GETTING EVIDENCE INTO CLINICAL PRACTICE: GETTING IT RIGHT

Stevenson K.^1,2, Hadley-Barrows T.³, Salt E.⁴, Rimmer Y.⁵, Larkin T.⁶, Smith P.¹, Babatunde O.¹, Jordan J.¹, Foster N.¹, Dziedzic K.¹

¹Keele University, Primary Care and Health Sciences, Newcastle under Lyme, United Kingdom, ²Staffordshire and Stoke-on-Trent Partnership NHS Trust, Rheumatology, Stoke on Trent, United Kingdom, ³The Royal Wolverhampton NHS Trust, Orthopaedic Clinical Assessment Service, Wolverhampton, United Kingdom, ⁴Burton Hospital NHS Foundation Trust, Physiotherapy, Burton, United Kingdom, ⁵Robert Jones and Agnus Hunt Orthopaedic Hospital, APCS Orthopaedics, Oswestry, United Kingdom, ⁶Staffordshire and Stoke-on-Trent Partnership NHS Trust, Physiotherapy, Rugeley, United Kingdom

Background: Getting good quality research evidence into clinical practice is a known challenge, with some estimates suggesting it takes, on average, 17 years (Green et al 2009). Factors such as lack of time, skills and availability of technology are often cited as reasons for lack of implementation of research findings (Scurlock-Evans et al 2014). This can result in outdated, ineffective or harmful care for patients. A group of musculoskeletal physiotherapists and researchers established a model to address the research practice gap (Stevenson at al 2007).

Purpose: To develop a model that would:
· ensure clinical practice is based on the best available evidence
· increase critical appraisal skills of clinicians
· foster partnerships between clinicians and researchers and generate practice-based clinical questions that require further research
· create a variety of environments to share knowledge

Methods: Over 60 musculoskeletal clinicians (Physiotherapists, Occupational Therapists, Rheumatologists, Podiatrists and a Pharmacist) across three NHS organisations have linked with researchers, librarians and systematic reviewers who specialised in musculoskeletal health care to developed collaborative opportunities to encourage the uptake of best evidence. Since 2003, a critically appraised topic (CAT) process (Foster et al 2001) has been utilised to search, appraise, summarise and implement best available evidence to inform clinical practice.

Results: The output and impact of our forum includes: · 44 CATs each with an evidence based recommendation for musculoskeletal practice · Of these: -29 reassured clinicians that no changes to current practice was needed -12 resulted in recommendations for change in practice including offering different treatments, stopping particular treatments and providing new information for patients to facilitate informed decision-making -3 resulted in clear future research recommendations and were subsequently developed into new randomised controlled trials (hand osteoarthritis, shoulder pain, and telephone triage) · Evidence produced has been used by two Clinical Commissioning Groups (NHS healthcare payers) to inform service redesign · Formation of a network (supported by the academic centre) and the opportunity for more clinicians to participate in this process across a large UK geographic region · Annual study day offers additional training and support · Clinical leadership to ensure change in practice occurs if required · Formation of similar groups e.g. practice nurse group · Recognised of this method by one large NHS Trust by embedding into its Strategic plan to foster evidence based care · Recognition by British Society of Rheumatology in the form of a National Best Practice award · Development of a website to disseminate clinical recommendations http://www.keele.ac.uk/ebp/mrfgroup/catbank/fulllistofcats/

Conclusion(s): Using the framework of CATs and multidisciplinary working, the translation of best available evidence into musculoskeletal clinical practice can be facilitated. The model of the CAT group has expanded through the addition of five additional groups across a large geographical region of the UK, now including 80 clinicians of which 62 are physiotherapists. Clinical leadership ensures that changes in practice are delivered where appropriate.

Implications: This successful model of getting evidence into practice could be replicated in a variety of settings to ensure practice is evidence based.

Funding acknowledgements: Primary Care Musculoskeletal Research Consortium, NIHR Research Professorships, Primary and Secondary Care Hospital Trusts in Staffordshire, Cheshire, Wolverhampton and Shropshire

Topic: Research methodology & knowledge translation

Ethics approval: No ethical application necessary for this work

All authors, affiliations and abstracts have been published as submitted.