Evidence-based medicine is a two-way interaction between the best available evidence, clinician experience and patient experience. One of the key challenges is to continuously source evidence that is high-quality, free from uncertainty and relevant to any one patient's case. In the majority of musculoskeletal conditions, evidence that meets these criteria is either poor quality, or is difficult to translate to the clinic. This situation will only change when practitioners and clinicians embrace Evidence-based medicine and begin to contribute their experiences and those of their patients to the improve the broader knowledge.
For those that have taken our last post to heart, as well as the thoughts of others on the subject, you will recognise the need to generate evidence specific to your clinic. By focusing on priority questions, it is possible to implement important changes to better align your practice with the best evidence. The most effective way to achieve this, is to implement a research program.
What is research?
Research is a key part of evidence-based medicine, but it's important to define what it is. Clinical research is meant to cover all types of investigation that address questions on the treatment, prevention, diagnosis/screening, prognosis of disease or enhancement and maintenance of health. To address a question fully, there are some broad components that need to be in place (Figure below). Often, for those previously involved in research activities, we tend to refer to ourselves as 'researching' if we are conducting any of the individual parts of this process.
In reality, without moving through all the key areas, including implementing the findings, the benefits of research are lost. Maybe it's time we start to consider the process in a more holistic way. It's important to remember that each of these steps, such as creating a plan or commencing a trial, can involve multiple actions and take years to complete. An effective research effort must be focused, adequately resourced and have a clear pathway of translation.
What are some reasons for getting started with research?
1 - No one else is going to drive the agenda: There is no doubt that considerable funding is provided to healthcare. Nevertheless, while the USA spent $3 trillion on healthcare in 2014 ($137 billion in Aus), just 4.5% of that expenditure was directed to medical research in 2012, across all conditions. Although musculoskeletal diseases and injuries pose one of the greatest burdens on society, we can't expect external funding bodies, such as governments, to drive the agenda.
2 - Data availability: contemporary clinical practice generates considerable amounts of data during each episode of care. With some minor additions and reorganisation, there is ample data in the majority of clinics to begin today, with little impact on current operations.
3 - Research can make important changes: The important role research has played in medical progress is undisputed. From providing early detection of failing joint implants; changing the way blood loss during surgery is managed, to revealing the worrying reinjury rates in athletes after reconstruction, clinicians asking questions of processes and outcomes have led the way, and made a significant progress.
4 - Reduce the time to translation: By driving ahead in areas of interest, clinicians can be at the forefront of translating findings to practice and reducing the time for their patients to experience better quality care and improved outcomes.
Where to from here?
The importance of addressing gaps in the current knowledge with relevant, high-quality information is hard to dispute. For many, the barriers to implementing a research program in their practice are significant, however the benefits to everyone are immeasurable. The question is how to start - here are a few suggestions.
1 - Grasp the Motivation: The most important aspect is to identify a problem in your practice, or dissatisfaction with status quo that can motivate action.
2 - Alignment: Consider the framework and identify where in the process your questions might align best. If you don't yet have any processes in place for monitoring care quality or patient outcomes, that is strongly recommended as a starting point for many questions.
3 - Plan: Before any concrete action is taken to set up a study, work out the plan! Prioritise your problems and questions. Work out a rough time scale and the nature of what it will take to answer the questions you've posed. Not sure? Bounce ideas - from colleagues, professional bodies, and if you're reading this article, feel free to drop me a line.
If you're thinking about the concepts in this article, or have been implementing them yourself, we'd be very interested in talking further. Feel free to contact us through here.