The reference percentiles extend the clinical utility of the GMFM-66 and GMFCS by providing for appropriate normative interpretation of GMFM-66 scores within GMFCS levels. When interpreting change in percentiles over time, therapists must carefully consider the large variability in change that is typical among children with CP. The use of percentiles should be supplemented by interpretation of the raw scores to understand change in function as well as relative standing.

BackgroundThe use of measurement tools is an essential part of good evidence-based practice; however, physiotherapists (PTs) are not always confident when selecting, administering, and interpreting these tools. The purpose of this study was to evaluate the impact of a multifaceted knowledge translation intervention, using PTs as knowledge brokers (KBs) to facilitate the use in clinical practice of four evidence-based measurement tools designed to evaluate and understand motor function in children with cerebral palsy (CP). The KB model evaluated in this study was designed to overcome many of the barriers to research transfer identified in the literature.MethodsA mixed methods before-after study design was used to evaluate the impact of a six-month KB intervention by 25 KBs on 122 practicing PTs' self-reported knowledge and use of the measurement tools in 28 children's rehabilitation organizations in two regions of Canada. The model was that of PT KBs situated in clinical sites supported by a network of KBs and the research team through a broker to the KBs. Modest financial remuneration to the organizations for the KB time (two hours/week for six months), ongoing resource materials, and personal and intranet support was provided to the KBs. Survey data were collected by questionnaire prior to, immediately following the intervention (six months), and at 12 and 18 months. A mixed effects multinomial logistic regression was used to examine the impact of the intervention over time and by region. The impact of organizational factors was also explored.ResultsPTs' self-reported knowledge of all four measurement tools increased significantly over the six-month intervention, and reported use of three of the four measurement tools also increased. Changes were sustained 12 months later. Organizational culture for research and supervisor expectations were significantly associated with uptake of only one of the four measurement tools.ConclusionsKBs positively influenced PTs' self-reported knowledge and self-reported use of the targeted measurement tools. Further research is warranted to investigate whether this is a feasible, cost-effective model that could be used more broadly in a rehabilitation setting to facilitate the uptake of other measurement tools or evidence-based intervention approaches.

OBJECTIVE -To improve clinical diabetes care, patient knowledge, and treatment satisfaction and to reduce health-adverse culture-based beliefs in underserved and underinsured populations with diabetes. RESEARCH DESIGN AND METHODS-A total of 153 high-risk patients with diabetes recruited from six community clinic sites in San Diego County, California were enrolled in a nurse case management (NCM) and peer education/empowerment group. Baseline and 1-year levels of HbA 1c , lipid parameters, systolic and diastolic blood pressure, knowledge of diabetes, culture-based beliefs in ineffective remedies, and treatment satisfaction were prospectively measured. The NCM and peer education/empowerment group was compared with 76 individuals in a matched control group (CG) derived from patients referred but not enrolled in Project Dulce. RESULTS-After 1 year in Project Dulce, the NCM and peer education/empowerment group had significant improvements in HbA 1c (12.0 -8.3%, P Ͻ 0.0001), total cholesterol (5.82-4.86 mmol/l, P Ͻ 0.0001), LDL cholesterol (3.39 -2.79 mmol/l, P Ͻ 0.0001), and diastolic blood pressure (80 -76 mmHg, P Ͻ 0.009), which were significantly better than in the CG, in which no significant changes were noted. Accepted American Diabetes Association standards of diabetes care, knowledge of diabetes (P ϭ 0.024), treatment satisfaction (P ϭ 0.001), and culturebased beliefs (P ϭ 0.001) were also improved.CONCLUSIONS -A novel, culturally appropriate, community-based, nurse case management/peer education diabetes care model leads to significant improvement in clinical diabetes care, self-awareness, and understanding of diabetes in underinsured populations. Diabetes Care 27:110 -115, 2004T he incidence of diabetes is rapidly increasing in Western societies. Specific racial and ethnic groups, such as Mexican Americans, African Americans, Asian Americans, and Native Americans, are disproportionately affected by diabetes (1,2). The adverse impact on health of uncontrolled diabetes in these groups is compounded by lack of access to traditional primary care and preventive health care services (3-5).In response to this lack of adequate care for the uninsured, there is an increasing impetus for defining and implementing additional methods of improving diabetes care. The Centers for Disease Control and Prevention's national health objectives for year 2010 include increasing the percentage of individuals with diabetes who achieve specific standards of diabetes care (6). Diabetes management and education programs have been shown to have a significant impact on improving health outcomes (7-10). However, there remains a significant gap in translating and implementing effective approaches in the treatment of diabetes, particularly in underserved racial and ethnic groups (11-13). There is limited experience and available data assessing nontraditional approaches to diabetes self-management and empowerment models in diverse ethnic groups and none testing a comprehensive management approach (14 -17). Project Dulce was designed to test ...

Considerable variation in brokering activities was demonstrated across KB participants. The KBs perceived their role as useful and indicated that organizational commitment is crucial to the success of this KT strategy.

Although administrators were philosophically supportive of knowledge brokering, they identified funding and resource constraints and the absence of evidence of the effectiveness of knowledge brokering as major barriers to the continuation of a KB role in their facility.