We will conduct a realist review . We report this realist review protocol following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (PRISMA-P) statement  (see checklist in Additional file 1). This protocol has been registered within the International Prospective Register of Systematic Reviews (PROSPERO) database (registration ID: CRD42020216105). The final review will be reported in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guideline .
The research team consists of seven co-investigators: three academic researchers (MEL, AL, MPG), two knowledge users (KB, PL), one research coordinator (JD), and one postdoctoral fellow (KL). The project involves a multidisciplinary team of experts in knowledge synthesis (AL), neurotrauma rehabilitation (MEL), management in traumatology settings (KB, PL), and KT (MEL, AL, MPG). Knowledge users are decision-makers representing health and social services settings in Quebec City. The postdoctoral fellow is working on developing expertise in knowledge synthesis and KT. All team members will contribute to the different stages of this project through document revision, reflection, and decision-making with regard to the methodological approach and the various analyses. Monthly written follow-up is planned, as well as two face-to-face meetings at the beginning of the project and one at the end of the project. Other meetings (by telephone or in-person) may be convened as needed in the course of the project.
Stages of the realist review
The realist review consists of four main stages: (1) formulation of initial theories, (2) search for evidence, (3) knowledge extraction and synthesis, and (4) recommendations .
Formulation of initial theories
In terms specific to the realist review, we will put forward initial theories to explain the context-mechanism-outcome (CMO) system. From a methodological point of view, researchers begin by extracting from the literature the main ideas that relate to a class of interventions (the initial theories). These initial theories explain how and why a class of interventions (in this case, organizational KT strategies) work and generate the outcome(s) of interest (in this case, change in the knowledge, attitudes, and clinical behaviors of allied health professionals in traumatology settings).
We will use the Consolidated Framework for Implementation Research (CFIR)  to guide the creation of the initial theories. The CFIR is a metamodel that groups constructs used in 19 different KT theories. This model distinguishes five main areas of factors influencing the achievement of KT strategies: (1) the characteristics of the evidence-based practices to be implemented, (2) the external context, (3) the internal context, (4) the individuals involved, and (5) the implementation techniques. CFIR is widely used in the study of complex implementation projects where interactions between factor categories are expected .
Based on CFIR and team members’ own clinical and organizational experience, we will develop initial theories explaining why, how, and in what context organizational KT strategies can work. Specifically, we will hold a 1.5-h, audio-recorded, group discussion to develop a first draft theory answering the following question: how (context and mechanism) an organizational KT strategy (intervention) has been shown to be effective or ineffective in changing the (a) knowledge, (b) attitudes, and (c) clinical behaviors of allied health professionals (outcomes). We will make an initial schematic representation based on the discussion and refine it through revision of the audio-recorded material. This representation will then be tested against data from studies included in the review.
Evidence search and eligibility criteria
Information source and search strategy
The search will be conducted in the MEDLINE, CINAHL, Embase, Cochrane, Ergonomic Abstracts, and Web of Science Core Collection databases and may be extended to other databases of a more social or sociological nature as required (planned date coverage between January 1990 and October 2020). It should be noted that, depending on the realist review methodology, subsequent iterative research may be conducted to generate additional data on a particular aspect of the research question.
Two knowledge management specialists will perform the primary article search in the various databases. Subsequently, the research team will use three different mechanisms: (1) the list of cited references will be reviewed to extract articles of interest, (2) the “find similar articles” function of the databases will be used to check if other articles of interest are related to the primary articles, and (3) the authors who have published more than two articles deemed relevant will be contacted by e-mail to request a list of relevant references, published or not, on our subject. All articles found during the secondary search will in turn be put through the three secondary search mechanisms to complete the search. Finally, Grey Matters, a practical tool for searching health-related grey literature , will be used to complement the secondary research. The list of articles will be recorded in a specialized reference management software (Endnote) and checked to eliminate duplicates. The search will include a broad range of terms and keywords related to knowledge translation + trauma + allied health professionals. A full draft search strategy for MEDLINE (OVID) is provided in Additional file 2.
