PJ A model for collaborative evaluation of
university-community partnerships Epidemiol Community
Health 200660902ndash907
7 Taylor RR Suarez-Balcazar Y Forsyth K Kielhofner G
Participatory research in occupational therapy In Kielhofner
G editor Research in occupational therapy Philadelphia
FA Davis 2006 pp 620ndash631
8 Sudsawad P Definition evolution and implementation
of evidence-based practice in occupational therapy In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 656ndash662
9 Whalley Hammel K Carpenter C Qualitative research in
evidence-based rehabilitation Edinburgh Churchill Living-
stone 2004 148 p
10 Law M Evidence-based rehabilitation A guide to practice
Thorofare Slack 2002 364 p
11 Baker NA Analyzing evidence for practice In Kielhofner G
editor Research in occupational therapy Philadelphia FA
Davis 2006 pp 663ndash684
12 Egan M Canadian occupational therapy research The little
profession that could Canad J Occupat Ther 200168143ndash
148
13 Korner-Bitenski N Wood-Dauphinee S Teasell R Hanley J
Harrison M Kaizer F Kehayia E Menon A Survey of
occupational therapy practices for stroke Canad J Occupat
Ther 2005(Suppl 1)33
14 McCluskey A Managing change and barriers to evidence-
based practice In Kielhofner G editor Research in
occupational therapy Philadelphia FA Davis 2006 pp
685ndash696
15 World Health Organization International Classification of
Functioning Disability and Health Geneva World Health
Organization 2001 306 p
16 Stucki G International Classification of Functioning Dis-
ability and Health (ICF) A promising framework and
classification for rehabilitation medicine Am J Phys Med
Rehabil 200584733ndash740
17 Jette AM Keysor J Coster W Ni P Haley S Beyond
function Predicting participation in a rehabilitation cohort
Arch Phys Med Rehabil 2005862087ndash2094
18 Salter K Jutai JW Teasell R Foley NC Bitensky J Issues for
selection of outcome measures in stroke rehabilitation ICF
Body Functions Disabil Rehabil 200527191ndash207
19 Mayo NE Poissant L Ahmed S Finch L Higgins J Salbach
NM Soicher J Jaglal S Incorporating the International
Classification of Functioning Disability and Health (ICF)
into an electronic health record to create indicators of func-
tion Proof of concept using the SF-12 J Am Med Informatics
Assoc 200411514ndash522
20 Frontera WR Fuhrer MJ Jette AM Chan L Cooper RA
Duncan PW Kemp JD Ottenbacher KJ Peckham PH Roth
EJ et al Rehabilitation medicine summit Building research
capacity (executive summary) Am J Speech Lang Pathol
2006153ndash14
21 Contandriopoulos A-P Champagne F Potvin L Denis J-L
Boyle P Savoir preparer une recherche la definir la
structurer la financer Montreal Les Presses de lrsquoUniversite
de Montreal 1990 193 p
22 DePoy E Gitlin LN Introduction to research understanding
and applying multiple strategies St Louis Elsevier Mosby
2005 346 p
23 Kielhofner G The neccessity of research in a profession In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 1ndash9
24 Auger C Demers L Swaine B Making sense of pragmatic
criteria for the selection of geriatric rehabilitation measure-
ment tools Arch Gerontol Geriatrics 20064365ndash83
25 Reardon R Lavis J Gibson J 2006 May 25 From research to
practice A knowledge transfer planning guide Accessed 25
May 2007 from the website http Institute for Work amp
Health
26 Hunt DL Haynes RB Hanna SE Smith K Effects of
computer-based clinical decision support systems on physi-
cian performance and patient outcomes A systematic review
JAMA 19982801339ndash1346
158 L Demers amp L Poissant
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
27 Patel VL Kushniruk AW Yang S Yale JF Impact of a
computer-based patient record system on data collection
knowledge organization and reasoning J Am Med Infor-
matics Assoc 20007569ndash585
28 Raschke RA Gollihare B Wunderlich TA Guidry JR
Leibowitz AI Peirce JC Lemelson L Heisler MA Susong
C A computer alert system to prevent injury from adverse
drug events Development and evaluation in a community
teaching hospital JAMA 19982801317ndash1320
29 Tamblyn R Huang A Kawasumi Y Bartlett G Grad R
Jacques A Dawes M Abrahamowicz M Perreault R Taylor
L et al The development and evaluation of an integrated
electronic prescribing and drug management system for
primary care J Am Med Informatics Assoc 200613148ndash159
30 Bates DW Kuperman GJ Wang S Gandhi T Kittler A Volk
L Spurr C Khorasani R Tanasijevic M Middleton B Ten
commandments for effective clinical decision support making
the practice of evidence-based medicine a reality J Am Med
Informatics Assoc 200310523ndash530
31 Gervais M Pepin C Carriere M TRIAGE ou comment adapter
une technique de recherche a lrsquointervention en ergotherapie
Revue Quebecoise drsquoErgotherapie 2000911ndash15
32 Morgan DL Scannell AU Planning focus groups Morgan
DL Krueger RA editors Thousand Oaks Sage 1997 139 p
33 Weinger MB Herndon OW Gaba DM The effect of
electronic record keeping and transesophageal echocardio-
graphy on task distribution workload and vigilance during
cardiac anesthesia Anesthesiology 199787144ndash155 discus-
sion 129Andash130A
34 McDermott R 1999 May 25 Nurturing three dimensional
communities of practice How to get the most out of human
works In Knowledge management review Accessed 25
May 2007 from the website http wwwco-i-lcomcoil
knowledge-gardencopdimensional
Connecting with clinicians 159
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
component of bringing knowledge into action [4]
There are many ways to disseminate research
findings from traditional approaches such as scien-
tific publications oral presentations at scientific
meetings to more innovative approaches such as
computerized evidence-based reviews With respect
