Integrating research into clinical practice: An introduction to conducting a rapid literature search to answer a clinical question

Description

Australian Physiotherapy Association - Orthopaedic Group News

QLD update

Submitted by: Thomas Petrie APAM

QLD Chair

 

One of the most important parts of our practice as physiotherapists is maintaining and building on evidence-based research. This e-Update, we asked one of our QLD committee members, Dr Larissa Sattler APAM, about the starting points for research.

 

Working as a clinician on a busy orthopaedic ward she had many clinical questions, but at the time wasn’t sure where to go to start the research process. Luckily, she found a mentor to help her initial forays, and a few years later those initial steps have developed into a PhD and her current academic position at Bond University.

Subject

Integrating research into clinical practice: An introduction to conducting a rapid literature search to answer a clinical question

Submitted by: Dr Larissa Sattler APAM

QLD committee member

 

 

Evidence-based practice (EBP) is often referred to as clinical decision-making based on information received from the following sources; patient values, clinical expertise, and knowledge of the best available research evidence (1).

 

When considering the best available research evidence there are typically two categories of research evidence described, primary and secondary (2). In simple terms, primary research could be described as gathering new data, whereas secondary research is a summary of existing data that has already been collected and published, such as a Systematic Review (3, 4). Systematic Reviews are often a good place to start when considering the best available research evidence, as they are based on the findings of multiple studies through comprehensive and systematic searching of relevant literature (2).

 

When searching for Systematic Reviews on a clinical topic of interest, an important first step is developing a well-defined research question, this is often done by using a “PICO” framework: Population, Intervention/Exposure, Comparison/Control, Outcomes (5). Using the PICO framework to structure a research question will help you to formulate a search strategy to locate Systematic Reviews in freely accessible databases such as the Cochrane Library or PubMed. Linking terms across each of the PICO categories can help to ensure that your search is specific to your topic, but also broad enough to capture all of the relevant sources available (5,6).

 

The PICO framework is:

 

• Population/Problem – Who is the patient? What is the problem?
• Intervention/Exposure – What is the treatment or exposure of interest?
• Comparison/Control – Is this an alternate, usual or no treatment group?
• Outcome/s – Common examples include functional (physical or self-reported), pain-related, psychological or economic measures. 

Let’s take a clinical example, such as an interest in the effects of preoperative exercise on postoperative functional outcomes for patients undergoing total knee replacement:

 

• The population will be patients undergoing primary total knee replacement.
• The intervention is exercise before surgery.
• The comparison is no pre-operative exercise before surgery.
• The outcomes are post-operative physical and self-reported function.

If we were to combine the above PICO concepts and build a simple search strategy in PubMed Advanced Search Builder it might look something like this: 

 

((total knee replacement) AND (exercise) AND (preoperative OR "before surgery") AND (function))

 

This initial search produces 408 results. However, if we then add the filters 'Systematic Review' and 'Meta-Analysis', with a publication date in the last five years, it reduces that number to 20.

 

Furthermore, if filtered by access to 'Free full text only', then we are left with a final eight articles that will likely be recent relevant reviews on our topic of interest, and available to read freely in full text.

 

References

 

1. Sackett D, Straus SE, Richardson WS, Rosenburg W, Haynes RB. Evidence based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone; 2000.
2. Gopalakrishnan S, Ganeshkumar P. Systematic reviews and meta-analysis: understanding the best evidence in primary healthcare. Journal of family medicine and primary care. 2013 Jan;2(1):9.
3. Jewell DV. Guide to Evidence-Based Physical Therapist Practice. Third edition. Jones & Bartlett Learning; 2014.
4. Hoffmann T, Bennett S, Del Mar C. Evidence-Based Practice Across the Health Professions. Churchill Livingstone; 2010.
5. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons; 2019 Sep 23.
6. Nishikawa-Pacher A. Research Questions with PICO: A Universal Mnemonic. Publications (Basel). 2022;10(3):21-. doi:10.3390/publications10030021
7. Pub Med. Bethesda, Md: National Library of Medicine [Internet]. 1996. [Retrieved 25 November 2022]. Available from: https://pubmed.ncbi.nlm.nih.gov/