Research Findings: helping you get to the heart of what really matters

Frontline has joined forces with a major research centre to bring you the best of physio-related research. Peter Davidson, director of the National Institute for Health Research Dissemination Centre, and Tara’s Lamont, deputy director, tells CSP’s Fran Fitch about the institute’s work. Find out more.

^{Nadine Foster, NIHR Professor of Musculoskeletal Health in Primary Care at Keele University}

What is the NIHR Dissemination Centre and what does it do?

The centre was set up in 2015 by the Department of Health and Social Care with some funding from Wales and Northern Ireland.

Its brief was to get relevant evidence to decision-makers in health and care. Hundreds of research studies come out every day and busy staff experience information overload. We help by filtering out the most important and reliable evidence and helping people to make sense of findings.

We publish themed reviews of NHS-relevant research on particular topics – from organisation of stroke services to end of life care. We are working currently on a review of musculoskeletal services targeted at physiotherapists, working closely with CSP, which will be released in July this year.

How do you choose which research to disseminate?

In addition to this work, we also produce NIHR Signals – critical summaries of the best recent research. We publish three or four of these a week.

We look for systematic reviews and landmark studies from top journals and get these rated by a pool of more than 1,000 clinicians (including physiotherapists and other allied health professionals) and patients.

They help us choose which are most important and relevant to the NHS and UK practice. We also look at all NIHR published studies. From all these sources, we select three to five studies a week to publish as Signals.

These cover all areas of clinical practice, as well as broader public health and social care topics, with brief findings, implications for practice and commentaries from experts and service leaders. We select only around one per cent of all the research we review.

Why should physios be aware of research findings?

Physiotherapists need to be aware of latest evidence on effectiveness of therapies and how services are delivered. For instance, research has shown how early supported discharge by specialist teams, including physiotherapists, can improve quality and reduce costs for people recovering from stroke. Other Signals we have produced recently cover a range of relevant topics, from resistance training in older people to breathing training before major surgery.

Research funded by NIHR includes trials to compare effectiveness of treatments, which may also inform national clinical guidelines. It also includes qualitative research and observation to provide insights into how care is delivered and experienced by staff and patients. Some research will have clear implications for practice, while other studies may be more equivocal.

New evidence might make physiotherapists and others think twice about existing practice, reflect and discuss with colleagues. Taking an interest in research is part of being a learning and reflective professional.

How can physios engage with the centre’s work?

Physiotherapists can become raters and help us choose which research to share. You can also subscribe to our NIHR Signals (some or all) to keep up to date with latest research. We also want to hear from you about topics and areas for our future work programme. Other parts of NIHR (www.nihr.ac.uk) also support physiotherapists to take part in trials and funds fellowships and trainee schemes for clinical staff.

Social media is a great way to share information and research. At the NIHR Dissemination Centre, we are building an online presence and connecting with communities such as @WeAHPs. We also hold events and tweetchats around particular projects and areas of interest. Do follow us on Twitter and join the conversation about evidence in practice @NIHR_DC. And watch out for our next article in May on exercise therapy after having a stroke.

Does research turn you off?

Nadine Foster, NIHR Professor of Musculoskeletal Health in Primary Care at Keele University, explains the value of Signals to Frontline readers.

Does the term ‘evidence-based practice’ switch you on or frustrate you, given the challenges of

a) keeping up to date with the high volume of research studies and

b) deciding if the studies are good quality and if you can trust the results?

Evidence-based practice has never been more important for physiotherapists, given the need to demonstrate clinical and cost effectiveness. But it can be difficult to find the right mix between the latest findings from the best quality research, clinical experience and patient preferences.

It is great to see the CSP help us with this, and here in Frontline to see evidence of the engagement between the CSP and the National Institute for Health Research (NIHR) Dissemination Centre, by showcasing some of the NIHR Signals and Themed Reviews.

What will appear in these pages is just a taster on the centre’s work. I wholeheartedly encourage you to sign up to receive the NIHR Signals, in addition to the Frontline articles. They really are an easy way to keep up to date with the latest evidence from high quality research. You can simply search the NIHR Dissemination Centre website for Signals relevant to you. Even better sign up for the Centre to send you ‘Signals’ or short summaries that interpret recent research, tailored to the areas of your interest and clinical practice.

Recent examples in my own areas of interest (back pain and knee osteoarthritis) include:

a Signal on radiofrequency denervation (the MINT trial with 681 adults from the Netherlands). This highlighted that this technique did not add
benefit to patients engaging in exercise for chronic back pain
a Signal from a systematic review of eight studies on the commonly used medications gabapentin and pregabalin which showed these drugs are not effective for chronic back pain.
a Signal from another systematic review concluding that acupuncture is better than usual care and sham acupuncture for musculoskeletal pain and knee osteoarthritis.

These Signals are not only about discovering the latest research in your field but they offer a short key summary that also considers how the findings compare with national guidance to date, so it is then clear whether there is a need to consider changing clinical practice.

The NIHR Dissemination Centre also produces NIHR Themed Reviews. These are more detailed and comprehensive summaries in priority areas. There are seven of these to date, and several are relevant to physiotherapy, such as the one on Comprehensive care – older people with frailty in hospital and the one on Roads to recovery – organisation and quality of stroke services.

By way of example, the Roads to recovery themed review looks at the configuration of stroke services, identifying stroke and acute management, recovery and rehabilitation, and life after stroke. It features 44 published studies, 29 ongoing studies and guides you on questions to ask about your stroke services with helpful quotes from commissioners, clinicians and service users. All in one place!

The CSP and NIHR are also working together to develop the upcoming NIHR-themed review on musculoskeletal physiotherapy.

Accessing the latest research – and working out if and how clinical practice needs to change – has just been made a lot easier. The latest important research, summarised, interpreted and delivered straight to you, whether you’re a practising clinician, manager or academic researcher.

21 March 2018

21 Mar 2018