to publishing journal articles are probably the most
popular strategies for dissemination of scientific
results Clearly the choice of the journal is of critical
importance and unfortunately researchers and clin-
icians may be completely divergent in their selection
of journal On one hand researchers will target
highly indexed journals which are definitely re-
warded with respect to obtaining grants scholarships
and salary support On the other hand these criteria
may be absolutely meaningless to clinicians who will
select journals on the basis of criteria such as
availability cost and diversity or specificity of its
content But there are others forms of publications
that are potentially very useful with respect to
knowledge dissemination These may include local
newsletter summary articles in professional journals
and local newspapers These other forms should not
be neglected because they are likely to be read by
more people including those who deliver rehabilita-
tion services [12] Although the writing style is
different the basic elements of the research and
most importantly the conclusions are being disse-
minated
Written publications are not the only method for
sharing research results Indeed oral presentations
whether at scientific meeting local events in-
service educational presentations can also be
efficient and have the foremost advantage of
permitting reception of constructive criticism [5]
As for publications the type of audience will
influence the way the study is presented Clinicians
quite rightly may have very pragmatic concerns
about how to implement research results For
researchers it is the ultimate test and challenge
as convinced clinicians are likely to become highly
credible messengers [25] From our experience
getting clinicians excited about study results is the
most rewarding part of the whole process Overall
both clinicians and researchers must ensure they
balance their participation in knowledge dissemina-
tion activities
Novel approaches to push knowledge dissemina-
tion to the stage of action lay within computerized
clinical information systems Order-entry systems
decision support tools reminders are some exam-
ples of innovative approaches that have been
effective in integrating best practices into the
clinical process [26ndash29] Once again establishing a
solid partnership between researchers and clinicians
will optimize adoption of these innovative technolo-
gies [30] and lead to better patient care
Strategies for implementing partnerships
This section describes key strategies that can facil-
itate partnerships between clinicians and researchers
regardless of whether the project originated from the
researcherrsquos perspective or was brought forward by
clinicians
Consider expertsrsquo committees
Being invited as an expert either as a clinician or as a
researcher brings personal satisfaction by valuing
expertise and favouring the perception of contribut-
ing to knowledge Expert committee sessions need
careful preparation and can take different forms such
as focus groups nominal groups or use specific
techniques like the Technique for Research of
Information by Animation of a Group of Experts
(TRIAGE) [31] Regardless of the technique
partnership will be reinforced if the outputs of these
sessions are made available to all clinicians after the
meeting [32]
Consider group discussions and information sessions
Less formal group discussions and information
sessions can be useful means for obtaining feedback
generating ideas and sharing progress Both types of
groups require identification of clear goals and
expectations from respective parties These sessions
must benefit researchers but also clinicians One
advantage of these sessions over the expert groups
may be the opportunity to get spontaneous ideas or
comments Attending weekly clinical meetings may
pay off in ensuring active clinical participation and
involvement in research projects
Consider seeking direct advice
Perhaps one of the most readily available strategies to
clinicians and researchers is to seek direct advice
from each other Discussing on a one-to-one basis is
likely to be perceived as rewarding provided it is
done in a timely manner with utmost respect for
busy schedules From a researchrsquos perspective
this approach may encourage clinicians to become
active collaborators on a research project and may
help removing potential barriers in conducting a
study
Consider undergraduate students
Undergraduate students are future clinicians
Providing opportunities for students to see research
environments discuss projects will make them more
acutely aware of the possibilities constraints and
challenges involved in conducting research Hiring
156 L Demers amp L Poissant
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
undergraduate students during the summer to work
on clinical research projects is a concrete way to
reinforce partnerships between clinicians and re-
searchers
Consider clinicians initiated projects
A second perspective to consider in enhancing
connections with clinicians is to get researchers to
collaborate on clinical research projects If such an
opportunity occurs it would be judicious to take it
As collaborators researchers should modestly assist
the clinicians in moving their project forward It is
important to be constructive and understand the goal
behind the initiative A given project may not lead to
a publication but may lead to improve patient
care and overall this should be recognized by
researchers as a legitimate goal and reason for their
implication
Consider networking
Next it is important to take part in broader events
involving the participation of varied stakeholders
