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Evidence-based Practice

We take the best available research and integrate it with our clinical expertise & values to provide you with the best management plan. That’s why you’re in the best hands.

What is evidence-based practice (EBP)?

“Evidence-based practice – often used interchangeably with the term “evidence-based medicine” when related to healthcare – is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

Sackett 1996

An essential part of the quotation provided above is “…the care of the individual patient”. Hence, the key components of Evidence-based practice are:

  1. Best research evidence
  2. Clinical expertise
  3. Patient values and preferences

What is evidence-based practice (EBP)?

Evidence-based practice is about encouraging healthcare professionals to deliver the most effective assessment, management & prevention strategies available, whilst ensuring that we are held accountable for the interventions that we provide (Stevenson et al 2004). That accountability can be viewed in the context of the various stakeholders including society, healthcare systems, family members, funders and most importantly… the patient.

At SHP we recognise that our challenge is to deliver best available care for every single individual patient.

Patient values & preferences

At SHP we listen to our patients. This might be as simple as asking people (and acting on) what their goals are, what their expectations of assessment and management are, what their main concerns are and importantly what the patient story is; sometimes referred to as the “patient narrative”.

Another way of putting the patient at the centre of what we do is to provide them with the opportunity to provide us with feedback on their experience of using our services. The measures used to collate this information are often referred to as “Patient Reported Experience Measures” or “PREMs”. At SHP we give people the opportunity to provide us with this information via our â€śHow are we doing?” survey and in other formats should they wish.

Clinical expertise

At SHP we are never happy to stand still and are committed to Continuing Professional Development (CPD). This means that we are always looking to improve what we do for our patients and our clients; demonstrated through our commitment to further education, the teaching and learning of others, inter-disciplinary collaboration and our own continuing, evidence-based clinical development.

Our practice lead, Dr Massimo Barcellona, is a Consultant Physiotherapist in Musculoskeletal at King’s College Hospital & has extensive experience of working in academia. He trained as a physiotherapist at the university of King’s College London gaining a first class honours degree. Massimo and the SHP Team have specialist knowledge and skills for the assessment, management & prevention of musculoskeletal problems and associated conditions. Our Team have worked for various NHS Foundation Trusts and have extensive experience of working in academia and in private practice, as well as experience of working with sports clubs and both amateur and professional sports people in the local area.

At SHP we are committed to continuing professional development and we continue to both undertake, as well as deliver, numerous post-graduate courses. Massimo is involved in the training of GPs – and other healthcare professionals – in the area of musculoskeletal medicine and has completed postgraduate training at the University of Plymouth in Injection Therapy for Health Professionals. Helen Barcellona is one of a small group of physiotherapists in the local area to be a chartered physiotherapist & fully certified APPI instructor (see our Team page for more details).  Helen is involved in the training of novice Pilates instructors.

We at SHP have founded the Surrey Musculoskeletal Network, which provides professional development for clinicians with an interest in musculoskeletal medicine. This is something that we really enjoy doing. When clinicians come together it helps us to be held accountable for what we do, and when combined with listening to our patients, it helps improve the standard of care for our patients and our clients… that’s evidence-based practice in action.

Outcome measures

At SHP we are committed to using outcome measures.

Patient reported outcome measures (“PROMs”) are typically questionnaires completed by patients.  PROMs help us to understand a patient’s views of their symptoms, their functional ability and their health related quality of life (Black 2013).

As well as helping clinicians to make better decisions about the health and wellbeing of the patient, PROMs also allow for comparisons to be made between different providers; making clinicians and healthcare providers accountable for what they do and driving improvements in services (Black 2013). These measures are also developed alongside patients and, therefore, include those types of questions that are important to patients.

At SHP (where appropriate) we use evidence-based PROMs including those that are;

We also use PROMs that help us to tailor treatment to the individual and that help us predict a patient’s likelihood of developing a persistent problem; such as the STarT Back Screening Tool (Hill et al 2011).  These tools are known as “risk stratification tools” and they help us to provide the patient with the care that they need.  These tools also help to hold us accountable so that we don’t provide people with unnecessary treatment.

Dr Massimo Barcellona has worked alongside Oxford University Innovation to develop a locally approved version of the Musculoskeletal Health Questionnaire (MSK-HQ) (Hill et al 2016).  The MSK-HQ was co-produced with patients to tease out the important parameters related to the individual with a musculoskeletal condition. These parameters include “pain severity, physical function, work interference, social interference, sleep, fatigue, emotional health, physical activity, independence, understanding, confidence to self-manage and overall impact” (Hill et al 2016).  Our locally approved version of the MSK-HQ is known as an “ePRO”, meaning that our patients can complete the measure either in clinic or remotely via the internet (Coons et al 2015). Throw in a little computer programming experience, and we have developed the ability for the MSK-HQ scoring to be calculated automatically and be available in real-time to facilitate the assessment and management process.

