To illustrate this cycle, consider a local group of patient advocates, public health, home care, and internal medicine clinicians, which identified that many people in their region who were admitted to a local hospital with falls and fractures were not subsequently assessed for osteoporosis or falls risk. Evidence from systematic reviews suggests that osteoporosis the rap (such as bisphosphonates) can decrease risk of fractures. Evidence around fall prevention is more controversial, but the group was interested in tackling this problem. They completed a local audit and found that less than 40% of patients aged 65 and older who were admitted to hospital with fractures were subsequently assessed for osteoporosis. Considering how to adapt the evidence to their context, the group created tools for patients to implement the evidence (recommending weight-bearing exercise, use of calcium and vitamin D) because many did not have a primary care physician or may not discuss this issue with their physician. Barriers to implementation included the lack of an integrated health record to identify patients at risk and the vast geographic distance across the region. The group developed a multicomponent, nurse-led strategy that incorporated patient education, self-management, medication review, and home assessment for falls risk. Because the group did not know if their knowledge translation strategy was effective, they implemented a randomized trial of the intervention.
The outcomes of interest included appropriate use of osteoporosis medications and falls at 6 and 12 months, quality of life, patient satisfaction, and fractures. Another outcome was the strength of collaborations this group developed, and this group grew to include representatives
from the provincial government, pharmaceutical companies, and insurance companies. This example highlights the collaborations necessary for the practice of knowledge translation
and the need to address questions that the stakeholders are interested in tackling.