© 2007 The Authors. Journal compilation © 2007 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 13 (2007) 681–688 681 Journal of Evaluation in Clinical Practice ISSN 1356-1294 Blackwell Publishing LtdOxford, UKJEPJournal of Evaluation in Clinical Practice1356 1294© 2007 The Authors; Journal compilation © 2007 Blackwell Publishing Ltd? 2007134681688Original Article Creating knowledge from systematic reviewsN.A. Scott et al . Creating clinically relevant knowledge from systematic reviews: the challenges of knowledge translation N. Ann Scott PhD, 1 Carmen Moga MD MSc, 1 Pamela Barton BSc (Hons) MD FRCPC, 2 Saifudin Rashiq BM BS MSc DA (UK) FRCPC, 3 Donald Schopflocher PhD, 4 Paul Taenzer PhD 5 and Christa Harstall BSc (MLS) MHSA 6 on behalf of the Alberta Ambassador Program Team 1 Research Associate, 6 Assistant Director, Health Technology Assessment Unit, Institute of Health Economics, Edmonton, AB, Canada 2 Clinical Associate Professor, Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, AB, Canada 3 Associate Professor, Division of Pain Medicine, Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada 4 Senior Biostatistician, Health Surveillance, Alberta Health and Wellness, Edmonton, AB, Canada 5 Clinical Service Manager, Calgary Health Region Chronic Pain Centre, Calgary, AB, Canada Abstract Rationale and objective A research translation strategy for chronic pain was developed that has significant potential to advance the usefulness of systematic reviews (SRs) in clinical practice. Method The strategy used interactive case-based workshops that summarize current evi- dence on treatments for chronic non-cancer pain. Health technology assessment research- ers and clinicians collaborated to translate SR evidence into education aids, but this proved far from straightforward. Results Sourcing and selecting the SR evidence required maintaining a credible balance between the diametrical concepts of comprehensiveness and efficiency, and relevance and validity. On examination of the collated evidence base, further challenges were encoun- tered in dealing with the lack of consistency among the SRs in the quality of execution, the scales used to rate the quality of the evidence, and the conclusions on common topic areas. Strategies for overcoming these difficulties are discussed. Conclusions The key elements for creating clinically relevant knowledge from SRs are: a flexible, consistent and transparent methodology; credible research; involvement of renowned content experts to translate the evidence into clinically meaningful guidance; and an open, trusting relationship among all contributors. Introduction The evidence-based medicine movement emerged in the 1990s in response to concerns that the influence of research evidence on clinical practice was subordinate to prior training, shared beliefs, personal opinion and habitual practice [1]. Even now, gaps persist between advice given by health professionals and the research evidence [1–3]. This is partly owing to the breathtaking volume of scientific knowledge being generated and the mistrust that endures between clinicians and researchers because of their differing prior- ities and inability to communicate [4,5]. Systematic reviews (SRs), which are designed to provide a comprehensive summation of the available evidence for decision makers in the health care system, were seen as a way to encourage the use of research evidence in clinical decision making [6,7]. However, over a decade after the advent of evidence-based medi- cine and the development of The Cochrane Library [8], a large repository of SRs on clinical questions, this hope has fallen short of the reality. Less than one in five general practitioners and surgeons use The Cochrane Library , and a survey of Australian surgeons found that only 46% rated the peer-reviewed literature as being very influential on their practice [3,9]. Not surprisingly, poor research transfer has been identified as a major barrier to evidence-based health care [10]. Simply providing evidence from clinical research through traditional passive dis- semination strategies is not sufficient to influence clinical practice and improve patient care [11]. While the evidence-based medicine movement has improved access to SRs and evidence-based guide- lines [5,6], the majority of these products are still disseminated through traditional, largely ineffective routes. Translating research evidence gleaned from SRs into a form that clinicians can use to inform their decisions will encourage the use of research evidence in clinical practice. Much has been written on how to conduct meaningful clinician training sessions and present research information in a palatable and user-friendly form, but the challenge of translating evidence from SRs, while maintaining a sufficient level of validity and relevance to satisfy both clinicians and researchers, is rarely discussed. Therefore, our aim is to out- line the issues that arise when clinicians and health technology assessment (HTA) researchers collaborate to synthesize, contextu- Keywords continuing medical education, diffusion of innovation, evidence-based medicine, knowledge translation, quality of health care, systematic reviews Correspondence Dr N. Ann Scott Institute of Health Economics #1200 10405 Jasper Avenue Edmonton Alberta Canada T5J 3N4 E-mail: capstone@shaw.ca Accepted for publication: 6 December 2006