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

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

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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

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onal

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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

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

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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

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

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

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ded

from

info

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rsity

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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

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

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

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

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

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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

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

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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-

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28 Raschke RA Gollihare B Wunderlich TA Guidry JR

Leibowitz AI Peirce JC Lemelson L Heisler MA Susong

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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

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graphy on task distribution workload and vigilance during

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sion 129Andash130A

34 McDermott R 1999 May 25 Nurturing three dimensional

communities of practice How to get the most out of human

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knowledge-gardencopdimensional

Connecting with clinicians 159

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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