A Study to Understand and Compare Evidence Based Practice Among Health Professionals Involved in Pain Management

Pain management is a common concern of multiple health professionals. Evidence-based practice (EBP) in pain management is a recognized approach used to improve health outcomes. EBP tools can facilitate its implementation. PAIN+ is a tool that provides access to pre-appraised current best research evidence on pain to support clinical decisions. It is important to understand the knowledge, attitudes and behavior of professionals towards EBP and more specifically how they access research about pain management. The overarching purpose of this thesis is to better understand how clinicians from different professions involved in pain management view EBP and implement specific strategies to find pain related research evidence. We conducted a series of studies incorporating various methods to address these questions. Data was collected supplementary to a large randomized control trial to compare “Push” vs. “Pull” strategies for uptake of pain research. In the first study, we compared the knowledge, attitudes, outcomes expectations and behaviors of physicians, nurses, physiotherapists, occupational therapists and psychologists towards EBP in pain management using a validated knowledge attitude and behavior (KABQ) questionnaire. In the second study, we used a mixed methods approach to understand the competencies of clinicians accessing electronic databases to search for evidence on pain management. In the third study, we performed a structured classification of the abstracts that were viewed by clinicians to understand their access behaviors. In the last part of the thesis, we compared the usefulness of PAIN+ with PubMed using a randomized crossover trial approach. The results of this thesis indicate that the professionals involved in pain management have good knowledge of and attitudes towards EBP, but behavior i.e. implementation of EBP in practice and perception of outcomes of implementing EBP were low. In the second study, we found that professionals had acceptable levels of basic literature searching skills but had low levels of use of more advanced skills, and were not aware of using clinical queries in their search. In the third study, we found that all professionals accessed research evidence when provided alerts about pain research and some variations in the types of studies accessed were observed. Differences in access behaviors might reflect differences in professional approach to pain management. In our fourth study the crossover randomized controlled trial; we found PAIN+ and PubMed were both rated useful in retrieving pain evidence for clinicians. Professionals showed an interest in evidence-based pain management, but their skills for finding evidence were limited, they appeared to need training in locating and appraising pain related research evidence, and may benefit from tools that reduce this burden

Reliability of Three Landmarking Methods for Dual Inclinometry Measurements of Lumbar Flexion and Extension

Background To examine the intra and inter-rater reliability of lumbar flexion and extension measurements attained using three landmarking methods for dual inclinometry. Methods This was a repeated measures reliability study. Convenience sampling was used to obtain forty volunteer subjects. Two assessors measured a series of lumbar flexion and extension movements using the J-Tech™ dual inclinometer. Three different landmarking methods were used: 1) straight palpation of PSIS and L1, 2) palpation of PSIS and the site of the nearest 5 cm interval point closest to L1 and 3) location of PSIS and 15 cm cephalad. Upon landmarking, adhesive tape was used to mark landmarks and the inclinometer was placed on sites for three trials of flexion and extension. Tape was removed and landmarks were relocated by the same assessor (intra-rater) for an additional three trials; and this process was repeated by a second assessor (inter-rater). Reliability was determined using intra-class correlation coefficients. Results Reliability within a set of three repetitions was very high (ICCs \u3e 0.90); intra-rater reliability after relocating landmarks was high (ICCs \u3e 0.80); reliability between therapists was moderate to high (0.60 \u3e ICCs \u3c 0.76). Assessment of flexion and extension movements by straight palpation of bony landmarks as in the Straight palpation of PSIS and L1 method (ICC: Flexion 0.60; Extension 0.74) was found to be marginally less reliable than the other two landmarking measurement strategies (ICC: Flexion 0.66; Extension 0.76). Conclusion All three methods of land marking are reliable. We recommend the use of the PSIS to 15 cm cephalad method as used in the modified-modified Schobers test as it is the simplest to perform and aligns with current clinical practice

Content Analysis of Work Limitation, Stanford Presenteeism, and Work Instability Questionnaires Using International Classification of Functioning, Disability, and Health and Item Perspective Framework

