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Arthritis Research UK Primary Care Centre Winner of a Queens Anniversary Prize For Higher and Further Education 2009 Integrating evidence, changing practice and closing the research-knowledge gap: An example of how UK clinicians are

  1. Arthritis Research UK Primary Care Centre Winner of a Queen‟s Anniversary Prize For Higher and Further Education 2009 Integrating evidence, changing practice and closing the research-knowledge gap: An example of how UK clinicians are tackling the issues K Stevenson 1 3 N Hellis 1 K Dziedzic 2 J Jordan 2 N Foster 2 Consultant Physiotherapist M.Phil SRP MCSP 1 University Hospital of North Staffordshire, UK 2 Arthritis Research UK National Primary Care Centre, Keele University, UK 3 Stoke Primary Care Trust UK

  2. Stoke on Trent, Staffordshire, UK Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  3. Stoke on Trent, Staffordshire, UK Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  4. Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  5. Introduction  Local health economy  Musculoskeletal Research Facilitation Group Critically appraised topics (CATs)  Changes in clinical practice  Subsequent trial Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  6. Local health economy Acute Teaching Hospital  cares for over 600,000 people includes emergency treatments planned operations and medical care 2 Local Primary Care Trusts  5 community hospitals cover population of 500,000 budget of over £800 million musculoskeletal problems are common Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  7. Musculoskeletal disease in Stoke on Trent  A typical General Practitioner (family physician) in Stoke on Trent will see 2,100 patients with musculoskeletal disease per year  21% of the registered population  4,400 musculoskeletal consultations in 12 months (Musculoskeletal Matters October 2009) Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  8. Arthritis Research UK Primary Care Centre 10 million people have pain and  disability due to musculoskeletal problems in the UIK (Arthritis Care 2004) Equates to £3.5 billion annually  (Department of Health 2006) Increasing elderly population  means figures will rise (ARMA 2009) Research into musculoskeletal  conditions and chronic pain Joint pain Osteoarthritis Back pain Widespread regional pain Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  9. Integrating the evidence  Healthcare which doesn‟t integrate evidence runs the risk of harm but also misses the opportunity to benefit patients (Grol and Grimshaw 2003, Dawes 2005)  How do we best integrate evidence into practice?  No single strategy is likely to work and may need to be tailored to suit different groups (Grol and Grimshaw 2003) Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  10. Background to Musculoskeletal Research Facilitation Group  Survey Community Physiotherapists (Bourne et al 2007)  Consultant Physiotherapist 2002  How can we make best use of Masters students? utilise current and best evidence? increase our partnership with researchers? Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  11. Musculoskeletal Research Facilitation Group Formed in April 2003  Professionals who have  interest in musculoskeletal disease Meet every 3 months  Information Librarian Nurses Occupational Therapists Physiotherapists Podiatrists Researchers Senior Lecturers in Clinical Research Professors in Physiotherapy Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  12. Aims of the group Ensure practice is evidence  based Ask and answer clinically relevant questions Utilise existing research Involve staff in research process  Identify areas for further training  Build on existing partnerships  Identify research questions  Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  13. Critically Appraised Topic (CAT)  A CAT is developed from a clinical question which is structured and answerable  It provides a summary of the best available evidence  Answers the clinical question and provides a „ clinical bottom line ‟ ‟ (Foster et al 2001) Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  14. Critically Appraised Topic Specific Clinical question Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  15. Critically Appraised Topic Search the Specific evidence Clinical question Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  16. Critically Appraised Topic Search the Specific Appraise the evidence Clinical question evidence Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  17. Critically Appraised Topic Search the Specific Appraise the evidence Clinical question evidence Clinical bottom line Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  18. Critically Appraised Topic Search the Specific Appraise the evidence Clinical question evidence Clinical bottom line Consider implications for practice Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  19. Critically Appraised Topic Search the Specific Appraise the evidence Clinical question evidence Clinical bottom line Consider implications for Evaluate and practice review Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  20. Critically Appraised Topic Search the Specific Appraise the evidence Clinical question evidence Clinical bottom line Design Consider implications for Evaluate and trial to practice review answer question Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  21. Clinical output  Clinical bottom line - 2 sentences  Clinical question- PICO Population, Intervention, Comparator, Outcome  Results and implications for practice Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  22. Feedback  Disseminated via training events, e-mail and staff meetings  Clinical bottom lines incorporated into physiotherapy algorithms to inform practice  Included in electronic Map of Medicine programme  Where guidelines available e.g. OA Knee incorporated into physiotherapy algorithms  Dedicated website Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  23. Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  24. Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

  25. Achievements to date 23 CATs to date  Answered a broad spectrum  of clinical questions Publications  Other groups  National and international  presentations Research funding application  to evaluate the process Funded research trials  Arthritis Research UK Primary Care Centre Arthritis Research Campaign Winner of a Queen‟s Anniversary Prize 2009 National Primary Care Centre Keele University

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