Musculoskeletal Matters 7

MUSCULOSKELETAL MATTERS Bulletin 7 HOW DO WE TRANSLATE EVIDENCE INTO PRACTICE? A LOCAL EXAMPLE OF WHERE CLINICIANS AND RESEARCHERS SOLVE THE PROBLEM TOGETHER Significant challenges exist when trying to integrate the best-quality evidence into daily clinical practice. However, lack of time, lack of skills to understand the literature and lack of resources are all cited as key barriers. Reducing these barriers would benefit patients and reduce the risk of harm (Grol and Grimshaw 2003, Dawes 2005). In 2003, a group of local clinicians and researchers picked up the challenge of how to get evidence into musculoskeletal practice. The Musculoskeletal Research Facilitation Group was established. It is a multidisciplinary group which looks for the best evidence to inform and underpin clinical practice. Members include physiotherapists, occupational therapists, rheumatologists, nurses, podiatrists, clinical researchers, librarians and systematic reviewers. Clinicians are encouraged to send in queries to the group that concern their clinical practice. This may relate to treatment, diagnosis, prognosis or could be about system or professional change e.g. the benefits of telephone triage. The literature is searched and the evidence appraised. The process culminates in developing recommendations for practice based on the best available evidence, which are disseminated through local networks and are housed on our website Here we describe two case studies. We hope we can inspire you to use the information we have produced to inform your practice, generate clinical questions, or even form your own group. Case study 1: Shoulder exercises A busy physiotherapist used shoulder stability exercises to treat patients with supraspinatus impingement syndrome. She found this to be a valuable approach but asked the group if there was any evidence to justify the treatment. 1.  She raised the question and helped to refine it, given her working context. 2. The librarian found nine relevant published studies. 3. A sub-group appraised and generated a clinical recommendation. • There was no evidence specific to this type of exercise (scapula stabilisation), but the literature did indicate positive outcomes for general shoulder exercises. • The group decided that this was an important area of practice, so they worked with their academic colleagues at the Arthritis Research UK Primary Care Centre, Keele University, to develop a randomised controlled trial to explore this intervention. • This was funded by the NIHR and the results are expected in 2014. For more details on this topic go to: “On occasion we have asked questions that have changed our practice within the acute hospital. This process has been reassuring and rewarding.” These bulletins are designed to provide information for general practitioners, the primary care team, teachers, trainers and policy makers about musculoskeletal problems in practice.