Current & Recent Projects
Developing an Innovative Conceptual Framework of Community-Based Rehabilitation to Inform Restorative Care
As is the case globally, Canada is experiencing a growing population of individuals living with chronic health conditions, along with an increasing aging population. In 2014-15, more than half of the Manitobans aged 40 and older had one or more chronic conditions; and in 2015-16, 15% of the population was aged 65 or above. Health care for these populations has traditionally been provided in hospital settings. However, hospitalization is costly, and the average cost of a hospital bed per day in Winnipeg was $800 in 2014. In contrast, the average home care client cost per day was $200. Given this, there is a dire need for alternative health care models that will shift the focus away from hospitalization to cost-effective community-based restorative care. To do so, it is important to first understanding the scope of the current community-based restorative care. Funded by the University of Manitoba Rady Innovation Fund ($100,000, 2017-19), this project seeks to (i) gain a comprehensive understanding of the current state of community-based rehabilitation; and (ii) develop a framework for community-based restorative care, which can be used in the design of future innovative community rehabilitation policy, planning, care, and research. Specific objectives of the projects are to:
- Identify the goals, resources and processes of home and community-based rehabilitation health care services for adults at risk of institutionalization in Winnipeg
- Determine what data is required to inform the transformation of home and community-based rehabilitation health care services to a restorative care approach for adults at risk of institutionalization
- Describe the experiences of home and community-based rehabilitation health care services among adults at risk of institutionalization in Winnipeg
- Synthesize the findings into a conceptual framework to be used in the design of future innovative health care and community restorative care research
The research team includes provincial health system decision makers and researchers from rehabilitation, medicine and nursing. Mixed methods approach will be used, including interviews with multiple stakeholder groups and users and providers of community-based restorative care, document review, and a comprehensive environmental scan. The quantitative and qualitative phases will be done concurrently and be interpreted together to inform the conceptual framework and overall project conclusions. The project will conclude with a consensus forum with stakeholders to develop a framework for community-based restorative care. The research team includes a key provincial health decision maker as a principal knowledge user –– who conceived of the need for this project –– which poised this project to have an immediate impact on policy and planning for community-based restorative care approaches to rehabilitation service delivery.
Advancing the Science of Integrated Knowledge Translation with Health Researchers and Knowledge Users: Understanding Current and Developing
Recommendations for Integrated KT Practice
Getting research results into everyday health care practice and policies is a long and painstaking process. The field of Knowledge Translation (KT) has emerged and is expanding in attempt to speed up this process. One approach of KT, called integrated KT, includes the users of research throughout the research process. Partnership between research producers and research users is key to producing evidence that is more relevant to its users. In health research, integrated Knowledge Translation (iKT) is a collaborative research approach in which research users (also called knowledge users), such as people with lived experiences of a health condition, families, health professionals and decision-makers, are involved throughout the research process. It makes knowledge translation more meaningful and effective by producing research that is more relevant and likely to be used.
Although iKT is a popular approach, there is little data on its effects. Using mixed methods approach, the overall goal of this CIHR-funded project is to examine how iKT has been conducted and evaluated in Canada. There are two key objectives of this project: 1) to develop a comprehensive understanding of current iKT practice; and 2) to make recommendations for conducting and evaluating iKT. These objectives will be achieved in three phases over the next four years (2018-2022):
- In phase I, a scoping review will be conducted to synthesize the contexts, methods, and outcomes of iKT reported in published.
- In phase II, interviews and surveys will be conducted with researchers and research users who have received integrated KT grants to identify the contexts, methods, outcomes, perceptions and perceived impact of conducting iKT in Canada, and to examine associations between these.
- In phase III, with the consensus of the research team, recommendations will be developed for conducting, reporting, evaluating integrated KT projects.
The research team includes both researchers and knowledge users –– including decision-makers, clinicians, and patient partners –– from across Canada who bring varied expertise to the project. The long term goal of this project is to improve the health of people across Canada by ensuring the latest research is quickly incorporated into everyday health care practice and policies.
REACT: Developing Theory-Based Interventions to Increase Clinical Measurement of Reactive Balance in Adults at Risk of Falls
Reactive balance is a critical skill for fall avoidance, but isn’t regularly assessed in clinical practice. This study attempts to implement a clinically feasible measure of reactive balance in three Ontario rehabilitation hospitals. In addition, this study addresses a gap in evidence for effective implementation interventions in rehabilitation settings. We have published a case report describing how the Theoretical Domains Framework (TDF) was used to develop an intervention to increase clinical measurement of reactive balance among physiotherapists who treat adults at risk of falls.
Core Outcome Set Development in Balance Exercise & Falls Prevention
Balance is a complex skill necessary to mobility and fall avoidance. There is a great interest in identifying best practices for maintaining and improving balance. Exercise plays a major role in balance and is a key component of fall interventions. However, putting together the best prescription for balance training is difficult, because over 60 different balance measures exist in the literature, and their use varies among clinical practitioners.
There is a need for consistency in standing balance measurement in both research and practice. One approach to achieving standardization is the development of a core outcome set (COS) for measuring standing balance. A COS is a recommended minimum set of outcomes or outcome measures for a particular health construct, condition, or population wherein the results should be reported for all trials related to that issue. COS recommendations do not imply that measurement be restricted to the COS, but rather that the COS forms a consistent component of measurement, to which specific evaluation tools can be added.
Through this initiative, we developed recommendations for a COS for measuring balance in research and practice in adult populations. The recommendations were developed with a consensus-based approach with 14 experts from around the world. Fifty-six validated balance measures used in the past 5 years were considered for the COS – of these, 2 measures reached consensus for recommendation. The expert panel recommended that (at a minimum), either the Berg Balance Scale (BBS) or Mini Balance Evalution Systems Test (Mini BESTest) be used when measuring standing balance in adult populations.
This project reflects the first attempt to make COS recommendations for the field of balance research and practice, and should be both viewed as a starting point and revisited in the future. The BBS and Mini-BESTest received the required votes because they collectively best represent the objectives of the standing balance COS. The expert panel noted that the BBS may be considered more suitable for lower functioning adults, while the Mini BESTest is a more comprehensive measure of balance.
Valuing All Voices: Towards a More Inclusive Framework for Patient Engagement in Health Research
In the Spring of 2015, the George and Fay Yee Centre for Healthcare Innovation hosted a workshop titled Patients as Research Partners in Manitoba that brought together 50 stakeholders from across Manitoba (including patients, caregivers, community researchers, healthcare practitioners, and policy-makers) for a one-day, face-to-face meeting. The purpose of the meeting was to explore how stakeholders conceptualize patient engagement, identify barriers and facilitators to patient engagement in health research in Manitoba, and prioritize next steps for a provincial patient engagement strategy.
Participants provided highly valuable insight into the climate of patient engagement in Manitoba, to which we responded by beginning to explore various practical and theoretical approaches to build a more inclusive framework for the involvement of patients and the public in health research in Manitoba. We developed an enhanced Valuing All Voices Framework, for which we have received a CIHR Collaborative Patient Engagement Grant that will be used to validate this framework through discussion groups and integrated knowledge translation activities with key stakeholders. This framework will help inform the development of a set of tools to assist researchers and the public in engaging in inclusive, safe, meaningful, and authentic engagement relationships.