New tool helps bridge clinical practice and research world

The Institute for Work & Health has launched a new clinical commentary tool, Practice Perspectives. It emerged from a clinician-scientist collaboration in which physiotherapists provided direct input into a research project.

The first issue of Practice Perspectives provides the physiotherapists’ commentary on a systematic review on low-back pain and exercise. In recent years, there has been a strong push to incorporate research evidence into clinical decision-making. The Institute has been a pioneer in communicating messages from research findings, and more recently it has begun to work with clinicians (see below) to integrate practical knowledge from clinicians into research. As one result of this experience, the concept of Practice Perspectives: commentaries on research was initiated. The commentaries are one way of completing the cycle of research informing practice, and practice informing research. The idea of Practice Perspectives is a very logical, useful contribution to patient care, says Marianne Rivington, an Ottawa-based physiotherapist who participated in the collaboration. It is important as a venue for communication between clinicians and researchers and as a vehicle for general dissemination of this information.

Each edition of Practice Perspectives will be developed by a group of clinicians with practice experience in the researchers’ topic area. The commentary will address the study or review findings in the context of the current health-care and clinical environment. It will also discuss the practical interpretations, impact, and whether findings are consistent with practice experience. The commentary gives targeted messages for specific audiences such as other clinicians, researchers or policy-makers, including potential “next step” research questions.

The collaboration began in 2005. Institute staff presented a tutorial about systematic reviews to several “educationally influential (EI)” physiotherapists, using an example of a review underway led by Dr. Jill Hayden. The researchers and knowledge transfer and exchange (KTE) staff recognized they could receive feedback from physiotherapists about this review. Clinicians providing input into the research process was invaluable, says Hayden. In their review, Hayden and her colleagues looked at the effectiveness of exercise therapy in patients with non-specific low-back pain. The physiotherapist EIs helped me identify what was missing in the research and gave me a sense of how the research results would be interpreted by clinicians.

Feedback from the physiotherapist EIs led to the development of a second research question within the systematic review. The EIs then assisted the researchers in reorganizing the published studies into clinically-relevant categories. They also discussed the clinical importance of the findings. Realizing that both the clinical and research communities might be interested in a published commentary from clinicians, the physiotherapist EIs, the Institute’s KTE staff and Hayden formed a group called the Commentary Task Group. They met to establish a consultation process and develop the consensus criteria used to create a commentary. Over the next year, the task group collaborated using face-to-face meetings, teleconferences and email exchanges.

I valued a sense of contributing to the project, being part of the whole process, says Rivington. It gave me a better appreciation and respect for research and how it can help me help patients. The documented support of exercise therapy is a valuable communication tool with colleagues, other professionals and clients.

To produce the commentary, the physiotherapists discussed the final results from Hayden’s systematic review. The subsequent notes were simplified into primary statements and discussion points. The group voted on them and when a statement received a 70 per cent agreement, it was considered final.

Practice Perspectives was distributed to the entire physiotherapist EI network – more than 100 members – for dissemination into their community. It is posted on the Institute’s website.

Source: At Work, Issue 50, Fall 2007: Institute for Work & Health, Toronto