A Knowledge Translation Framework for Optimizing Physical Therapy in Patients With Heart Failure

Abstract

The American Physical Therapy Association (APTA) has supported the development of clinical practice guidelines to promote and support evidence-based practice and reduce unwarranted practice variation. Essential to the success of this effort is the generation of knowledge translation—a concept that emphasizes the translation of global knowledge to an application that can be effectively integrated into clinical practice. The Physical Therapy Clinical Practice Guideline for the Management of Individuals with Heart Failure published in the Physical Therapy Journal in January 2020 provides a broad base of knowledge related to evidence-based treatment interventions for patients with heart failure. However, the application and integration of this knowledge in clinical practice need further elucidation. Therefore, this perspective paper aims to serve as a complementary knowledge translation resource to the recently published practice guideline to maximize the utilization of contemporary evidence in clinical practice. This resource provides the physical therapist with practical guidance in the management of patients with heart failure by placing research findings in the context of other knowledge and practice norms that can be applied at the point of care and across the continuum of care. We propose a novel ABCDE (Assessment, Behavior, Cardiorespiratory Fitness, Dosage, and Education) practical framework. This clinical paradigm is grounded in ongoing physical therapist assessment throughout the episode of care, along with behavior modification, assessment of cardiorespiratory fitness, appropriate selection and dosing of interventions and patient education. Examples highlighting the use of this model in patients with heart failure across the continuum of care are provided for application in clinical care.

Cardiovascular and Pulmonary Research: The Year (2021) in Review

“…The education component emphasized the importance of patient recognition of decompensation, as well as importance of medication management and nutritional adherence. 2 Overall, this article concluded that through the use of this multidimensional framework, physical therapists can help reduce HF-related hospitalizations/readmissions, while optimizing movement and physical activity in patients with HF. 2…”

“…The article of Dias et al 2 related to a framework for knowledge translation from the 2020 Heart Failure Clinical Practice Guideline (HF CPG) by Shoemaker et al 3 The perspective article by Dias et al 2 aimed to serve as a complimentary resource to the HF CPG, to “maximize the utilization of contemporary evidence in clinical practice.” Current evidence provided in the HF CPG is based on a “relatively select group of patients,” including men aged 50 to 60 years, NYHA class II–III, in an outpatient setting. 2,3 This group of patients is “relatively stable” and may lack the comorbidities or instability seen in clinical practice. The application of the HF CPG in the care of complex patients may be challenging because a “mismatch” may be present between the patients studied in clinical trials and the complex patients seen in clinical practice.…”

“…If physical therapists recognize signs and symptoms of acute decompensation, such as S3 heart sound, pulmonary crackles, and increase in peripheral edema, it is crucial to recommend prompt medical follow-up. Utilization of the detailed algorithms provided in the article of Dias et al 2 can also be used as a supplement to the algorithms presented in the HF CPG given by Shoemaker et al 3 .…”

“…This framework included assessment, behavior modification, cardiorespiratory fitness, dosage, and education. 2 Assessment of stability at rest and during exertion is crucial, as a decrease in stability may increase the likelihood of decompensation, leading to an increase in hospital admissions. Behavior modification in the HF population is important for patient adherence to management behaviors, including nutrition, medication compliance, and exercise.…”

Using knowledge translation to establish a model of hospital-based early supported community reintegration for stroke patients in South Korea

“…The knowledge-to-action cycle entails: (1) identifying knowledge; (2) adapting the knowledge to the local situation; (3) assessing barriers and facilitators to its use in practice; (4) selecting, tailoring, and using strategies to implement the use of this knowledge; (5) monitoring knowledge use; (6) evaluating outcomes; and (7) sustaining the use of knowledge over time. In the field of medicine, knowledge translation has been recently widely used to analyze the experiences and needs of patients and caregivers [ 16 , 17 ], to develop interventions and guidelines [ 18 ], and to verify the effectiveness of newly developed interventions and guidelines [ 19 ].…”