This is an article I wrote for the May/June edition of Osteopathy Today.
Education and the dissemination of research in osteopathy
It is well known that there is a significant delay before findings from primary research reaches clinical practice. Several authors estimate that the average delay to be around 17 years (Morris, Wooding & Grant, 2011). Such delays are common across all healthcare disciplines, and osteopathy is unlikely to be an exception.
Some reasons for the poor rate of translation from research into practice include clinicians feeling too busy to read research in the first place (Bussières et al 2016), or feeling that they are not equipped to interpret research (Schneider et al 2015). Within osteopathy specifically, these factors can be further compounded by the mistrust that some clinicians feel towards modern research methodologies and 'evidence-based practice' (EBP) (Figg-Latham & Rajendran, 2017).
This complex environment, with time-poor clinicians who can be sceptical toward research, makes it challenging to ensure that evidence-informed best practices are effectively disseminated throughout the profession, from undergraduates to seasoned clinicians. Starting within the Osteopathic Educational Institutions, osteopaths are exposed to specialist knowledge which we blend with technical skill and compassion (Tyreman & Cymet, 2014). This blending process continues through our commitment to Continuous Professional Development and lifelong learning. Post-graduation, the realities of clinical practice can make it impractical to closely examine every message that purports to be based in reliable research. Additionally, misinterpretation of the tenets of EBP can lead to us feeling that there is little room for experience and judgement (Greenhalgh, Howick & Maskrey, 2014).
Current efforts to address these issues focus on emphasising the value of clinician expertise and the importance of patients' wishes, and recognising that the flood of complex and sometimes contradictory evidence can feel overwhelming. This ‘renaissance' in EBP (ibid) may help avoid the unintended negative effects that have contributed to the mistrust of research-informed clinical practice.Research-informed practice empowers osteopaths to balance their technical skills with up-to-date knowledge, and to place compassion for the patient at the centre of health-care decisions. NCOR strives to support all working osteopaths by analysing, producing, and disseminating osteopathically-relevant research.
Research organisations are increasingly focusing on production of very brief evidence summaries for busy clinicians who don't have time to seek out and appraise all new research, for example the National Institute for Health Research's Dissemination Centre. To help support busy osteopaths, NCOR recently launched our Centre for Reviews and Summaries (CFRS) with the aim of producing regular bite-sized snapshots of current, clinically-relevant evidence. These short précis are designed to highlight salient points from recent research relating to osteopathic practice, and augment our existing Snapshot Summaries.
NCOR's evidence summaries are great starting points for thinking critically about research. For further information on integrating evidence into your clinical practice, start with our masterclass on critical appraisal (Fawkes, Ward & Carnes, 2015).
What is evidence-based practice?
Evidence-based practice is one of the key components of clinical governance. It can be described as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients, integrating individual clinical expertise with the best available external clinical evidence from systematic research" (Bury & Mead, 1998). It requires practitioners to:
- Ask questions in a focused manner
- Locate the evidence to answer the questions
- Critically appraise the available evidence
- Apply the evidence in an appropriate manner
- Evaluate performance(s) based on the application of that evidence.
NCOR's CFRS is available at http://www.ncor.org.uk/cfrs/
NCOR's Snapshot Summaries are available at http://www.ncor.org.uk/research/snap-shot-summaries/
The NIHR Dissemination Centre can be found at http://www.dc.nihr.ac.uk/
Bury T and Meade J. Evidence-based Healthcare. Butterworth-Heineman, 1998
Bussières A, Zoubi F, Stuber K, French S, Boruff J, Corrigan J, Thomas A (2016). Evidence-based practice, research utilization, and knowledge translation in chiropractic: a scoping review BMC Complementary and Alternative Medicine. 16(216) Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944433/
Fawkes C, Ward E, Carnes D, 2015. What evidence is good evidence? A masterclass in critical appraisal. International Journal of Osteopathic Medicine. 2015 Jun; 18(2):116-129. Available online at http://bit.ly/critical-appraisal-masterclass
Figg-Latham J, Rajendran D, 2017. Quiet dissent: the attitudes, beliefs and behaviours of UK osteopaths who reject low back pain guidance – a qualitative study. Musculoskeletal Science and Practice. 2017 Feb; 27:97-105. Available online at http://bit.ly/osteopaths-beliefs-lbp
Greenhalgh T, Howick J, Maskrey N, 2014. Evidence based medicine: a movement in crisis? BMJ. 2014;348:g3725. Available online at http://bit.ly/ebm-crisis
Morris Z, Wooding S, Grant J, 2011. The answer is 17 years, what is the question: understanding time lags in translational research. Journal of the Royal Society of Medicine. 2011 Dec; 104(12): 510–520. Available online at http://bit.ly/research-delay
Schneider M, Evans R, Haas M, Leach M, Hawk C, Long C, Cramer G, Walters O, Vihstadt C, Terhorst L (2015). US chiropractors’ attitudes, skills and use of evidence-based practice: A cross-sectional national survey Chiropractic and Manual Therapies. 23(16) Available online at http://chiromt.biomedcentral.com/articles/10.1186/s12998-015-0060-0
Tyreman S, Cymet T, 2014. Creating an osteopathic community with education at its core. International Journal of Osteopathic Medicine. 2014 March, 17(1):1-4. Available online at http://bit.ly/osteopathic-education