Table 1 Overview of the Physical therapist-driven Education for Actionable Knowledge translation (PEAK) learning objectives and four consecutive interdependent learning components

Learning Objectives

By the end of the intervention we expected that therapists would be able to:

1. Identify gaps in knowledge and develop focused, searchable clinical questions;

2. Find the best available evidence to inform their question using appropriate online databases;

3. Critically appraise the quality of found evidence;

4. Write succinct statements of locally recommended practices that integrate research evidence with their clinical expertise and knowledge of patient perspective; and

5. Integrate newly learned skills and behaviors into their everyday work habits.

Additionally, from an organizational perspective, we expected that, at the conclusion of the PEAK program, all therapists would:

1. Agree to follow the common set of locally generated, evidence-based, best practices that they had developed, for a specific group-selected patient population;

2. Engage in activities to support using research to inform clinical practice for other patients; and

3. Demonstrate implementation of research within their clinical practice.

Instructor

The instructor for the program was the study principal investigator (PI; JKT) – a physical therapist with 10 years experience teaching EBP and promoting KT in clinical and classroom environments.

Component 1

Prior to starting the PEAK program leadership support was secured by engaging managers of the three, geographically separate physical therapy service departments (2 outpatient, 1 inpatient) at the University of Southern California (USC) to contribute to logistical organization of the PEAK program and to participate throughout the program. Resources for supporting the integration of research in practice were provided to all participants as follows:

 • A custom library web page developed and maintained by a medical librarian to reflect key online resources

 • A group online reference manager account (EndNote Web® [Thompson Reuters])

 • An online collaboration tool (Backpack™, 37 Signals, LLC) was purchased and set-up for all participants to use (a research assistant managed organization of the collaboration tool)

 • Skype™ (Microsoft Skype Division) accounts were established for each facility, including purchase and installation of webcams to facilitate inter-facility web conferencing

Links to online resources were installed as bookmarks on each participant’s work computer.

Component 2

During the first month of the program participants attended a two-day workshop that combined didactic and active learning around topics of EBP and KT including:

 • Review of the 5-step EBP model (1 h)

 • Searching skills (3 h; PubMed, National Guidelines Clearinghouse, Translating Research Into Practice, PEDro)

 • Appraisal skills (3 h; primary studies of interventions, systematic reviews, and clinical practice guidelines)

 • Integrating research evidence with patient perspectives and clinical expertise (1 h)

 • Using technology to keep up to date (2 h: podcasts, myNCBI auto-searches, RSS feeds, etc.; study-specific tools: Backpack™, EndNote Web®, Skype™)

 • Selection of clinical area and five sub-topics around which a list of locally relevant evidence-based best practices would be generated (2 h)

 • Initiation of small group work for developing the Best Practices List (2 h)

A librarian attended one day of the workshop to promote participants’ use of library resources and was available for consultation throughout the course of the educational program. A copy of the educational materials used for the 2-day workshop is available from the corresponding author.

It is important to note that the participants selected the clinical area that would be pursued for the rest of the program based on their common interests and a perceived opportunity for patient benefit. Further, participants identified five sub-topics of the clinical area and organized themselves into five corresponding small groups based on the sub-topic(s) of greatest interest to each participant.

Component 3

For 5 months following the workshop, participants met regularly in small groups (three to seven therapists) to develop a list of locally relevant ‘best practices’ for their clinical sub-topic. A designated group leader accepted responsibility for organizing regular small group communication and monthly reporting to the larger group. Each small group worked through the five EBP steps to find, appraise, and synthesize the highest quality research evidence for their clinical sub-topic. More specifically, groups were tasked to use research evidence, their own expertise, and knowledge of patient perspectives to generate actionable, evidence-based behaviors that could be implemented in their own practice. Actionable, evidence-based behaviors submitted by each small group were compiled into a single, “Best Practices List” for all participants to implement.

Small groups determined how often they met (virtually or in person) and used the online collaboration tool to accomplish their work. Monthly lunchtime meetings were conducted using Skype™ video conference for all participants to report on and discuss their progress. Monthly meetings were facilitated by the study principal investigator (PI) and attended by the study librarian. The study principal investigator and librarian met individually with groups when requested.

Component 4

At the end of the 5^th month, each small group submitted between 7 and 15, actionable, evidence-based behaviors to the Best Practices List. The study PI compiled the behaviors and distributed them to all participants for review and comment. Two rounds of review and comment were conducted online. Next, the list was sent for external review by experts selected by participants. Expert feedback was incorporated into the Best Practices List and at the end of the 6^th month, participants attended a final two hour meeting to review and discuss each behavior. Edits were made until all participants were satisfied that they could adhere to the recommended practice. At the conclusion of this final meeting the study participants gave verbal affirmation that they agreed with and would follow the behaviors outlined in the Best Practices List. This final list (online Appendix) was published in booklet form and distributed electronically and in hard copy to all participants.