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:
At SHP Health (SHP) we like to think of these elements as part of a whole and not as a list, where it might be suggested that one of these components is ranked higher than the others.
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.
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 “How are we doing?” survey and in other formats should they wish.
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.
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.
At SHP we have an ongoing commitment and involvement in research.
Our involvement in research includes:
