Executive summary

Title of research proposal Quality improvement by DistributiOn of Computer-AssisTed Evidence Synopses

Short title Quality aDvOCATES

Background

Musculoskeletal (MSK) conditions are the largest contributor to the burden of disability in the UK. State regulated Allied Health professions including osteopathy and physiotherapy are predominantly sought by people with MSK conditions. Policy makers, professional bodies, and patient representatives expect these professions to demonstrate evidence-informed practice. However, uptake of evidence by these therapists remains limited due to the complexity of clinical practice and cultural contexts.

This problem is mirrored by the need for research institutions to demonstrate impact while reducing costs. This demands innovative solutions in the production and dissemination of research.

The well-recognised "research-to-practice gap" indicates the persistence of these twin challenges.

Aims and objectives

This project has the following aims:

  1. to understand the value that manual therapists and their patients place on priority research topics;
  2. to design, implement and evaluate a programme to increase this perceived value through dissemintaion via peer advocates;
  3. to overcome bottlenecks in the discovery of relevant research and production of evidence synopses that are agreeable to clinicians.

The objectives are: to investigate factors influencing the value placed on research, and to pilot computer-assisted streamlining of evidence synopsis production. Ultimately, this will increase the evidential component in interventions delivered by manual therapists, thereby improving patient care and patient perceived benefit.

This project will establish a growing database of evidence synopses on priority clinical topics, and a network of evidence advocates within an Allied Health profession.

The student will target the following points at which evidence 'leaks' en route to the patient:

  • the bottleneck of finding and summarising current evidence;
  • clinician awareness of this evidence;
  • negative beliefs among clinicians e.g. they lack the time or skills to understand research.

The student will explore whether:

  • computer assistance can significantly reduce the time and resources required to find and summarise research;
  • peer-group advocates within the osteopathic profession can raise awareness of current research more effectively than passive dissemination;
  • synopses can be produced in a format that is palatable to clinicians.

Method and design

This will be a mixed methods project based on the 'plan, do, study, act' (PDSA) approach. The student will be required to learn the methodologies for, and to conduct, a systematic narrative review, a critical literature review, and a thematic analysis. The student will also be required to implement a prototype tool for improving database searches, using machine learning techniques.

Phase I

Coordinate an expert panel to generate an initial list of priority research topics, building on a previously published Delphi consensus study.

Critical literature review of best-practices in quality improvement (QI) and impact assessment. This will be used to determine the specific approach outlined in Phase IV.

Phase II

Systematic narrative review of "short-form" evidence synopsis methodologies. State-of-the-art literature review of behaviour-change models. These will influence management of volunteers and interpretation of their attitudes towards evidence-informed practice.

Implement and run a pilot system for conducting semi-automated literature searches and topic analysis. This will feature elements of machine learning, including query expansion techniques using word2vec (a neural network that maps words from a given corpus into a numerical "vector space") and unsupervised topic allocation using latent Dirichlet allocation (a Bayesian approach to modelling the probability that any topic represents a given document), or similar approaches.

Phase III

Recruit volunteer advocates and assess their current attitudes to research through one or more of the following: validated survey tool; reflective diaries and interviews; focus group discussions; interviews.

For practical reasons the total number of advocates per cycle will be no more than 10. Recruitment of advocates is a common first step in a PDSA approach (Morelli 2016).

Phase IV

Guide the advocates in the production of evidence synopses. Upon completion, reassess their attitudes and practises.

Phase V

Repeat cycle of advocate recruitment, synopsis production, and impact assessment from phases III and IV. This repetition will provide two PDSA cycles; PDSA is iterative by design, hence requires a minimum of two cycles (Taylor et al 2013).

After the second iteration the student will produce a thematic analysis of the changes in advocates' attitudes and practises.

Final output

The information collected will enable Allied Health regulators, commissioners and policy makers understand the value that clinicians and patients place on research, thereby identifying hindrances that slow the adoption of evidence into practice. It will also highlight areas where further research would be beneficial.

The student will create a library of regularly-updated evidence synopses for manual therapists, and a growing network of clinicians who will advocate within their profession. It is hoped that this project will provide a template for others who are aiming to improve the efficiency of secondary research, and its impact on clinical practice.

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