Translating burn scar assessment into clinical care: How do we measure up?

Dr Megan Simons1, Dr Leanne Sakzewski2, Prof Roy Kimble3, Dr Zephanie Tyack4

1Occupational Therapy Consultant, Stuart Pegg Paediatric Burns Centre, Lady Cilento Children’s Hospital, 501 Stanley Street, South Brisbane, Queensland, 4101. megan.simons@health.qld.gov.au
2Research Fellow, Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Queensland, 4101. l.sakzewski1@uq.edu.au
3Director, Centre for Children’s Burns & Trauma Research, Centre for Children’s Health Research, Raymond Terrace, South Brisbane Queensland, 4101. royk@uq.edu.au
4Research Fellow, Centre for Children’s Burns & Trauma Research, Centre for Children’s Health Research, Raymond Terrace, South Brisbane Queensland, 4101. z.tyack@uq.edu.au

Incorporating evidence into clinical practice is a complex process. To date, knowledge translation strategies to change clinical practice behaviour have achieved only modest improvements (8-15%) [1]. This project investigated the translation of burn scar assessment evidence into policy and practice.

A formative evaluation was undertaken using a mixed-method approach, including a literature review, retrospective audit of clinical practice in a paediatric burns centre and interviews with clinicians. Translation behaviours were considered within the context of a behaviour change wheel [2] to assess how influential strategies have been in producing behaviour change within both the research community and for a single discipline (Occupational Therapy) in an acute tertiary hospital.

Strategies targeting behaviour change through interventions (education and training, modelling, environmental restructuring) and policy guidelines resulted in limited translation. Less than 43% of human trials with scar evaluation from October 2014 to October 2015 used an evidence-based outcome measure. In the clinical setting, 41-63% of patient encounters recorded the use of an appropriate burn scar assessment. The top three barriers identified were: culture and habit; time and resources, and belief that education and training would be sufficient to translate evidence. The top three enablers were supportive management, strong collaborations between researchers and clinicians to guide translation, and clinical mentoring relationships with health practitioners.

Addressing the evidence-practice gap and long time lag to move research findings into routine clinical care is a critical issue, as is describing the impact of changing these health practices on people with burns.

[1] Grimshaw JM, Eccles MP, Lavis JN, et al. Knowledge translation of research findings. Implementation Science 2012;7

[2] Michie S, van Stralen M, West R. The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions. Implementation Science 2011;6:42.

Key Words

implementation science, burn scar assessment, evidence-based care

Biography

Megan Simons is currently an Occupational Therapy Consultant at the Lady Cilento Children’s Hospital, Brisbane. She has worked in burns care over 20 years, with research interests in evaluating intervention effectiveness, health-related quality of life and translation of the evidence into daily clinical practice.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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