including clinicians and researchers as well as clients
policy-makers and health managers Symposiums
colloquiums and network meetings are exceptional
forums to learn about whatrsquos going on in the field of
rehabilitation to influence decisions to connect with
potential collaborators to understand the struggle
others have to go through and to build research that
is meaningfully grounded Striking differences may
be observed in the way clinicians with different
professional background researchers and managers
consider problems that are raised in these network
gatherings Some may be focussed on training issues
costs data collection and staff turnover Others may
be worried about time constraints and how to let go of
pre-existing approaches to assessment or treatment
Yet others may be centered on theoretical issues
Again the richness of the exchanges between various
points of view is critical in choosing and developing
ultimately the evaluations and interventions that may
best serve patients
Consider developing communities of practice
Communities of practice (CoPs) refer to groups of
individuals who share common ideas goals and
interest and work together in pursuit of these goals
[33] A CoP aimed at strengthening rehabilitation
research through goal-directed activities would in-
corporate clinicians decision-makers and research-
ers The collaborative work and knowledge
exchanges that characterize CoPs have been identi-
fied as an effective way to accelerate knowledge
dissemination and to encourage adoption of
innovations [34] An emergent concept in the
healthcare system CoPs will undoubtedly find
adopters in the rehabilitation field
Conclusion
Gaps and challenges
Over the past few years reducing the gap between
clinicians and researchers has become a priority
Furthermore research is now being conducted to
better understand and identify the best strategies to
increase knowledge uptake by clinicians Interest-
ingly the outcomes of this emerging research
domain around knowledge exchange targets not only
clinicians but also researchers Indeed researchers
will need to take an active role in updating their
dissemination strategies to better match the needs of
clinicians
Throughout this paper we demonstrated the
necessity to create sustainable and dynamic links
between the clinical and research communities to
strengthen rehabilitation research and improve qual-
ity of rehabilitation care and services Clinicians and
researchers have different priorities and concerns
yet we provided concrete approaches to overcome
these differences Accordingly clinicians and re-
searchers move at different speeds While researchers
make small and very slow steps toward the best
possible knowledge clinicians constantly face pro-
blems that require rapid solutions What services are
required What is the level of pain now Can this
person drive safely These decisions bear a lot of
consequences and can hardly wait Not surprisingly
how little can be accomplished in research for
immediate and urgent clinical problem may be seen
as an obstacle in the relationship between clinicians
and researchers and nourish the perception that
these two worlds are incompatible Again through-
out the paper we presented ideas and approaches
that should remove these attitudinal barriers
The reality faced by healthcare professionals and
managers must also be taken into consideration We
acknowledge the fact that the shortage of resources
and constant pressures to be effective and efficient
restrict the latitude of clinicians to participate in
research activities This situation is prone to lead to
frustration unless both parties join their efforts to
ensure that research activities are prioritized within
an organization or health network
Overall each opportunity at hand that favours
connecting clinicians and researchers must be
explored and reinforced An example of such
opportunity which was raised earlier in this paper
is to increase the number of research-trained
clinicians With the imminent move towards a
master-entry level for rehabilitation disciplines in
Connecting with clinicians 157
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
occidental countries more classroom time will be
devoted to research and its clinical impacts More-
over field work completed as part of the upgraded
curriculum will have a much stronger research
component attached to it These new legal-profes-
sional requirements associated to an increased
number of clinicians accessing graduate programs
and going back to clinical environments will have
major impact on clinical practice Future clinicians
will indeed have the capacity to take on the role of
leaders to improve care and services through the
adoption of best practices
Connecting researchers and clinicians has many
facets all of which may be considered as adding
value to rehabilitation research and clinical practice
The broad scope of topics methods and populations
covered by rehabilitation researchers and clinicians
highlights the need to develop and reinforce this
connection The implementation of traditional and
innovative approaches described in this paper will
encourage both clinicians and researchers to develop
sustainable partnerships which in turn will optimize
rehabilitation care and services
Acknowledgements
The authors are supported by the lsquolsquoFonds de la
recherche en sante du Quebecrsquorsquo An earlier version of
this paper was presented as a keynote presentation by
the first author to the 10th Research Colloquium on
Rehabilitation McGill University Quebec Canada
on May 4 2006
Declaration of interest The authors report no
conflicts of interest The authors alone are respon-
