Rankin G1, Summers R2,3, Barker K4,5, Cowan K6, Fashanu B7, Goodare H8, Harvey J9, Moran F10, O'Neill B10, Waterfield J11, Westwater-Wood S12, Wellwood I13
1Chartered Society of Physiotherapy, London, United Kingdom, 2University of Southampton, Southampton, United Kingdom, 3Summers Research Consultancy, Southampton, United Kingdom, 4University of Oxford, Oxford, United Kingdom, 5Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom, 6James Lind Alliance, Southampton, United Kingdom, 7Southend University Hospital NHS Foundation Trust, Southend, United Kingdom, 8Cochrane Consumer Network, London, United Kingdom, 9Plymouth Marjon University, Plymouth, United Kingdom, 10Ulster University, Newtownabbey, United Kingdom, 11Queen Margaret University, Edinburgh, United Kingdom, 12University of Nottingham, Nottingham, United Kingdom, 13Univesrity of Cambridge, Cambridge, United Kingdom

Background: Physiotherapy needs to continuously update and extend its evidence base to reflect new technologies, changes in physiotherapy practice and service provision and to demonstrate its role and value in current healthcare.

Purpose: This project aimed to identify research priorities for the UK physiotherapy profession that will engage research funders and researchers to develop the evidence in areas that matter most to patients, carers and clinicians and are relevant to healthcare policy.

Methods: The project was undertaken as a James Lind Alliance (JLA) Priority Setting Partnership. It used JLA's structured framework to bring together clinicians, patients and carers to identify and prioritise unanswered questions in different areas of physiotherapy.
1. Identification of uncertainties (May -July 2017): Key stakeholders (clinicians, patients and carers, researchers, educators, students, service providers/commissioners and policy makers ) were surveyed (online / paper-based) and asked to identify uncertainties around areas of physiotherapy: interventions; self-management; prevention and service delivery.
2. Analysis and verification of uncertainties (June - Oct 2017): coding and thematic analysis were used to develop similarly themed “indicative” questions. Literature searches confirmed whether questions were unanswered.
3. Interim prioritisation (Nov - Dec 2017): clinical physiotherapists, patients and carers selected and ranked their top ten questions using an online survey. Ranked lists from patients/carers and physiotherapists were analysed separately; then combined to produce an equally weighted ranked list of indicative questions.
4. Final prioritisation (Feb 2018): discussion of the top 25 questions at a workshop using nominal group technique, involving small groups of patients, carers and clinicians, to agree and rank them and choose the top ten generic research priorities for physiotherapy as a whole.

Results: Of the 510 responses identifying uncertainties, around half were from patients, carers or the public. Analysis of the 2152 submitted uncertainties produced 65 unanswered indicative questions, falling into 15 broad themes. The mean number of uncertainties underpinning an indicative question was 33 (standard deviation 48, range 1-255). Of 636 interim prioritisation responses, 14% were from the patient group.
The final top ranked priority was “When health problems are developing, at what point is physiotherapy most/least effective for improving patient results compared to no physiotherapy? What factors affect this?”
The top ten questions (available www.csp.org.uk/priorities ) fall within six themes: optimisation (top question, underpinned by 18 uncertainties); access (3 questions); effectiveness (3 questions); patient and carer knowledge, experiences, needs and expectations; supporting patient engagement and self-management; diagnosis and prediction.

Conclusion(s): A patient- and clinician-focussed approach was used to agree the top ten physiotherapy research questions out of 65 identified uncertainties. The questions are relevant for all areas of physiotherapy encompassing clinical practice, self-management, prevention and service delivery. Further work will develop specific research questions.

Implications: The priorities are being widely disseminated to inform research strategies, research commissioning bodies and researchers about what evidence will have greatest impact for patients/carers and clinicians.
Secondary thematic analysis of the data will provide unique insights into patients' experiences, views, and uncertainties in relation to UK Physiotherapy and allow comparison of patients' and physiotherapists' priorities.

Keywords: Research priorities, Co-production, Consensus

Funding acknowledgements: Chartered Society of Physiotherapy Charitable Trust. The National Institute for Health Research funds the infrastructure of the James Lind Alliance.

Topic: Research methodology & knowledge translation

Ethics approval required: No
Institution: Not applicable
Ethics committee: Not applicable
Reason not required: Using the NHS Health Research Authority decision toolkit the study is not considered research by the NHS and did not require ethical approval

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

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