Background. Presenteeism refers to reduced performance or productivity while at work due to health reasons. WLQ-26, SPS-6, and RA-WIS are the commonly used self-report presenteeism questionnaires. These questionnaires have acceptable psychometric properties but have not been subject to structured content analysis that would define their conceptual basis. Objective. To describe the conceptual basis of the three questionnaires using ICF and IPF and then compare the distribution and content of codes to those on the vocational rehabilitation core set. Methods. Two researchers independently linked the items of the WLQ-26, SPS-6, and RA-WIS to the ICF and IPF following the established linking rules. The percentage agreement on coding was calculated between the researchers. Results. WLQ-26 was linked to 62 ICF codes, SPS-6 was linked to 17 ICF codes, and RA-WIS was linked to 74 ICF codes. Most of these codes belonged to the activity and participation domains. All the concepts were classified by the IPF, and the most were rational appraisals within the social domain. Only 12% of codes of the core set for vocational rehabilitation were used in this study to code these questionnaires. Conclusion. The specific nature of work disability that was included in these three questionnaires was difficult to explain using ICF since many aspects of content were not confined. The core set for vocational rehabilitation covered very limited content of the WLQ-26, SPS-6, and RA-WIS

A structured classification of the types of pain research studies accessed by different health professionals involved in pain management

© The British Pain Society 2019. Objectives: The aim of this study was to describe the information access behaviours of clinicians involved in pain management with respect to their use of a pain evidence resource and to determine the areas of professional differences. Methods: Users (n = 258) of a free pain evidence alerting service (PAIN+) were enrolled in this study. The users regularly received email alerts about newly published clinical articles about pain that were pre-appraised for scientific merit and clinical relevance. A sample of up to 10 abstracts retrieved by each user were retrieved and classified using a descriptive classification system to describe the types of research, pain subtypes, interventions and outcomes that were reported in the accessed studies. Frequencies and chi-square tests were performed to compare access behaviours across professions. Results: A total of 258 participants viewed 2311 abstracts. More than 52% of abstracts viewed were primary clinical studies; the majority (87%) addressed treatment effectiveness and were quantitative research (99.8%). The most commonly accessed clinical topic (58%) related to musculoskeletal pain and the most accessed pain type was chronic pain (76%). Drugs, injections and rehabilitation therapy were most commonly addressed in accessed intervention studies. Differences in professional focus were reflected in access: physicians/nurses accessed studies on injections (23%) and drugs (26%) and nurses accessed surgical studies, whereas other professions rarely did. Physiotherapists (PTs) and occupational therapists (OTs) preferentially accessed studies on rehabilitation. OTs and psychologists preferentially accessed the available studies on cognitive interventions; OTs accessed more ergonomic studies. Psychologists most accessed educational and psychosocial intervention studies. There were no differences in access across professions to multidisciplinary interventions. Conclusion: While access partially reflects the content of the pain repository, professional differences in access were evident that related to the nature of the intervention, type of pain and the research design. Multidisciplinary evidence repositories may need to consider how to include and meet varied information needs

Attitudes, knowledge and behaviors related to evidence-based practice in health professionals involved in pain management

© 2018 University of Adelaide, Joanna Briggs Institute. Background: Healthcare professionals involved in pain management come from different disciplines, which may have different perspectives and training about evidence-based practice (EBP). A common concern for health professionals is pain management. Understanding how different professions involved in pain management view EBP forms the ideal context to study professional differences in EPP, and how this might influence pain management. Purpose: The purpose of this study was to compare different professions with respect to knowledge, attitudes and self-reported behavior toward EBP. Study design: Cross-sectional study. Methods: Physicians, nurses, occupational therapists, physical therapists and psychologists who were involved in pain management (n = 675) completed an online survey on a single occasion. The survey included demographic questions and the EBP-knowledge, attitude, behavior questionnaire (EBP-KABQ). This is a 27-item questionnaire that has been validated for use with different health professionals, and measures four constructs related to EBP (knowledge, attitude, behavior and outcome/decision). Differences between professionals were identified using a one-way between groups analysis of variance, with post-hoc testing (statistical significance was set at P value less than 0.05; clinical significance set at a mean difference of 10%). Results: The score on three of the four subscales of the KABQ were statistically different across professions. In general, knowledge scores were high for all professions (83-87%). Nurses demonstrated statistically higher levels of EBP knowledge (87%) when compared with other groups (F = 4.79, P = 0.001), but the differences were not deemed clinically relevant. Behavior was the lowest subscale and the most variable across professions (37-56%). Physicians had statistically significant (F = 25.69; P = 0.001), and clinically relevant, higher behavior subscale scores (56%) when compared with other professional groups. Physicians (73%) also had higher outcome/decision subscale scores (F = 6.50; P = 0.001), but this was only marginally different from other professions (65-73%). The attitude subscale scores were low and were not different across professions (range 57-59%; F = 1.65, P = 0.16; NS). Conclusion: The current study indicates that physicians and allied health professionals have similar EBP attitudes and knowledge. All professional groups seem to have suboptimal implementation of EBP. The nature of medical decision-making, its evidentiary pool, or longer experience with EBP may contribute to greater implementation amongst physicians

