Can you FORCE research implementation? A PERUKI survey to evaluate knowledge translation of the FORCE study

Abstract

Aims: To assess the uptake of the Forearm Fracture Recovery in Children Evaluation (FORCE) trial findings into clinical practice, and to identify the influence of targeted dissemination tools on implementation. Methods: A cross-sectional electronic survey was distributed via the Paediatric Emergency Research in the UK and Ireland (PERUKI) network. The survey captured data on clinician awareness of the FORCE trial, current management of paediatric torus fracture, the use of dissemination materials, and perceived barriers and enablers to implementation. Results: A total of 113 responses were analyzed. Most respondents (84.5%) were aware of the FORCE trial. Following publication of the findings, 54.0% reported managing torus fractures in line with trial recommendations - offering a soft bandage or no immobilization, compared with 1.8% prior to the trial. Clinicians involved in delivering the trial were significantly more likely to adopt the recommended management (p = 0.021) and follow-up approach (p = 0.004). Of respondents, 43.4% reported encountering barriers to implementation, the most common being colleague or parent expectations. Peer-to-peer influence (40.8%) and the use of FORCE dissemination tools (38.8%) were the most frequently cited enablers. Among those using the dissemination tools, 79.5% implemented the recommended management compared with 18.2% who did not (p < 0.001). Conclusion: The findings of the FORCE trial have been adopted across paediatric Emergency Departments in the UK, representing a substantial shift from pretrial practice. Active involvement in research, peer influence, and practical dissemination tools were key drivers of this change. Publication alone appeared insufficient; implementation required engagement, ownership, and resources designed for real-world use. When these were present, practice changed most consistently - supporting the theory that you can FORCE research implementation.