It was Article of the Week for a year and we can learn many lessons from the publications we have covered. As we near the end of the academic year and the transition from undergraduate to graduate, let's cover the key lessons from Article of the Week!
Follow the example of these clinical trials and physiotherapy research has a bright future
Physiotherapeutic research has developed further in the last ten years, but there are still many published publications that come under criticism because of a lack of energy, a lack of methodological rigor and a lack of generalizability. So what makes a great clinical study on physiotherapy?
2020 marked the 20th anniversary of PEDro, the Physiotherapy Evidence Database, and in celebration of PEDro, physical therapists were asked to nominate RCTs published between 2015-2019 that answered key clinical questions.
The submissions were evaluated by a panel of experts and they nominated a Top 5 based on innovation, clinical effectiveness and robust methodology. By looking at these five key articles we can identify topics that are hallmarks of high quality physical therapy research, and which we can all use to guide future research. The first five were:
LIPPSMAck POP – Prevention of lung infections after operations – Major Abdominal with preoperative physiotherapy
SARAH – Exercises to improve the function of the rheumatoid hand
AVERT – efficacy and safety of a very early mobilization within 24 hours after the onset of the stroke
HIHO – Effect of inpatient rehabilitation compared to a monitored home program on the mobility of patients with knee arthroplasty
UK FASHIoN – Hip arthroscopy compared to the best conservative treatment for the treatment of femoroacetabular impingement syndrome
The most important thing all 5 studies have in common is that they aimed to answer important clinical questions that challenge conventional thinking and have a direct impact on clinical practice.
Clinical prediction rules for musculoskeletal practice should not be trusted
Clinical Predictive Rules (CPRs) are tools designed to guide clinicians in their daily clinical decision making. They provide an evidence-based tool to aid patient management in diagnosing or predicting a response to a particular intervention. They tend to be prescriptive and are growing in popularity, but is that a good thing?
Some believe that there was too much focus on creating new CPRs instead of validating and updating existing ones – they actually did exactly what they wanted to do.
The results of the systematic review show that many CPRs are created without validation being carried out to support their use in clinical practice. Even the CPRs for which validation studies were carried out often had methodological deficiencies. If you are using a CPR in clinical practice, check the validity of the instrument before using it.
Don't overlook online learning – it's as good as it is practical!
Physiotherapists pride themselves on their clinical acumen and practical skills, and rightly so. Practical skills are woven into the fabric of our training but does this preference for practical training limit our ability to explore more effective and accessible forms of education?
Up until the pandemic, digital and blended learning approaches were not fully accepted by our profession and were criticized for not being well founded from a learning theory perspective. This contrasts with evidence that has long shown the effectiveness of the use of digital learning for health education, but the issue is still debated.
Test online learning for free
In early 2021, a systematic review was published which aimed to elucidate the effectiveness of digital and blended learning designs in physiotherapy and to end this debate once and for all. The systematic review, which was of a high standard, showed that:
Blended learning is likely to be more effective than traditional face-to-face teaching in physical therapy training for both knowledge acquisition and practical skills acquisition
The students preferred upside down classroom, interactive websites / apps and self-produced videos instead of traditional classroom experiences, which also led to better learning effects
MCQs provide a useful and effective learning tool
The most important finding from this systematic review is that blended learning showed at least the same, if not statistically better learning results compared to conventional methods. We should no longer limit our approaches to practical education.
Courses improve clinical practice more than journal articles
At the end of 2020 an interesting survey was published in the BJSM, which examined what resources were used to change their clinical practice. For some the results may be a bit surprising, for others they might confirm a long held opinion, but clinicians do not use journals to change their clinical practice . Instead, courses and peer-to-peer learning lead to direct clinical changes.
They used data from over 2,000 clinicians, and clinicians learned by far the most frequently through peer-to-peer discussions (52%). One surprising finding was that clinicians prefer to use magazine articles to transform clinical practice, rather than podcasts, SoMe posts, or YouTube videos. Perhaps it is due to the trustworthiness of the sources, the quality of the content or simply because we as a profession are still adjusting to online / virtual CPD.
It would be interesting to repeat this survey after going through the multiple avenues of the pandemic. It is likely that the way out of professional life and the changes in clinical practice have changed forever.
Try a discussion with a difference
It is important to understand how to understand a systematic review
Systematic reviews are one of the most reliable ways to use journal articles to transform your clinical practice. Often the only way to answer questions that individual studies alone cannot answer, and they are an important resource for clinicians, researchers, patients, and policymakers alike. However, they only achieve this role if they are transparent, accurate, and complete, including the whys and whys of the review itself.
The P referred R the I tems for the S systematic review and M eta- A nalyses (PRIMSA) Statement is a guideline designed to ensure that systematic reviews are accurate, complete and transparent. Understanding them is essential for the evaluation of a systematic review, since, like all research distortions and methodological errors, the applicability to clinical practice is influenced.
In 2020 the PRISMA guideline was updated and is a must for new graduates especially as there is increasing criticism that insufficient systematic review research methods are investigated in undergraduate education.
