Using research findings in clinical practice – demystifying the process of appraisal of literature for clinicians Rosalyn Stanton Physiotherapy Clinical Educator Rehabilitation, Aged and Community Care Bridging the gap – translating evidence into practice 2014 ACT Health 7th Allied Health Symposium Translating research evidence into clinical practice Evidence based practice requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances. (Straus et al 2010) Translating research evidence into clinical practice • Despite knowledge of EBP to improve patient outcomes, there remains a significant time gap in translation of evidence into clinical practice. • Additionally, only a small proportion of evidence based findings have been implemented into clinical practice. (Beech 2014; Green 2014) Challenges for allied health professionals • Increasing amounts of research is being published – Approximately 20 000 papers on public health published yearly (Clarke et al 2007) – More than 18 000 RCTs and 3 500 systematic reviews indexed on “PEDro” (Elkins et al 2013) • Increased access for health professionals with the impact of electronic and open access journals Challenges for allied health professionals • Research is of variable quality – “Physiotherapy Evidence Database” • the mean quality score of published trials on PEDro 4.86/10 (SD 1.58) (Moseley et al, 2014) – Systematic review methods/reporting an area for improvement (Beller et al 2013; Beller et al 2011) – Improvements needed in the consideration and reporting of external validity (Zerhouni, 2005) – Clinically relevant research questions are not being investigated (Scott & Glasziou, 2012) Challenges for allied health professionals • Searching, appraisal of quality and interpretation of research requires knowledge and skill. • Whilst health professionals are interested in learning these skills, many feel unprepared for this part of clinical practice. (McCluskey et al 2013; Straus et al 2010; Salbach et al 2009) Within a local context - challenges • Lack of high quality, relevant clinical research in some areas of clinical practice • Overwhelming volume of research (of varying quality) • Therapist knowledge, training and skill – Clinical – Searching, appraising and implementing evidence • Staffing resources resulting in workload pressures limiting time, and an environment of high staff turnover • Patient expectations • Organisational culture Evidence - strategies for translation of research into clinical practice • • • • • • Use of opinion leaders Educational meetings Educational outreach visits Audit and feedback Educational material Targeted interventions incorporating the above strategies to overcome identified local barriers (CLinEdQ) Within a local context - strategies • • • • • Education in evidence based practice Journal groups Peer review Clinical leaders Research in the clinical setting How do we make these strategies effective and sustainable? Questions? References • • • • • • • • • • • • • Beech (2014) Answering the call: Translating evidence-based findings to community-based settings. Family and Community Health, 37(2):102-3 Beller EM, Chen JK, Wang UL & Glasziou PP (2013) Are systematic reviews up-to-date at the time of publication? Systematic Reviews, 28(2):36 Beller EM, Glasziou PP, Hopewell S & Altman DG (2011) Reporting of effect direction and size in abstracts of systematic reviews. JAMA: The Journal of The American Medical Association, 306(18):1981-2. Clarke A, Gatineau M, Grimaud O, Royer-Devaux S, Le Bis I, Lewison G (2007) A bibliometric overview of public health research in Europe. European Journal of Public Health. 17 Supp 1: 43-9. ClinEdQ Allied Health Clinical Education and Training. Translating evidence into allied health practice. Accessed 30/03/2014. http://www.health.qld.gov.au/hpresearch/docs/EBPlitreview.pdf Elkins MR, Moseley AM, Sherrington C, Herbert RD & Maher CG (2013) Growth in the Physiotherapy Evidence Database (PEDro) and use of the PEDro scale. British Journal of Sports Medicine 47(4): 188-89. Green LW (2014) Closing the chasm between research and practice: evidence of and for change. Health Promotion Journal of Australia. Online first http://dx.doi.org/10.1071/HE13101 McCluskey A, Vratsistas-Curto A & Shurr K (2013) Barriers and Enablers to implementing multiple stroke guideline recommendations: A qualitative study. BMC Health Services Research, 13:323. Moseley AM, Elkins MR, Janar-Duncan L & Hush JM (2014) The quality of reports of randomized controlled trials varies between subdisciplines of physiotherapy. Physiotherapy Canada, 66(1):36-43. Salbach NM, Veinot P, Rappoly S, Bayley M, Burnett D, Judd M & Jaglal SB (2009) Physical therapists’ experiences updating the clinical management of walking rehabilitation after stroke: A qualitative study. Physical Therapy, 89(6): 556-68. Scott IA & Glasziou PP (2012) Improving the effectiveness of clinical medicine: the need for better science. The Medical Journal of Australia, 196(5): 3040-8. Straus (2010) Evjdence-Based Medicine: How to practice and teach it. 4th Edition. Churchill Livingstone. Zerhouni EA (2005) Translational and clinical science – Time for a new vision. The New England Journal of Medicine, 353 (15):1621-3.