BackgroundTo better understand the efficacy of various implementation strategies, improved methods for describing and classifying the nature of these strategies are urgently required. The aim of this study was to develop and pilot the feasibility of a taxonomy to classify the nature and content of implementation strategies.MethodsA draft implementation taxonomy was developed based on the Cochrane Effective Practice and Organisation of Care (EPOC) data collection checklist. The draft taxonomy had four domains (professional, financial, organisational and regulatory) covering 49 distinct strategies. We piloted the draft taxonomy by using it to classify the implementation strategies described in the conference abstracts of the implementation stream of the 2010 Guideline International Network Conference. Five authors classified the strategies in each abstract individually. Final categorisation was then carried out in a face-to-face consensus meeting involving three authors.ResultsThe implementation strategies described in 71 conference abstracts were classified. Approximately 15.5% of abstracts utilised strategies that could not be categorised using the draft taxonomy. Of those strategies that could be categorised, the majority were professionally focused (57%). A total of 41% of projects used only one implementation strategy, with 29% using two and 31% three or more. The three most commonly used strategies were changes in quality assurance, quality improvement and/or performance measurement systems, changes in information and communication technology, and distribution of guideline materials (via hard-copy, audio-visual and/or electronic means).ConclusionsFurther refinement of the draft taxonomy is required to provide hierarchical dimensions and granularity, particularly in the areas of patient-focused interventions, those concerned with audit and feedback and quality improvement, and electronic forms of implementation, including electronic decision support.

This paper reviews studies which demonstrate the importance of kinaesthesis in the acquisition and performance of motor skills. A method of measuring kinaesthetic sensitivity in children and adults (recently developed) is briefly described. Developmental trends in kinaesthetic perception are discussed and large individual differences found within age groups. It was shown that kinaesthetically undeveloped children can be trained to perceive and memorize kinaesthetic information with greatly improved accuracy. Furthermore perceptual training facilitates the performance of a drawing skill. On the basis of these results an argument is made for the importance of kinaesthesis in skilled motor behaviour.

SUMMARY A test of kinaesthetic sensitivity to passive movements of the upper limbs was constructed consisting of two tasks: position and movement discrimination, and movement pattern perception and memory. 475 subjects ranging in age from five years to adult were tested and developmental trends were established. The test was found to be a useful tool in measuring the kinaesthetic sensitivity of normal subjects, as well as of intellectually and physically handicapped children. Results for right and left arms did not differ in the test of kinaesthetic perception and memory. Kinaesthetic sensitivity was found to be correlated with everyday motor functions involving fine manual control, as well as with co‐ordinated gross body movements. RÉSUMÉ Sensibilité kinesthésique des mouvements passifs et sa relation avec le développement moteur et le contrôle moteur Un test de sensibilité kinesthésique aux mouvements passifs du membre supérieur a étéétabli à partir de deux tâches: discrimination de la position et du mouvement, perception et mémoire d'un mouvement complexe. 475 sujets âgés de cinq ans au moins jusqu'a l'âge adulte ont été examinés et l'allure du développement a pu être établie. Le test s'est révélé un outil utile dans la mesure de la sensibilité kinesthésique chez les sujets normaux et aussi bien chez les enfants intellectuellement et physiquement handicapés. Les résultats pour le bras gauche et le bras droit étaient identiques dans le test de perception kinesthésique et de mémorisation. La sensibilité kinesthésique s'est révélée corrélée avec les fonctions motrices de la vie de tous les jours exigeant un contrôle gestuel fin aussi bien qu'avec les mouvements globaux coordonnés du corps. ZUSAMMENFASSUNG Kinästhetische Sensitivität für passive Bewegungen und ihre Beziehung zur motorischen Entwicklung und – Kontrolle Es wurde ein Test für kinästhetische Sensitivität für passive Bewegungen der oberen Extremität erarbeitet, der aus zwei Aufgaben bestand: Unterscheidung von Position und Bewegung und Perception und Erinnern von Bewegungsmustern. 475 Probanden im Alter von fünf Jahren bis zum Erwachsenenalter wurden gestestet und die Entwicklungstendenzen wurden registriert. Der Test stellte sich als brauchbare Methode heraus, um bei gesunden Probanden sowie bei geistig und körperlich behinderten Kindern die kinästhetische Sensitivitat zu prüfen. Die Ergebnisse für den rechten und den linken Arm unterschieden sich nicht in dem Test für kinästhetische Perception und Erinnerung. Man fand, daß die kinästhetische Sensitivität zu täglichen Motorfunktionen, die die feine manuelle Kontrolle beinhalten, sowie zu koordinierten großen Körperbewegungen korreliert ist. RESUMEN Sensibilidad cinéstésica a los movimientos pasivos y su relación con el desarrollo y control motores Se elavoró un test de sensibilidad cinestésica para los movimientos pasivos de las extremidadas superiores, que consistía en dos tareas: discriminación de la posición y movimiento, y percepción y memoria de esquemas de movimiento. Fueron examinados 475 sujet...

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The reduction was significant but inappropriate practice was not eliminated. For as long as decision-support systems are 'stand-alone' applications, achieving full compliance is dependent on continuous and expensive processes of education and enforcement. A better understanding of why clinicians fail to follow recommended practice is required, and decision support must be better embedded into clinical workflow.