sible for the content and writing of the paper
References
1 Tate DG The state of rehabilitation research Art or science
Arch Phys Med Rehabil 200687160ndash166
2 Cicerone KD Evidence-based practice and the limits of
rational rehabilitation Arch Phys Med Rehabil 2005861073ndash
1074
3 Ilott I Challenges and strategic solutions for a research
emergent profession Am J Occupat Ther 200458347ndash352
4 Graham ID Logan J Harrison MB Straus SE Tetroe J
Caswell W Robinson N Lost in knowledge translation
Time for a map J Continuing Educ Health Professions 2006
2613ndash24
5 Stratton Johnson L From knowledge transfer to knowledge
translation Applying research to practice Occupat Ther Now
2005711ndash14
6 Bowen S Martens PJ A model for collaborative evaluation of
university-community partnerships Epidemiol Community
Health 200660902ndash907
7 Taylor RR Suarez-Balcazar Y Forsyth K Kielhofner G
Participatory research in occupational therapy In Kielhofner
G editor Research in occupational therapy Philadelphia
FA Davis 2006 pp 620ndash631
8 Sudsawad P Definition evolution and implementation
of evidence-based practice in occupational therapy In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 656ndash662
9 Whalley Hammel K Carpenter C Qualitative research in
evidence-based rehabilitation Edinburgh Churchill Living-
stone 2004 148 p
10 Law M Evidence-based rehabilitation A guide to practice
Thorofare Slack 2002 364 p
11 Baker NA Analyzing evidence for practice In Kielhofner G
editor Research in occupational therapy Philadelphia FA
Davis 2006 pp 663ndash684
12 Egan M Canadian occupational therapy research The little
profession that could Canad J Occupat Ther 200168143ndash
148
13 Korner-Bitenski N Wood-Dauphinee S Teasell R Hanley J
Harrison M Kaizer F Kehayia E Menon A Survey of
occupational therapy practices for stroke Canad J Occupat
Ther 2005(Suppl 1)33
14 McCluskey A Managing change and barriers to evidence-
based practice In Kielhofner G editor Research in
occupational therapy Philadelphia FA Davis 2006 pp
685ndash696
15 World Health Organization International Classification of
Functioning Disability and Health Geneva World Health
Organization 2001 306 p
16 Stucki G International Classification of Functioning Dis-
ability and Health (ICF) A promising framework and
classification for rehabilitation medicine Am J Phys Med
Rehabil 200584733ndash740
17 Jette AM Keysor J Coster W Ni P Haley S Beyond
function Predicting participation in a rehabilitation cohort
Arch Phys Med Rehabil 2005862087ndash2094
18 Salter K Jutai JW Teasell R Foley NC Bitensky J Issues for
selection of outcome measures in stroke rehabilitation ICF
Body Functions Disabil Rehabil 200527191ndash207
19 Mayo NE Poissant L Ahmed S Finch L Higgins J Salbach
NM Soicher J Jaglal S Incorporating the International
Classification of Functioning Disability and Health (ICF)
into an electronic health record to create indicators of func-
tion Proof of concept using the SF-12 J Am Med Informatics
Assoc 200411514ndash522
20 Frontera WR Fuhrer MJ Jette AM Chan L Cooper RA
Duncan PW Kemp JD Ottenbacher KJ Peckham PH Roth
EJ et al Rehabilitation medicine summit Building research
capacity (executive summary) Am J Speech Lang Pathol
2006153ndash14
21 Contandriopoulos A-P Champagne F Potvin L Denis J-L
Boyle P Savoir preparer une recherche la definir la
structurer la financer Montreal Les Presses de lrsquoUniversite
de Montreal 1990 193 p
22 DePoy E Gitlin LN Introduction to research understanding
and applying multiple strategies St Louis Elsevier Mosby
2005 346 p
23 Kielhofner G The neccessity of research in a profession In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 1ndash9
24 Auger C Demers L Swaine B Making sense of pragmatic
criteria for the selection of geriatric rehabilitation measure-
ment tools Arch Gerontol Geriatrics 20064365ndash83
25 Reardon R Lavis J Gibson J 2006 May 25 From research to
practice A knowledge transfer planning guide Accessed 25
May 2007 from the website http Institute for Work amp
Health
26 Hunt DL Haynes RB Hanna SE Smith K Effects of
computer-based clinical decision support systems on physi-
cian performance and patient outcomes A systematic review
JAMA 19982801339ndash1346
158 L Demers amp L Poissant
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
27 Patel VL Kushniruk AW Yang S Yale JF Impact of a
computer-based patient record system on data collection
knowledge organization and reasoning J Am Med Infor-
matics Assoc 20007569ndash585
28 Raschke RA Gollihare B Wunderlich TA Guidry JR
Leibowitz AI Peirce JC Lemelson L Heisler MA Susong
C A computer alert system to prevent injury from adverse
drug events Development and evaluation in a community
teaching hospital JAMA 19982801317ndash1320
29 Tamblyn R Huang A Kawasumi Y Bartlett G Grad R
Jacques A Dawes M Abrahamowicz M Perreault R Taylor
L et al The development and evaluation of an integrated
electronic prescribing and drug management system for
primary care J Am Med Informatics Assoc 200613148ndash159
30 Bates DW Kuperman GJ Wang S Gandhi T Kittler A Volk
L Spurr C Khorasani R Tanasijevic M Middleton B Ten
commandments for effective clinical decision support making
the practice of evidence-based medicine a reality J Am Med
Informatics Assoc 200310523ndash530
31 Gervais M Pepin C Carriere M TRIAGE ou comment adapter
une technique de recherche a lrsquointervention en ergotherapie
Revue Quebecoise drsquoErgotherapie 2000911ndash15
32 Morgan DL Scannell AU Planning focus groups Morgan
DL Krueger RA editors Thousand Oaks Sage 1997 139 p
33 Weinger MB Herndon OW Gaba DM The effect of
electronic record keeping and transesophageal echocardio-
