Use of Knowledge Translation Strategies to Increase the Use of the Alberta Infant Motor Scale in Patients with Congenital Muscular Torticollis in the Pediatric Outpatient Hospital Based Setting

Background & Purpose: The Physical Therapy Management of Congenital Muscular Torticollis (CMT): A 2018 Evidence-Based Clinical Practice Guideline from the APTA Academy of Pediatric Physical Therapy supports the use of a standardized outcome measure (SOM) in the evaluation of a pediatric patient with CMT in order to remediate potential developmental delays. One of the recommended SOMs is the Alberta Infant Motor Scale (AIMS). Evidence shows there is limited use of SOMs across allied health professionals. This pediatric setting identified limited use of the AIMS in the evaluation of patients with CMT. Knowledge translation (KT) strategies have been identified as a method to promote practice change based on research. The purpose of this administrative case report was to increase use of the AIMS with patients with CMT utilizing KT strategies.

Case Description: KT initiative was developed based in part on the knowledge-to-action framework. Knowledge of the AIMS via clinician self-report (via SurveyMonkey©) and utilization of the AIMS during CMT evaluations (via chart audits) were assessed at baseline. Per survey results, 78% of clinicians were familiar with the AIMS; however per chart audits, only 10% included the AIMS. Through survey questions, it was identified that length of appointment time, clinician knowledge, availability of test materials, and time to document were barriers to implementation. An action plan was created to address modifiable barriers, including use of in-services, peer-to-peer mentoring, and development of an electronic resource database. Testing materials were organized in order to improve efficiency of use. Documentation time was improved through creation of EPIC© smartphrases.

Outcomes: To determine if significant change was seen post implementation of KT strategies, clinician self-report of knowledge was reassessed after two years, where all clinicians reported familiarity with the AIMS. Additionally, percentage of CMT evaluations with completion of the AIMS were compared from baseline to 1.5 and 2.5 years post baseline via chi-square test of independence. All CMT evaluations were audited for AIMS completion, with exclusion of telehealth and those that included a different SOM. A significant increase was seen in 1.5 (44%) and 2.5 (77%) years from baseline (10%).

Discussion: For this setting, KT strategies resulted in increased AIMS use during CMT evaluations. The COVID-19 pandemic may have impacted our ability to implement the KT strategies efficiently and time needed to observe the positive change. More research is needed to determine how these results affect clinical decision making. Use of KT strategies can be utilized to promote practice change based on research in this setting. Specific strategies such as implementation of a centralized research database, use of documentation templates, and peer-to-peer mentoring/education could be successful in translating evidence into practice.