Research activities

 

At SHP we have an ongoing commitment and involvement in research.

Our involvement in research includes:

    1. Sothinathan, C., & Barcellona, M. G. (2021, November 5). Patient and staff satisfaction of physiotherapy delivered remotely during the COVID-19 pandemic: A service evaluation. Physiotherapy UK 2021.
    2. Galea Holmes, M. N., Wileman, V., McCracken, L. M., Critchley, D., March, M. K., Norton, S., Moss-Morris, R., Noonan, S., Barcellona, M., & Godfrey, E. (2021). Experiences of training and delivery of Physical therapy informed by Acceptance and Commitment Therapy (PACT): A longitudinal qualitative study. Physiotherapy, 112, 41–48. https://doi.org/10.1016/j.physio.2020.12.004
    3. Look, M. C., Iyengar, Y., Barcellona, M., & Shortland, A. (2021). Does delayed onset muscle soreness affect the biomechanical variables of the drop vertical jump that have been associated with increased ACL injury risk? A randomised control trial. Human Movement Science, 76, 102772. https://doi.org/10.1016/j.humov.2021.102772
    4. Barcellona, M. G. (2021). Symptom versus condition modifying care: Can such a dichotomy be useful? Physical Therapy Reviews, 26(2), 81–86. https://doi.org/10.1080/10833196.2020.1825034
    5. Godfrey, E., Wileman, V., Galea Holmes, M., McCracken, L. M., Norton, S., Moss-Morris, R., Noonan, S., Barcellona, M., & Critchley, D. (2020). Physical Therapy Informed by Acceptance and Commitment Therapy (PACT) Versus Usual Care Physical Therapy for Adults With Chronic Low Back Pain: A Randomized Controlled Trial. The Journal of Pain, 21(1), 71–81. https://doi.org/10.1016/j.jpain.2019.05.012
    6. Alexander, J., McLachlan, S., Barcellona, M., & Sackley, C. (2019). Technology-enhanced learning in physiotherapy education: Student satisfaction and knowledge acquisition of entry-level students in the United Kingdom. Research in Learning Technology, 27. https://doi.org/10.25304/rlt.v27.2073
    7. Barcellona, M. G., Buckley, L., Palmer, L. J. M., Ormond, R. M., Owen, G., Watson, D. J., Woledge, R., & Newham, D. (2017). The effect of minimalist footwear and instruction on running: An observational study. BMJ Open Sport & Exercise Medicine, 3(1), e000160. https://doi.org/10.1136/bmjsem-2016-000160
    8. Godfrey, E., Holmes, M. G., Wileman, V., McCracken, L., Norton, S., Moss-Morris, R., Pallet, J., Sanders, D., Barcellona, M., & Critchley, D. (2016). Physiotherapy informed by Acceptance and Commitment Therapy (PACT): Protocol for a randomised controlled trial of PACT versus usual physiotherapy care for adults with chronic low back pain. BMJ Open, 6(6), e011548. https://doi.org/10.1136/bmjopen-2016-011548
    9. Barcellona, M. G., & Morrissey, M. C. (2016). The effect of open kinetic chain knee extensor resistance training at different training loads on anterior knee laxity in the uninjured. Manual Therapy, 22, 1–8. https://doi.org/10.1016/j.math.2015.12.011
    10. Barcellona, M. G., Morrissey, M. C., Milligan, P., Clinton, M., & Amis, A. A. (2015). The effect of knee extensor open kinetic chain resistance training in the ACL-injured knee. Knee Surgery, Sports Traumatology, Arthroscopy, 23(11), 3168–3177. https://doi.org/10.1007/s00167-014-3110-6
    11. Vauhnik, R., Perme, M. P., Barcellona, M. G., Morrissey, M. C., Sevšek, F., & Rugelj, D. (2015). Effect of repeated passive anterior loading on human knee anterior laxity. Manual Therapy, 20(5), 709–714. https://doi.org/10.1016/j.math.2015.02.007
    12. Head, P., Austen, B., Browne, D., Campkin, T., & Barcellona, M. (2015). Effect of practical blood flow restriction training during bodyweight exercise on muscular strength, hypertrophy and function in adults: A randomised controlled trial. International Journal of Therapy and Rehabilitation, 22(6), 263–271. https://doi.org/10.12968/ijtr.2015.22.6.263
    13. Barcellona, M. G., Morrissey, M. C., Milligan, P., & Amis, A. A. (2014). The effect of thigh muscle activity on anterior knee laxity in the uninjured and anterior cruciate ligament-injured knee. Knee Surgery, Sports Traumatology, Arthroscopy, 22(11), 2821–2829. https://doi.org/10.1007/s00167-013-2695-5