graphy on task distribution workload and vigilance during
cardiac anesthesia Anesthesiology 199787144ndash155 discus-
sion 129Andash130A
34 McDermott R 1999 May 25 Nurturing three dimensional
communities of practice How to get the most out of human
works In Knowledge management review Accessed 25
May 2007 from the website http wwwco-i-lcomcoil
knowledge-gardencopdimensional
Connecting with clinicians 159
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
undergraduate students during the summer to work
on clinical research projects is a concrete way to
reinforce partnerships between clinicians and re-
searchers
Consider clinicians initiated projects
A second perspective to consider in enhancing
connections with clinicians is to get researchers to
collaborate on clinical research projects If such an
opportunity occurs it would be judicious to take it
As collaborators researchers should modestly assist
the clinicians in moving their project forward It is
important to be constructive and understand the goal
behind the initiative A given project may not lead to
a publication but may lead to improve patient
care and overall this should be recognized by
researchers as a legitimate goal and reason for their
implication
Consider networking
Next it is important to take part in broader events
involving the participation of varied stakeholders
including clinicians and researchers as well as clients
policy-makers and health managers Symposiums
colloquiums and network meetings are exceptional
forums to learn about whatrsquos going on in the field of
rehabilitation to influence decisions to connect with
potential collaborators to understand the struggle
others have to go through and to build research that
is meaningfully grounded Striking differences may
be observed in the way clinicians with different
professional background researchers and managers
consider problems that are raised in these network
gatherings Some may be focussed on training issues
costs data collection and staff turnover Others may
be worried about time constraints and how to let go of
pre-existing approaches to assessment or treatment
Yet others may be centered on theoretical issues
Again the richness of the exchanges between various
points of view is critical in choosing and developing
ultimately the evaluations and interventions that may
best serve patients
Consider developing communities of practice
Communities of practice (CoPs) refer to groups of
individuals who share common ideas goals and
interest and work together in pursuit of these goals
[33] A CoP aimed at strengthening rehabilitation
research through goal-directed activities would in-
corporate clinicians decision-makers and research-
ers The collaborative work and knowledge
exchanges that characterize CoPs have been identi-
fied as an effective way to accelerate knowledge
dissemination and to encourage adoption of
innovations [34] An emergent concept in the
healthcare system CoPs will undoubtedly find
adopters in the rehabilitation field
Conclusion
Gaps and challenges
Over the past few years reducing the gap between
clinicians and researchers has become a priority
Furthermore research is now being conducted to
better understand and identify the best strategies to
increase knowledge uptake by clinicians Interest-
ingly the outcomes of this emerging research
domain around knowledge exchange targets not only
clinicians but also researchers Indeed researchers
will need to take an active role in updating their
dissemination strategies to better match the needs of
clinicians
Throughout this paper we demonstrated the
necessity to create sustainable and dynamic links
between the clinical and research communities to
strengthen rehabilitation research and improve qual-
ity of rehabilitation care and services Clinicians and
researchers have different priorities and concerns
yet we provided concrete approaches to overcome
these differences Accordingly clinicians and re-
searchers move at different speeds While researchers
make small and very slow steps toward the best
possible knowledge clinicians constantly face pro-
blems that require rapid solutions What services are
required What is the level of pain now Can this
person drive safely These decisions bear a lot of
consequences and can hardly wait Not surprisingly
how little can be accomplished in research for
immediate and urgent clinical problem may be seen
as an obstacle in the relationship between clinicians
and researchers and nourish the perception that
these two worlds are incompatible Again through-
out the paper we presented ideas and approaches
that should remove these attitudinal barriers
The reality faced by healthcare professionals and
managers must also be taken into consideration We
acknowledge the fact that the shortage of resources
and constant pressures to be effective and efficient
restrict the latitude of clinicians to participate in
research activities This situation is prone to lead to
frustration unless both parties join their efforts to
ensure that research activities are prioritized within
an organization or health network
Overall each opportunity at hand that favours
connecting clinicians and researchers must be
explored and reinforced An example of such
opportunity which was raised earlier in this paper
is to increase the number of research-trained
clinicians With the imminent move towards a
master-entry level for rehabilitation disciplines in
Connecting with clinicians 157
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
occidental countries more classroom time will be
devoted to research and its clinical impacts More-
over field work completed as part of the upgraded
curriculum will have a much stronger research
