Using Research Findings in Clinical Practice-Rosalyn

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Transcript Using Research Findings in Clinical Practice-Rosalyn

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
(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
• Additionally, only a small proportion of
evidence based findings have been
implemented into clinical practice.
(Beech 2014; Green 2014)
Challenges for allied health
• Increasing amounts of research is being
– 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
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
(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
• 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
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?
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.
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
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