CPDspot

MACP/PPA Collaborative Study Day 2007 - Online Now!

The Manipulation Association of Chartered Physiotherapists (MACP) have released their first online course. It is an online version of the 2007 MACP/PPA collaborative study day and is very much an evidence-based programme where both manual therapy and pain based approaches to treatment were respected and represented. The online course includes audiovisual presentaions plus related learning activities using materials from the sessions that were presented at this study day and provides a course certificate on completion of the course.

 

Session 1 - The Evidence for Manual Therapy presented by Dries Hettinga
Session 2 -CBT: What is it and can physios do it? presented by Zara Hansen
Session 3 - Exercise: Making It Happen presented by Zara Hansen
Session 4 - The Physiology of Manual Therapy presented by Stephanie Griffiths.

Go to the online course

Contemporary Interventions in Neurological Rehabilitation at Sheffield Hallam University

This course investigates and critically evaluates interventions currently used or being researched in neurological rehabilitation. The module will enable a new approach to examining practice in neurology, starting with researched interventions and making implications from these into our day-to-day practice. This module will compliment the approaches dominant in other neurological therapy modules and is highly recommended as a "starter module" for experienced physiotherapists and occupational therapists new to level 7 study.  Successful completion of this module will earn you 15 level 7 credits which may be put towards the MSc Advancing Physiotherapy.

The module will include
• upper limb rehabilitation interventions such as assistive splints, constraint induced movement therapy, sensory training and trunk restraint therapy
• robotics
• functional electric stimulation
• treadmill training and
• stretching and strengthening

Provisional Timetable
Mon 10th Nov, Tues 11th Nov, Mon 8th Dec, Tues 9th Dec, Thurs 22nd Jan, Fri 23rd Jan

More Information

Blood Investigations in Advanced Musculoskeletal Practice at Sheffield Hallam University

This course is designed for physiotherapists working or developing towards an Advanced Practice/Extended Scope role.

The module aims to develop an understanding of
• blood investigations in advanced musculoskeletal practice
• the consequences of such investigations
• how blood investigations might influence patient management.

The module will promote reflection on the practitioners' clinical role and scope of practice and will include the practical skills around taking blood. Successful completion of this module will earn you 15 level 7 credits which may be put towards the MSc Advancing Physiotherapy.

Provisional Timetable
Fri 3rd Oct, Fri 24th Oct, Fri 7th Nov, Fri 21st Nov, Fri 12th Dec.

More Information

Physiospot Facelift

Physiospot has had a fresh and bright facelift!!  The different clinical specialities are now clearly recognisable in the left sidebar and all pages have been updated.

Our Musculoskeletal, Neurology, CardioRespiratory, Paediatric and Sport blogs are proving to be the most popular, closely followed by our pain, Womens Health and CAM blogs.  We are also contributing to new blogs in  the clinical areas of Rheumatology and Extended Scope Practice but are looking for assistance with these before their launch.  If you are interested in helping out please don't hesitate to get in touch.

Evidence Based Professional Development

The more I think about CPD and EBP the more I realise that, although they are never discussed together, they are not mutually exclusive processes.  So how do Continual Professional Development (CPD) and  Evidence Based Practice (EBP) connect?

In simple terms, clinical expertise is an aspect of both the CPD and the EBP processes.  CPD results in clinical expertise and clinical expertise is an important part of EBP.  But it is also worth considering that:

EBP is a part of the CPD process.
CPD is a range of planned and unplanned learning experiences through which health professionals develop throughout their career. EBP occurs as an unplanned learning experience.  A clinical question may arise during an interaction with a patient, this initiates the EBP process where ultimately learning of knowledge, skill or attitude occurs.  This is then implemented into practice and contributes to increasing clinical expertise and CPD.  Therefore EBP is included in CPD.

CPD is a part of the EBP process.
EBP is the integration of best research evidence with clinical expertise and patient values.  Through CPD clinical expertise is achieved, this when combined with the best research evidence and patient values in response to a specific clinical question is EBP.  Therefore CPD is required for EBP.

In all, the main objective is improved patient outcome which is the ultimate reason to formally consider your CPD and EBP.