component attached to it These new legal-profes-
sional requirements associated to an increased
number of clinicians accessing graduate programs
and going back to clinical environments will have
major impact on clinical practice Future clinicians
will indeed have the capacity to take on the role of
leaders to improve care and services through the
adoption of best practices
Connecting researchers and clinicians has many
facets all of which may be considered as adding
value to rehabilitation research and clinical practice
The broad scope of topics methods and populations
covered by rehabilitation researchers and clinicians
highlights the need to develop and reinforce this
connection The implementation of traditional and
innovative approaches described in this paper will
encourage both clinicians and researchers to develop
sustainable partnerships which in turn will optimize
rehabilitation care and services
Acknowledgements
The authors are supported by the lsquolsquoFonds de la
recherche en sante du Quebecrsquorsquo An earlier version of
this paper was presented as a keynote presentation by
the first author to the 10th Research Colloquium on
Rehabilitation McGill University Quebec Canada
on May 4 2006
Declaration of interest The authors report no
conflicts of interest The authors alone are respon-
sible for the content and writing of the paper
References
1 Tate DG The state of rehabilitation research Art or science
Arch Phys Med Rehabil 200687160ndash166
2 Cicerone KD Evidence-based practice and the limits of
rational rehabilitation Arch Phys Med Rehabil 2005861073ndash
1074
3 Ilott I Challenges and strategic solutions for a research
emergent profession Am J Occupat Ther 200458347ndash352
4 Graham ID Logan J Harrison MB Straus SE Tetroe J
Caswell W Robinson N Lost in knowledge translation
Time for a map J Continuing Educ Health Professions 2006
2613ndash24
5 Stratton Johnson L From knowledge transfer to knowledge
translation Applying research to practice Occupat Ther Now
2005711ndash14
6 Bowen S Martens PJ A model for collaborative evaluation of
university-community partnerships Epidemiol Community
Health 200660902ndash907
7 Taylor RR Suarez-Balcazar Y Forsyth K Kielhofner G
Participatory research in occupational therapy In Kielhofner
G editor Research in occupational therapy Philadelphia
FA Davis 2006 pp 620ndash631
8 Sudsawad P Definition evolution and implementation
of evidence-based practice in occupational therapy In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 656ndash662
9 Whalley Hammel K Carpenter C Qualitative research in
evidence-based rehabilitation Edinburgh Churchill Living-
stone 2004 148 p
10 Law M Evidence-based rehabilitation A guide to practice
Thorofare Slack 2002 364 p
11 Baker NA Analyzing evidence for practice In Kielhofner G
editor Research in occupational therapy Philadelphia FA
Davis 2006 pp 663ndash684
12 Egan M Canadian occupational therapy research The little
profession that could Canad J Occupat Ther 200168143ndash
148
13 Korner-Bitenski N Wood-Dauphinee S Teasell R Hanley J
Harrison M Kaizer F Kehayia E Menon A Survey of
occupational therapy practices for stroke Canad J Occupat
Ther 2005(Suppl 1)33
14 McCluskey A Managing change and barriers to evidence-
based practice In Kielhofner G editor Research in
occupational therapy Philadelphia FA Davis 2006 pp
685ndash696
15 World Health Organization International Classification of
Functioning Disability and Health Geneva World Health
Organization 2001 306 p
16 Stucki G International Classification of Functioning Dis-
ability and Health (ICF) A promising framework and
classification for rehabilitation medicine Am J Phys Med
Rehabil 200584733ndash740
17 Jette AM Keysor J Coster W Ni P Haley S Beyond
function Predicting participation in a rehabilitation cohort
Arch Phys Med Rehabil 2005862087ndash2094
18 Salter K Jutai JW Teasell R Foley NC Bitensky J Issues for
selection of outcome measures in stroke rehabilitation ICF
Body Functions Disabil Rehabil 200527191ndash207
19 Mayo NE Poissant L Ahmed S Finch L Higgins J Salbach
NM Soicher J Jaglal S Incorporating the International
Classification of Functioning Disability and Health (ICF)
into an electronic health record to create indicators of func-
tion Proof of concept using the SF-12 J Am Med Informatics
Assoc 200411514ndash522
20 Frontera WR Fuhrer MJ Jette AM Chan L Cooper RA
Duncan PW Kemp JD Ottenbacher KJ Peckham PH Roth
EJ et al Rehabilitation medicine summit Building research
capacity (executive summary) Am J Speech Lang Pathol
2006153ndash14
21 Contandriopoulos A-P Champagne F Potvin L Denis J-L
Boyle P Savoir preparer une recherche la definir la
structurer la financer Montreal Les Presses de lrsquoUniversite
de Montreal 1990 193 p
22 DePoy E Gitlin LN Introduction to research understanding
and applying multiple strategies St Louis Elsevier Mosby
2005 346 p
23 Kielhofner G The neccessity of research in a profession In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 1ndash9
24 Auger C Demers L Swaine B Making sense of pragmatic
criteria for the selection of geriatric rehabilitation measure-
ment tools Arch Gerontol Geriatrics 20064365ndash83
25 Reardon R Lavis J Gibson J 2006 May 25 From research to
practice A knowledge transfer planning guide Accessed 25
May 2007 from the website http Institute for Work amp
Health
26 Hunt DL Haynes RB Hanna SE Smith K Effects of
computer-based clinical decision support systems on physi-
cian performance and patient outcomes A systematic review
JAMA 19982801339ndash1346
158 L Demers amp L Poissant
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
27 Patel VL Kushniruk AW Yang S Yale JF Impact of a
