In our regular round-up of research that's relevant to physiotherapy staff, Janet Wright looks at how healthcare professionals rely on research to expand their evidence-based practice.
Physios tackle barriers to research
Healthcare professionals rely on research to expand their evidence-based practice. But relatively few physios carry out research themselves, say the authors of a study published by Physiotherapy journal online.
As part of a project aimed at increasing physios’ participation in research, Jessie Janssen, of the allied health professions research unit at the University of Central Lancashire, and colleagues set out to discover what was currently preventing this.
Twenty-five physios working at a New Zealand rehabilitation hospital volunteered to fill in questionnaires about their attitudes to research, and 15 were interviewed by the research team.
Almost all the volunteers considered research made a positive contribution to physiotherapy, even though they lacked time to do it themselves.
‘Time has long been recognised as the greatest barrier to reading and using research in practice,’ say Dr Janssen’s team.
Most of the volunteers lacked confidence in their own ability to conduct research and found it difficult to access databases.
They saw research as something difficult and academic. They only really valued randomised controlled trials (RCTs, in which the effects of a treatment are measured by randomly allocating patients into groups receiving either that treatment, or another treatment, or no treatment) and systematic reviews (for which researchers weigh up all the high-quality evidence they can find on a particular subject).
To help lift these barriers, the team recommend teaching physios how to assess papers, allocating specific time for research, and promoting a wider range of research methods.
‘Systematic reviews and RCTs are not generally easy to do,’ say the authors. They suggest starting with more accessible methods such as qualitative studies (using interviews rather than just measurements to look at a subject in more depth) and case studies.
CSP members can read the whole paper online free of charge. Janssen J et al. Perceptions of physiotherapists towards research. Physiotherapy 2015.
Work in progress
Researchers at Glasgow Caledonian University are sifting the evidence on women’s urinary incontinence, to provide physios with guidelines for best practice.
Doreen McClurg and colleagues are conducting a Cochrane overview: summarising the results of numerous systematic reviews covering different interventions for the condition.
‘Current clinical practice often does not reflect the available increasing evidence base,’ says Dr McClurg, noting that people simply don’t have enough time to read and compare all the available evidence.
‘Patients often have complex conditions and identifying the most effective rehabilitation intervention is not always easy,’ she says.
The team, funded by the Physiotherapy Research Foundation, aims to create an accessible document combining all high-quality evidence on the subject. It will highlight the limitations of current best evidence and allow comparisons of the effects of different interventions.
Can physiotherapy outweigh fear?
Physiotherapy may be especially helpful to people with sciatica who are frightened that movement will make their symptoms worse, say researchers in Holland.
Annemieke Verwoerd and colleagues noted that kinaesiophobia, or fear of movement, had been associated with poor recovery from sciatica. So the team, from Erasmus MC University medical centre in Rotterdam, investigated whether it affected outcomes for patients receiving physiotherapy.
They randomly allocated 135 sciatica patients to receive either GP care alone, or GP care plus physiotherapy. Before treatments started, they assessed whether patients were afraid of movement, and to what extent.
Following up three months after the trial, the researchers found no great difference relating to patients’ fear of movement. But at the 12-month follow up, there was a significant difference.
Among the most kinaesiophobic patients, those who received physiotherapy now had significantly less leg pain than those who had received only GP care.
‘The study provides preliminary evidence that patients with a higher level of kinaesiophobia at baseline may particularly benefit from physical therapy with regard to decreasing leg pain intensity at 12-month follow-up,’ the authors conclude. Verwoerd AJH et al. Does Kinesiophobia Modify the Effects of Physical Therapy on Outcomes in Patients With Sciatica in Primary Care? Physical Therapy 2015.
Comments and conclusions
Testing the strength of people’s hands could be a simple, low-cost health check. A weak grip is linked with greater risk of heart attack and stroke and a shorter life expectancy, according to a study of nearly 140,000 adults from 17 rich and poor countries. Leong DP et al. Lancet 2015.
People who followed diet and activity guidelines before being diagnosed with bowel cancer have a better chance of survival than those who had a less healthy lifestyle, a study of more than half a million patients shows. Romaguera D et al. BMC Medicine 2015.
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