The yield and usefulness of PAIN+ and PubMed databases for accessing research evidence on pain management: a randomized crossover trial

Abstract Introduction PAIN+ and PubMed are two electronic databases with two different mechanisms of evidence retrieval. PubMed is used to “Pull” evidence where clinicians can enter search terms to find answers while PAIN+ is a newly developed evidence repository where along with “Pull” service there is a “Push” service that alerts users about new research and the associated quality ratings, based on the individual preferences for content and altering criteria. Purpose The primary purpose of the study was to compare yield and usefulness of PubMed and PAIN+ in retrieving evidence to address clinical research questions on pain management. The secondary purpose of the study was to identify what search terms and methods were used by clinicians to target pain research. Study design Two-phase double blinded randomized crossover trial. Methods Clinicians (n = 76) who were exposed to PAIN+ for at least 1 year took part in this study. Participants were required to search for evidence 2 clinical question scenarios independently. The first clinical question was provided to all participants and thus, was multi-disciplinary. Participants were randomly assigned to search for evidence on their clinical question using either PAIN+ or PubMed through the electronic interface. Upon completion of the search with one search engine, they were crossed over to the other search engine. A similar process was done for a second scenario that was discipline-specific. The yield was calculated using number of retrieved articles presented to participants and usefulness was evaluated using a series of Likert scale questions embedded in the testing. Results Multidisciplinary scenario: Overall, the participants had an overall one-page yield of 715 articles for PAIN+ and 1135 articles for PubMed. The topmost article retrieved by PAIN+ was rated as more useful (p = 0.001). While, the topmost article retrieved by PubMed was rated as consistent with current clinical practice (p = 0.02). PubMed (48%) was preferred over PAIN+ (39%) to perform multidisciplinary search (p = 0.02). Discipline specific scenario: The participants had an overall one-page yield of 1046 articles for PAIN+ and 1398 articles for PubMed. The topmost article retrieved by PAIN+ was rated as more useful (p = 0.001) and consistent with current clinical practice (p = 0.02) than the articles retrieved by PubMed. PAIN+ (52%) was preferred over PubMed (29%) to perform discipline specific search. Conclusion Clinicians from different disciplines find both PAIN+ and PubMed useful for retrieving research studies to address clinical questions about pain management. Greater preferences and perceived usefulness of the top 3 retrieved papers was observed for PAIN+, but other dimensions of usefulness did not consistently favor either search engine. Trial registration Registered with ClinicalTrials.gov Identifier: NCT01348802 , Date: May 5, 2011

Understanding the Experiences of Clinicians Accessing Electronic Databases to Search for Evidence on Pain Management Using a Mixed Methods Approach

The act of searching and retrieving evidence falls under the second step of the EBP process—tracking down the best evidence. The purpose of this study is to understand the competencies of clinicians accessing electronic databases to search for evidence on pain management using a mixed methods approach. Thirty-seven healthcare professionals (14 occupational therapists, 13 physical therapists, 8 nurses, and 2 psychologists) who are actively involved in pain management were included. This study involved two parts (a qualitative and a quantitative part) that ran in parallel. Participants were interviewed using a semi-structured interview guide (qualitative data); data were transcribed verbatim. During the interview, participants were evaluated in comparison to a set of pre-determined practice competencies using a chart-stimulated recall (CSR) technique (quantitative data). CSR was scored on a 7-point Likert scale. Coding was completed by two raters; themes across each of the competencies were integrated by three raters. Seven themes evolved out of the qualitative responses to these competencies: formulating a research question, sources of evidence accessed, search strategy, refining the yield, barriers and facilitators, clinical decision making, and knowledge and awareness about appraising the quality of evidence. The qualitative results informed an understanding of the strengths and weaknesses in the competencies evaluated. In conclusion, using a mixed methods approach, we found that clinicians were performing well with their basic literature review skills, but when it came to advanced skills like using Boolean operators, critical appraisal and finding levels of evidence they seem to require more training