Rationale Despite the available evidence to support optimal practices in rehabilitation, significant knowledge practice gaps persist. Opinion leaders (OLs) and knowledge brokers (KBs) can enhance the success of knowledge translation (KT) interventions and improve uptake of best practices among clinicians. However, the literature on the mechanisms underpinning OLs'/KBs' activities, and guidance on the type of support needed for successful implementation of these roles in rehabilitation contexts is scarce. This research aimed to highlight the differences and similarities between OLs and KBs with respect to context, mechanism, and outcomes as well as describe the common patterns of OLs and KBs by creating a context‐mechanism‐outcomes configuration. Methods We conducted a realist review to synthesize the available evidence on OLs/KBs as active KT strategies. A search was conducted across five databases up to November 2019. Two independent reviewers extracted the data using a structured form. A context‐mechanism‐outcome configuration was used to conceptualize a cumulative portrait of the features of OLs/KBs roles. Results The search identified 3282 titles after removing duplicates. Seventeen studies (reported in 20 articles) were included in the review. Findings suggest a number of desirable features of OLs/KBs roles that may maximize the achievement of targeted outcomes namely being (a) embedded within their organization as “insiders”; (b) adequately skilled to perform their role; (c) identified as able to fulfil the role; (d) appropriately trained; and (e) able to use different KT interventions. Conclusion Findings of this realist review converge to create a context‐mechanism‐outcomes configuration with suggestions to optimally utilize OLs/KBs in rehabilitation. The configurations suggest desirable features that can lead to a greater potential to achieve targeted goals. It is preferable that OLs/KBs be embedded in the organization and that they are adequately skilful and well‐trained. Also, OLs/KBs should perform the required roles using KT interventions adapted to the local context.
IntroductionTelehealth interventions have the potential of improving exacerbation and health outcomes for individuals with chronic obstructive pulmonary disease (COPD), by delivering care in between clinical visits. However, the precise impact on avoiding exacerbation and reducing the incidence of hospital readmissions remains inconclusive. This lack of knowledge on the effectiveness of telehealth for COPD care might be due to non-adherence or partial adherence to intervention programmes and/or the withdrawal of participants over the course of previous studies.ObjectivesTo conduct a systematic review of trials of telehealth interventions (including randomised control trials (RCT), crossover and pre-post studies) to: (1) estimate the acceptance, adherence and dropout rates; (2) identify the reasons for dropout from telehealth interventions among individuals with COPD; (3) evaluate the impact of trial-related, sociodemographic and intervention-related factors on the acceptance, adherence and dropout rates and (4) estimate the extent to which the acceptance, adherence and dropout rates impact outcomes in comparison with usual monitoring.Methods and analysisA systematic literature review of four databases from earliest records to November 2018 will be carried out using CINAHL, Medline (Ovid), Cochrane Library and Embase. Randomised and non-randomised control studies will be included, in addition to crossover and pre-studies post-studies comparing telehealth with standard monitoring among individuals with COPD only. Two independent reviewers will screen all relevant abstracts and full-text studies to determine eligibility, assess the risk of bias and extract the data using structured forms. If the included studies are sufficiently homogenous in terms of interventions, populations and objectives, a meta-analysis will be performed.Ethics and disseminationEthical considerations are not required for this research.Trial registration numberCRD42017078541.
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