computer-based patient record system on data collection
knowledge organization and reasoning J Am Med Infor-
matics Assoc 20007569ndash585
28 Raschke RA Gollihare B Wunderlich TA Guidry JR
Leibowitz AI Peirce JC Lemelson L Heisler MA Susong
C A computer alert system to prevent injury from adverse
drug events Development and evaluation in a community
teaching hospital JAMA 19982801317ndash1320
29 Tamblyn R Huang A Kawasumi Y Bartlett G Grad R
Jacques A Dawes M Abrahamowicz M Perreault R Taylor
L et al The development and evaluation of an integrated
electronic prescribing and drug management system for
primary care J Am Med Informatics Assoc 200613148ndash159
30 Bates DW Kuperman GJ Wang S Gandhi T Kittler A Volk
L Spurr C Khorasani R Tanasijevic M Middleton B Ten
commandments for effective clinical decision support making
the practice of evidence-based medicine a reality J Am Med
Informatics Assoc 200310523ndash530
31 Gervais M Pepin C Carriere M TRIAGE ou comment adapter
une technique de recherche a lrsquointervention en ergotherapie
Revue Quebecoise drsquoErgotherapie 2000911ndash15
32 Morgan DL Scannell AU Planning focus groups Morgan
DL Krueger RA editors Thousand Oaks Sage 1997 139 p
33 Weinger MB Herndon OW Gaba DM The effect of
electronic record keeping and transesophageal echocardio-
graphy on task distribution workload and vigilance during
cardiac anesthesia Anesthesiology 199787144ndash155 discus-
sion 129Andash130A
34 McDermott R 1999 May 25 Nurturing three dimensional
communities of practice How to get the most out of human
works In Knowledge management review Accessed 25
May 2007 from the website http wwwco-i-lcomcoil
knowledge-gardencopdimensional
Connecting with clinicians 159
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
occidental countries more classroom time will be
devoted to research and its clinical impacts More-
over field work completed as part of the upgraded
curriculum will have a much stronger research
component attached to it These new legal-profes-
sional requirements associated to an increased
number of clinicians accessing graduate programs
and going back to clinical environments will have
major impact on clinical practice Future clinicians
will indeed have the capacity to take on the role of
leaders to improve care and services through the
adoption of best practices
Connecting researchers and clinicians has many
facets all of which may be considered as adding
value to rehabilitation research and clinical practice
The broad scope of topics methods and populations
covered by rehabilitation researchers and clinicians
highlights the need to develop and reinforce this
connection The implementation of traditional and
innovative approaches described in this paper will
encourage both clinicians and researchers to develop
sustainable partnerships which in turn will optimize
rehabilitation care and services
Acknowledgements
The authors are supported by the lsquolsquoFonds de la
recherche en sante du Quebecrsquorsquo An earlier version of
this paper was presented as a keynote presentation by
the first author to the 10th Research Colloquium on
Rehabilitation McGill University Quebec Canada
on May 4 2006
Declaration of interest The authors report no
conflicts of interest The authors alone are respon-
sible for the content and writing of the paper
References
1 Tate DG The state of rehabilitation research Art or science
Arch Phys Med Rehabil 200687160ndash166
2 Cicerone KD Evidence-based practice and the limits of
rational rehabilitation Arch Phys Med Rehabil 2005861073ndash
1074
3 Ilott I Challenges and strategic solutions for a research
emergent profession Am J Occupat Ther 200458347ndash352
4 Graham ID Logan J Harrison MB Straus SE Tetroe J
Caswell W Robinson N Lost in knowledge translation
Time for a map J Continuing Educ Health Professions 2006
2613ndash24
5 Stratton Johnson L From knowledge transfer to knowledge
translation Applying research to practice Occupat Ther Now
2005711ndash14
6 Bowen S Martens PJ A model for collaborative evaluation of
university-community partnerships Epidemiol Community
Health 200660902ndash907
7 Taylor RR Suarez-Balcazar Y Forsyth K Kielhofner G
Participatory research in occupational therapy In Kielhofner
G editor Research in occupational therapy Philadelphia
FA Davis 2006 pp 620ndash631
8 Sudsawad P Definition evolution and implementation
of evidence-based practice in occupational therapy In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 656ndash662
9 Whalley Hammel K Carpenter C Qualitative research in
evidence-based rehabilitation Edinburgh Churchill Living-
stone 2004 148 p
10 Law M Evidence-based rehabilitation A guide to practice
Thorofare Slack 2002 364 p
11 Baker NA Analyzing evidence for practice In Kielhofner G
editor Research in occupational therapy Philadelphia FA
Davis 2006 pp 663ndash684
12 Egan M Canadian occupational therapy research The little
profession that could Canad J Occupat Ther 200168143ndash
148
13 Korner-Bitenski N Wood-Dauphinee S Teasell R Hanley J
Harrison M Kaizer F Kehayia E Menon A Survey of
occupational therapy practices for stroke Canad J Occupat
Ther 2005(Suppl 1)33
14 McCluskey A Managing change and barriers to evidence-
based practice In Kielhofner G editor Research in
occupational therapy Philadelphia FA Davis 2006 pp
685ndash696
15 World Health Organization International Classification of
Functioning Disability and Health Geneva World Health
Organization 2001 306 p
16 Stucki G International Classification of Functioning Dis-
ability and Health (ICF) A promising framework and
classification for rehabilitation medicine Am J Phys Med
Rehabil 200584733ndash740
