The Rick Hansen Institute is fortunate to count among its many valued partners Dr. Dalton Wolfe, a Scientist at Parkwood Institute in London, Ontario and Assistant Professor at Western University. RHI recently sat down with Dr. Wolfe to talk about his current research.
His initiatives with RHI
Dr. Wolfe has two major initiatives currently underway with RHI. One is in conjunction with Dr. Susan Jaglal, professor and Vice-Chair of Research in the Department of Physical Therapy at the University of Toronto. He and Dr. Jaglal are developing a program of self-management that will be largely delivered online. It will provide people with SCI with the resources and skills they need and link them with peers and care providers to support their specific needs. In this way, people with a spinal cord injury will be empowered to prevent and better manage the complications and issues they face in dealing with their condition. Such a program is especially worthwhile to overcome the issues that people face after returning home following rehabilitation only to find that the specialized care and information needed is not readily available in the community. It is anticipated that this initiative will be ready for a pan-Canadian validation trial in 2017.
The other major initiative he is involved in is the Spinal Cord Injury Knowledge Mobilization Network (SCI KMN), a community of practice that brings together seven rehabilitation sites across Canada. “The network brings those sites together to develop their capacity in implementation science,” explains Dr. Wolfe. “It will ensure that when a new practice comes along, that it’s implemented successfully and that it stays implemented. That is the real trick -- making sure things are sustained in terms of practice and purpose.“ To date, the SCI KMN has provided improved pressure ulcer risk assessment, interprofessional care planning, and education for over 1900 SCI rehabilitation patients across Canada. The network has also initiated work in improving practices associated with pain management.
In addition to these major initiatives, Dr. Wolfe is also involved in the Rick Hansen Institute Spinal Cord Registry (RHISCR).
Dr. Wolfe is excited to be a part of RHI-initiated networks and he sees real benefit to bringing together a group of people who are focused on a common goal around SCI care and innovation in addition to the day-to-day operations of an organization. In fact, he says it’s sometimes the priorities of organizations that may make it challenging to focus on the priorities of patient populations such as SCI. “By participating in a network where people are focused on common priorities around the patients we serve, we can keep focused on what’s important, that is, improving things like quality of life, and care for persons with spinal cord injury. It’s really that those networks enable us to stay focused on those key tasks.”
His collaboration with Dr. Justine Baron
An exciting collaboration is underway between Dr. Wolfe and Dr. Justine Baron, a postdoctoral fellow in the Clinical Epidemiology Program at the Ottawa Hospital Research Institute and recent recipient of a joint scholarship with RHI and the University of Ottawa. Dr. Wolfe and Dr. Baron, along with her postdoctoral supervisor Dr. Jeremy Grimshaw -- a renowned leader in knowledge translation -- will be working together to examine the issue of spinal cord injury and pressure ulcers. “This will also intersect with our initiative that has to do with self-management,” says Dr. Wolfe. “Dr. Baron is looking at finding out what the true barriers are to people maintaining good skin care and embedding that into planning for a self-management intervention to assist people in maintaining better skin health.”
On translating evidence into practice
Collaborative research projects like this one with Dr. Jaglal are the starting point for what will eventually be used in providing treatment and care for people with SCI, but Dr. Wolfe knows firsthand the barriers to translating evidence into practice. The most significant barrier, he says, is the very nature of the health system. “It’s a complex environment with lots of things happening and a lot of priorities on any given day. But there is very little time to take a systematic approach and step back to consider what the true barriers are. One of those issues is that, although we often do things typically with the best of intentions, we assume that just by providing training, that we will be successful in changing practice. But there are very few other things that are typically done.” He notes that it is challenging to find the time to put all the critical components into place that are needed to make sustainable change. Some of those critical components might include establishing appropriate data management systems, effective clinical decision support and clear feedback and communication systems to ensure that leadership and front line clinicians are on the same page. “We have a long way to go, but by collaborating on projects such as the ones with Drs. Jaglal, Baron and SCI KMN, we are working to create change in this system.” Initiatives like the SCI KMN and the development of a SCI-specific self-management program will go a long way to meeting these challenges.
His biggest motivator
Enabling collaborations between SCI consumers, front-line clinicians and researchers is a key motivator in Dr. Wolfe’s work. The research initiatives that he and his teams have undertaken are focused on bringing together many perspectives that get to the heart of improving a person’s care and quality of life. “What’s most exciting is when you can see a need, work on a project, develop a solution, work to enact the solution, validate it, and put it into place.”