Exploration of clinicalacademic collaboration to achieve evidence based practice.

robert-van-deursen

Exploration of clinicalacademic collaboration to achieve evidence based practice.

Professor Archie Cochrane (1972) argued that healthcare interventions should only be provided unless effectiveness has been demonstrated using scientific methods. Since his recommendation, scientific evidence has become an important ingredient of clinical decision making and a lot has happened to develop evidence-based practice (EBP) in the UK as well as world-wide. Within rehabilitation it has been a bit of a wake-up call that for EBP one needs evidence; and for evidence one needs research on questions relevant to rehabilitation. Fortunately, it was realised that no evidence of effect is not the same as evidence of no effect. However, that does mean that research evidence needs to emerge at some point. It is helpful that a reasonable number of countries have decided to incorporate healthcare education into the university-level. For instance in the UK, physiotherapy has become a university degree in the early 90s. Being part of a university has facilitated the addition of post-graduate education and research programmes becoming available for continued professional development. These will certainly have contributed to the development and adoption of EBP in clinical practice but the process of producing research evidence in rehabilitation still requires substantial effort.

Stroke rehabilitation is a good example where a lot of progress with EBP has been made. An online literature search for [clinical guidelines” AND stroke AND rehabilitation] reveals that 55 documents were published between 1995 and 2015. In this same period around 120 systematic reviews related to stroke rehabilitation were published. Starting with one systematic review in the year 1997 the annual number has increased gradually to twelve in 2015. The UK published its latest version of clinical guidelines for stroke rehabilitation in 2013 based on just under 300 studies comprising of systematic reviews and randomised controlled trials (RCTs). However, these guidelines are not yet comprehensive since some aspects of the rehabilitation care pathway were not covered because of a lack of RCTs in these areas. For other neurological conditions the lack of evidence is much more apparent and therefore a continued effort to fill the existing gaps is necessary.

The need to build academic and clinical research capability and capacity in physiotherapy and neurorehabilitation is clear but this objective has not yet been sufficiently accomplished. The traditional relationship between clinical and academic physiotherapy has predominantly revolved around undergraduate and clinical placement learning. However, research has become part of both career pathways. If we focussed our collaborative efforts more on ensuring there will be enough active researchers in both environments this would speed up the rate of evidence production in rehabilitation. In academia, research excellence is not only defined by publications but also by research impact. For instance, patient benefit is an important impact category. Also, the current emphasis on translational and on clinical research means that there seems to be a fertile ground for such collaborations to flourish. In this presentation I will explore ideas how we can capture opportunities for collaboration in both the clinical and academic environment to progress rehabilitation research in support of EBP.