Table 4.

Evaluation of KT Interventions

Ref	Methodology to Evaluate Clinician Behavior Change	Clinician Behavior Change Results	Methodology to Evaluate Patient Outcomes	Patient Outcome Results
(18, 19)	Study document audit Team member interview Self-reported awareness of the KT intervention No statistical analysis	68.7% of patients were informed of the KT intervention 100% adherence to use of the assessment list 32% of all patients received >6 contacts (KT intervention-recommended) while 43% of all patients received < 4 Contents of the KT intervention not executed as intended in many instances	Self-reported quality of follow-up care experience Prevalence of UTI, pressure ulcers and the number of re-admissions in the control and experimental groups Analyzed results using statistical analyses	Quality of follow-up care experience not statistically significant The prevalence of pressure ulcers, UTIs and the number of re-admissions were not statistically significant
(20)	Attendance at education fair Anonymous questionnaire after the fair asking about the usefulness of the KT intervention No statistical analysis	95/110 staff members attended the fair 80% of respondents said knowledge had increased due to the fair 65% stated they saw caregivers from other disciplines using info from fair 28% applied knowledge from other disciplines into their practice Most thought the fair was beneficial	NR	NR
(21)	Medical record audit Analyzed results using statistical analyses	No statistical difference in duration of the prophylaxis use of compression device Statistically significant change in the type of medication used and increase in documentation of physical assessment Patient education improved with statistically significance between 2nd and 3rd cohort only Increasing trend in the protocol adherence rate reported (no statistical significance noted)	Pre-post comparison of DVT rate via medical record audit and prospective measurement Analyzed results using statistical analyses	Diagnosis of DVT increased from across the cohorts, but the results were not statistically significant
(22)	Self-reported use of suggested test and perception of implementation extent No statistical analysis	Each study center implemented 3 to 7 of 8 tests over the study period Trend towards more centers taking on fuller implementation	Participants’ responses about the role of each of the implemented tests No statistical analysis	Overall participants thought the tests informed them about their function (67– 100%), led to discussions with their therapists (33– 96%) and were clear (95– 100%) and easy to perform (81–100%). Little support for the tests leading to changes in rehabilitation (11–38%)
(23)	Medical record audit Analyzed results using statistical analyses	Documentation was not statistically different for patient history, physical examination, functional assessment and bowel management education, or patient/caregiver competence in bowel management. A statistically significant increase in bowel care program documentation was reported	Pre-post comparison of neurogenic bowel management adverse events proposed but not completed No statistical analysis	NR
(24)	Staff questionnaire on the knowledge of MSCC and the clinical guideline No statistical analysis	Overall improvement in knowledge and practice (No numerical results reported)	NR	NR
(25)	Medical record audit Analyzed results using statistical analyses	Statistically significant reduction of the proportion of patients being nursed flat	Medical record audit Analyzed results using statistical analyses	Reduction of respiratory infections was not statistically significant Statistically significant decrease in in-patient death Survival rates at 78 weeks showed no statistically significant difference
(26)	Medical record audit No statistical analysis	3/39 patients were not treated according to the clinical pathway after its implementation	Pneumonia, pressure ulcers, LOS, ventilator days and total cost reduction per patient compared before and after implementation Analyzed results using statistical analyses	No statistically significant difference between cohorts for total episode of pneumonia, average pneumonia episode and incidence of pressure ulcers Statistically significant improvement in LOS and ventilator days Total cost reduction per patient was $21,881 (no statistical significance reported)
(27, 28)	Reports from the staff Staff questionnaire E-survey of IT personnel Semi-structured interviews with staff Follow-up interviews No statistical analysis	E-survey and interview result showed that there are variations in staff access to CCR There were 2 sites without a standing order policy	Self-reported vaccination rates and patients’ change in attitude Analyzed results using statistical analyses	Statistically significant increase in vaccination rates for entire sample Statistically significant increase in participants’ perception of vaccination importance
(29)	Medical record audits No statistical analysis	Increase in the number of notes for respiratory technicians, social work, OT and nutritional services	Compared treatment-related factors Analyzed results using statistical analyses	Statistically significant reduction in LOS of survivors and average days febrile Statistically significant increase in stabilization procedures and a decrease in surgical decompressions and tracheostomies

^*The results were statistically significant if p<0.05

Abbreviations: CCR, Computerized Clinical Reminders; DVT, Deep Vein Thrombosis; ICU, Intensive Care Unit; IT, Informational Technology; LOS, Length of Stay; MSCC, Malignant Spinal Cord Compression; NR, Not Reported; OT, Occupational Therapist; SCI, Spinal Cord Injury; T1, Cohort 1; T2, Cohort 2; T3, Cohort 3; UTI, Urinary Tract Infection