    14. Nicholettos, A., Barcellona, M. G., & Morrissey, M. C. (2013). The immediate effects of open kinetic chain knee extensor exercise at different loads on knee anterior laxity in the uninjured. The Knee, 20(6), 500–504. https://doi.org/10.1016/j.knee.2012.10.014
    15. Barcellona, M. G., Christopher, T., & Morrissey, M. C. (2013). Bench Testing of a Knee Joint Arthrometer. Orthopedics, 36(8), e1000–e1006. https://doi.org/10.3928/01477447-20130724-14
    16. Vauhnik, R., Perme, M. P., Barcellona, M. G., Rugelj, D., Morrissey, M. C., & Sevsek, F. (2013). Robotic knee laxity testing: Reliability and normative data. The Knee, 20(4), 250–255. https://doi.org/10.1016/j.knee.2012.10.010
    17. Barcellona, M. G. (2010). The effect of thigh muscle resistance training on knee laxity. King’s College London.
    18. Barcellona, M., & Thomson, D. (2002). Restoring psychological wellbeing of injured sportspeople. British Journal of Therapy and Rehabilitation, 9(11), 426–430. https://doi.org/10.12968/bjtr.2002.9.11.13682
        1. The beliefs and current clinical practice of physiotherapists in the United Kingdom for the conservative management of anterior cruciate ligament (ACL) injury (Reference Number: LRS-16/17-4676, Co-Authors: Massimo Barcellona, Corinne Pepper, Dominic Platt & Elizabeth Brown).
        1. Exercise for the conservative management of anterior cruciate ligament injuries: A systematic review. (Co-Authors: Dale Hoadley, Jai Mistry, Massimo Barcellona).
        2. The beliefs, attitudes and opinions of physiotherapists regarding the conservative management of anterior cruciate ligament (ACL) injury: a qualitative study. (Reference Number: LRS-17/18-6589, Co-Authors: Massimo Barcellona, Euan Sadler, Samuel Biermann, Neven Znaor Wassall, Rebecca Wilkinson)
            1. Comparison of the clinical and cost effectiveness of two management strategies for non-acute Anterior Cruciate Ligament (ACL) injury: rehabilitation versus surgical reconstruction. Co-Local Principal Investigator: Dr Massimo Barcellona (Consultant Physiotherapist in MSK at King’s College Hospital).
            2. Research for Patient Benefit (RfPB) Programme: PB-PG-1112-29055 – A randomised controlled trial of brief physiotherapy informed by Acceptance and Commitment Therapy for chronic low back pain: the PACT study. Co-applicant: Dr Massimo Barcellona (Consultant Physiotherapist in MSK at King’s College Hospital).
            3. Physiotherapy rehabilitation for osteoporotic vertebral fracture-a randomised controlled trial and economic evaluation (PROVE trial). Local Principal Investigator: Becca Hull (Musculoskeletal Physiotherapist at the Royal Surrey County Hospital).

                 

                1. Contribution to the Standardised National Data Collection for First Contact Physiotherapy Practitioners led Amanda Hensman-Crook in collaboration with NHS England.

                           

                          1. World Congress of Physical Therapy 2019 (Geneva). Platform presentation. Title: Beliefs, attitudes and opinions of UK physiotherapists regarding the conservative management of anterior cruciate ligament (ACL) injury; a qualitative study. (Abstract number: A-0990-0000-02020).
                          2. Association of Foot & Ankle Physiotherapists & AHPs (AFAP) 2019. Platform presentation. Title: The effect of minimalist footwear and instruction on running.
                          3. Barcellona MG, Buckley L, Palmer LJ, Ormond RM, Owen G, Watson DJ, Newham DJ. The effect of minimalist footwear and instruction on running: an observational study. Physiotherapy. 2017 Dec 1; 103:e126-7.
                          4. Barcellona MG. World Congress of Physical Therapy. Amsterdam. Jun 2011. “The effect of knee extensor resistance training at different loads on knee laxity change in the ACL-injured knee”.

                           

                          1. Slovenian Ministry of Education, Science and Sport. International Cooperation in Higher Education Fund.  Completed in March 2015.

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