There is a great Google Hangout discussion produced by PT Now, and “hosted by Mary Tischio Blackinton, PT, EdD, CEEAA, GCS. Dr Blackinton interviews Patty Scheets, PT, DPT, MHS, NCS, director of quality and clinical outcomes at Infinity Rehab and vice president of the APTA Neurology Section, and Ken Miller, PT, DPT, CEEAA, clinical educator for Catholic Home Care, guest lecturer and adjunct teaching assistant in the DPT program at Touro College, and chair of the APTA Home Health Section’s Practice Committee, provided some very interesting insights and observations.” (PT Now)
The hang out is about 40 minutes long and located at the PT Now site -
Early into the interview Dr. Sheets points out the “knowledge translation” barrier to incorporating evidence into practice. I agree. The only thing I would change is that the knowledge translation component is more than implementation strategies for how to bring empirical evidence from systematic reviews, and possibly more than what a clinical practice guideline can offer. At this point reviews continue - appropriately - slanted toward the empiricist epistemological foundation. Clinical practice guidelines do as well. A knowledge based practice recognizes that translation from evidence to knowledge includes generalization of premises with appropriate conditions with a balanced empirical - rationale - pragmatic epistemology. “Knowledge translation” should not simply be another empirical body of observations about the move of empirical findings (evidence) to practice. Knowledge translation should recognize the epistemology being used to generate knowledge and then implement the knowledge that has been generated. In other words, there is a stopping point, where knowledge grows prior to be implemented. As I have said before in an early post. This is not a radical concept. This is not something people are likely to debate. It is important to point it out and then ask what it means.
What I believe an explicit “knowledge based practice” offers is the appropriate balance of empirical and rationale, balanced with pragmatism through a critical realist foundation, during the knowledge generation process. Current empirical approaches collect observations and then continue to apply the same empirical foundation when attempting to articulate what knowledge comes from the evidence. It is a tacit acceptance of a strongly empirical epistemology. I believe knowledge translation will be more effective when we include in the repertoire of translating a clinical epistemology that weaves empiricism, rationalism and pragmatism through a critical realist foundation of epistemology.
I enjoyed the interview and am thankful to have learned from the interviewer and interviewees. Thank you!