17 Jette AM Keysor J Coster W Ni P Haley S Beyond
function Predicting participation in a rehabilitation cohort
Arch Phys Med Rehabil 2005862087ndash2094
18 Salter K Jutai JW Teasell R Foley NC Bitensky J Issues for
selection of outcome measures in stroke rehabilitation ICF
Body Functions Disabil Rehabil 200527191ndash207
19 Mayo NE Poissant L Ahmed S Finch L Higgins J Salbach
NM Soicher J Jaglal S Incorporating the International
Classification of Functioning Disability and Health (ICF)
into an electronic health record to create indicators of func-
tion Proof of concept using the SF-12 J Am Med Informatics
Assoc 200411514ndash522
20 Frontera WR Fuhrer MJ Jette AM Chan L Cooper RA
Duncan PW Kemp JD Ottenbacher KJ Peckham PH Roth
EJ et al Rehabilitation medicine summit Building research
capacity (executive summary) Am J Speech Lang Pathol
2006153ndash14
21 Contandriopoulos A-P Champagne F Potvin L Denis J-L
Boyle P Savoir preparer une recherche la definir la
structurer la financer Montreal Les Presses de lrsquoUniversite
de Montreal 1990 193 p
22 DePoy E Gitlin LN Introduction to research understanding
and applying multiple strategies St Louis Elsevier Mosby
2005 346 p
23 Kielhofner G The neccessity of research in a profession In
Kielhofner G editor Research in occupational therapy
Philadelphia FA Davis 2006 pp 1ndash9
24 Auger C Demers L Swaine B Making sense of pragmatic
criteria for the selection of geriatric rehabilitation measure-
ment tools Arch Gerontol Geriatrics 20064365ndash83
25 Reardon R Lavis J Gibson J 2006 May 25 From research to
practice A knowledge transfer planning guide Accessed 25
May 2007 from the website http Institute for Work amp
Health
26 Hunt DL Haynes RB Hanna SE Smith K Effects of
computer-based clinical decision support systems on physi-
cian performance and patient outcomes A systematic review
JAMA 19982801339ndash1346
158 L Demers amp L Poissant
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
27 Patel VL Kushniruk AW Yang S Yale JF Impact of a
computer-based patient record system on data collection
knowledge organization and reasoning J Am Med Infor-
matics Assoc 20007569ndash585
28 Raschke RA Gollihare B Wunderlich TA Guidry JR
Leibowitz AI Peirce JC Lemelson L Heisler MA Susong
C A computer alert system to prevent injury from adverse
drug events Development and evaluation in a community
teaching hospital JAMA 19982801317ndash1320
29 Tamblyn R Huang A Kawasumi Y Bartlett G Grad R
Jacques A Dawes M Abrahamowicz M Perreault R Taylor
L et al The development and evaluation of an integrated
electronic prescribing and drug management system for
primary care J Am Med Informatics Assoc 200613148ndash159
30 Bates DW Kuperman GJ Wang S Gandhi T Kittler A Volk
L Spurr C Khorasani R Tanasijevic M Middleton B Ten
commandments for effective clinical decision support making
the practice of evidence-based medicine a reality J Am Med
Informatics Assoc 200310523ndash530
31 Gervais M Pepin C Carriere M TRIAGE ou comment adapter
une technique de recherche a lrsquointervention en ergotherapie
Revue Quebecoise drsquoErgotherapie 2000911ndash15
32 Morgan DL Scannell AU Planning focus groups Morgan
DL Krueger RA editors Thousand Oaks Sage 1997 139 p
33 Weinger MB Herndon OW Gaba DM The effect of
electronic record keeping and transesophageal echocardio-
graphy on task distribution workload and vigilance during
cardiac anesthesia Anesthesiology 199787144ndash155 discus-
sion 129Andash130A
34 McDermott R 1999 May 25 Nurturing three dimensional
communities of practice How to get the most out of human
works In Knowledge management review Accessed 25
May 2007 from the website http wwwco-i-lcomcoil
knowledge-gardencopdimensional
Connecting with clinicians 159
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
27 Patel VL Kushniruk AW Yang S Yale JF Impact of a
computer-based patient record system on data collection
knowledge organization and reasoning J Am Med Infor-
matics Assoc 20007569ndash585
28 Raschke RA Gollihare B Wunderlich TA Guidry JR
Leibowitz AI Peirce JC Lemelson L Heisler MA Susong
C A computer alert system to prevent injury from adverse
drug events Development and evaluation in a community
teaching hospital JAMA 19982801317ndash1320
29 Tamblyn R Huang A Kawasumi Y Bartlett G Grad R
Jacques A Dawes M Abrahamowicz M Perreault R Taylor
L et al The development and evaluation of an integrated
electronic prescribing and drug management system for
primary care J Am Med Informatics Assoc 200613148ndash159
30 Bates DW Kuperman GJ Wang S Gandhi T Kittler A Volk
L Spurr C Khorasani R Tanasijevic M Middleton B Ten
commandments for effective clinical decision support making
the practice of evidence-based medicine a reality J Am Med
Informatics Assoc 200310523ndash530
31 Gervais M Pepin C Carriere M TRIAGE ou comment adapter
une technique de recherche a lrsquointervention en ergotherapie
Revue Quebecoise drsquoErgotherapie 2000911ndash15
32 Morgan DL Scannell AU Planning focus groups Morgan
DL Krueger RA editors Thousand Oaks Sage 1997 139 p
33 Weinger MB Herndon OW Gaba DM The effect of
electronic record keeping and transesophageal echocardio-
graphy on task distribution workload and vigilance during
cardiac anesthesia Anesthesiology 199787144ndash155 discus-
sion 129Andash130A
34 McDermott R 1999 May 25 Nurturing three dimensional
communities of practice How to get the most out of human
works In Knowledge management review Accessed 25
May 2007 from the website http wwwco-i-lcomcoil
knowledge-gardencopdimensional
Connecting with clinicians 159
Dis
abil
Reh
abil
Dow
nloa
ded
from
info
rmah
ealth
care
com
by
Mic
higa
n U
nive
rsity
on
111
014
For
pers
onal
use
onl
y
top related