We will consider French- and English-language studies relating to organizational KT strategies published. The definition of KT used for the purpose of article selection is the one provided by the Canadian Institutes of Health Research (https://cihr-irsc.gc.ca/e/29529.html):
A dynamic and iterative process that includes synthesis, dissemination, exchange, and ethically sound application of knowledge to improve the health of Canadians provide more effective health services and products and strengthen the health care system.
We believe that the last 30 years are sufficient to identify organizational KT strategies that correspond to the reality of the current health network. All study designs will be considered. We will include studies conducted with allied health professionals (occupational therapists, physiotherapists, social workers, psychologists, speech-language pathologists, sexologists) in traumatology settings. For the outcomes, we will include all objective measures that demonstrate a change in the clinical knowledge, attitudes, and behaviors of allied health professionals.
Selection, extraction, and knowledge synthesis
First (by title and abstract) and second (full-text review) screenings will be carried out independently by two reviewers (KL, MEL) using Covidence . We will pilot the screening form across a random sample of 20 titles and abstracts. In the event of a difference of opinion for a given article, a third researcher will take a position on the eligibility of the study. The same method will be applied to full-text reviews. The appraisal of the articles will focus on (a) relevance, i.e., does the study create at least one CMO configuration about organizational KT strategies, and (b) rigor, i.e., whether this CMO configuration has sufficient weight to make a methodologically credible contribution . This will lead to the development of the final list of included articles that will be retained for the data collection process. It is possible that the choice of articles may raise questions about the focus of the review and, as a result, iteratively reflect on the research question and the selection of articles . These questions and reflections will be put to the research team.
Data collection process
We will carry out a thorough reading of the selected articles followed by the extraction of relevant data. The extraction will be also performed in parallel by two research team members (MEL, JD) using a standard Covidence  extraction form to reduce variability and bias . Categories of data extraction will include the following:
Study characteristics: title, first author, publication year, country, participants (which allied health professional), study objectives, trauma setting (hospital, community), and outcomes (what specific changes have been measured in the (a) knowledge, (b) attitudes, and (c) clinical behaviors)
Intervention: type of organizational KT strategies
Program theory: refined or refuted CMO configurations developed in the initial theory and new CMO configurations
Methodology: data collection method and type of analysis
The extraction form will be piloted with five studies. Here again, data extraction can lead to questions about the focus of the synthesis and, consequently, to iterative reflection on the research question and selection of articles. These questions and reflections will also be referred to the research team.
Data/knowledge synthesis and recommendations
Two independent analysts will examine the selected articles and indicate to what extent they correspond to each CMO configurations developed in the original theory. They will also identify any new CMOs that may emerge from the studies. Results will then be compare in a cross-tabulation matrix. A consensus will have to be reached before results are presented to the rest of the team. Data synthesis will take into account the circumstances in which these organizational KT strategies were used, including the characteristics of the targeted evidence-based practices, as well as internal, external, and personal contexts of individuals involved, in addition to any other information that supports the understanding of the context. Based on the emerging results of the studies, the research team will be able to validate (confirm or refute) the initial theories on the effectiveness of organizational KT strategies through group discussion. The team will perform a comparative analysis between the initial theories and the emerging results of the review as well as a search for both contradictory and consensual results [24, 26]. Specifically, they will meet for a 1.5-h, audio-recorded group meeting. From this discussion, several proposals for CMO combinations will emerge to better specify which organizational KT strategies are most effective in influencing professionals’ knowledge, attitudes, and behaviors. According to the data, it will be possible to identify patterns of CMO and to identify a final theory that will enable a theoretical generalization of the observed results in other contexts . This in turn will “[p]rovide guidance on what policy-makers or practitioners could put in place to change the context or provide resources in a way that most likely triggers the appropriate mechanism(s) to produce the desired outcome” . Together with the knowledge users on the research team we will determine based on the final results how to best present our findings to their colleagues. Traditional methods such as article publication and presentation at national or international conferences will also be used.