These thoughts are by no means concrete, they are a work in progress!  I'd be interested to hear your opinions on this?

EBM Tutorial

Connie Schardt of Duke University Medical Center Library and Jill Mayer of University of North Carolina Chapel Hill Health Science Library have produced a very informative Introduction to Evidence-Based Medicine.  It is an on-line tutorial intended for any health care practitioner or student   who needs a basic introduction to the principles of Evidence-Based Medicine.  On completion of this tutorial you will be able to:       

• define Evidence-Based Medicine (EBM)

• identify the parts of  a well-built clinical question

• identify EBM searching strategies that could improve MEDLINE retrieval        

• identify key issues that help determine the validity of the results of a study

It is a great adjunct to the posts on EBP that I have written recently and goes into much more detail for each step of the EBP process.  View the tutorial here.

EBP Presentation

This presentation on evidence based practice is free to view. It aims to briefly explain EBP and describe the EBP process. We hope it will provide you with more confidence to answer clinical questions with research evidence and incorporate it into your practice.             

View the EBP presentation

5. Evaluate the Outcome

The fifth and final step in the process is to evaluate the effectiveness and efficacy of your decision in direct relation to your patient. You may ask questions such as:

Was the application of the new information effective?
Should this new information continue to be applied to practice?
How could any of the 5 processes involved in the clinical decision making process be improved the next time a question is asked?

 

 

This step completes the EBP process which is a cycle of continuous improvement. With conscientious application of these 5 simple steps, each time the cycle completes a turn, clinical practice and ultimately patient care can improve.

So from now on, when a question becomes evident during a patient interaction, follow these 5 simple steps and not only will your clinical practice and patient care improve but you will also be continually professionally developing. 

4. Apply the evidence

The fourth step is the application of the best evidence and relevant information to the patient and/or clinical setting. This step should involve an individual clinical decision where the evidence from research is combined with clinical expertise and the patient's values.

Best Evidence

• relates to the clinical situation and specific patient(s)
• is methodically sound evidence from reputable sources
• is the best available and most appropriate  study
  design and level of evidence for the clinical situation
• is critically appraised

Patient Values

• and also the patients needs and wishes first by the clinician
• patient values include: culture, gender, age, socioeconomic,
  psychological, religious and spiritual factors
• means that the clinician recognises that each patient is unique
• focus is on what's best for each specific patient

Clinical Expertise

• is sound and current academic and clinical training
• and experience are applied
• means the clinician is able to clinically reason and apply knowledge
• and the clinician is able to critically apprise the literature
• and also the clinician actively participates in clinical decision making

The selected information is integrated into practice which can then be justified as evidence based. It is important to remember however, that even where clear evidence of treatment effects exists, implementing evidence-based practice can be difficult, especially if the evidence conflicts with current practice or patient values.

3. Appraise the evidence

After identifying an article or resource that seems appropriate to your question, the third step is to appraise the information critically. This allows you to assess the evidence for its validity, that is its’ closeness to the truth, and applicability, or in other words its’ usefulness in clinical practice.

To do this use a simple critical appraisal method that will answer these questions:

• What question did the study address?
• Were the methods valid?
• What are the results?
• How do the results apply to your practice?

It is important to be skilled in critical appraisal so that you can further filter out studies that may seem interesting but are weak.

Resources that may help you with appraisal include SIGN Critical Appraisal Notes and Checklists, the CASP Appraisal Tools and the CEBM Resources.

2. Find the best available evidence

The second EBP step is to find the relevant evidence. You should be able to identify search terms directly from the question that you generated in step one.  You may then need to consult several types of information resources. Large databases such as  PubMed will give you access to the primary literature, secondary resources such as the National Library for Health and the National Institute for Clinical Evidence will provide you with an assessment of the original study, other databases such as the Cochrane Library provide access to systematic reviews which help summarize the results from a number of studies.

Your search strategy should include a number of steps in itself. You should search each term separately for the mesh term. Once you have done this for all your search terms combine the resulting mesh terms to refine your search. The results should then be limited using methodological filters to target the right type of study for the question and target the highest possible levels of evidence. By broadening the search to include all relevant high quality articles, you will be more likely find the best answer to the question.