Quality in Primary Care Open Access

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Knowledge Share - (2006) Volume 14, Issue 2

Web alert: quality in physiotherapy and rehabilitation

Ben Skinner BSc (Hons) MA*

Evidence-Based/Knowledge Management Librarian, KnowledgeShare, The Library, Audrey Emerton Building, Royal Sussex County Hospital, UK

Corresponding Author:
Ben Skinner
Evidence-Based/Knowledge Manage-ment Librarian
KnowledgeShare, The Library, Audrey Emerton Building
Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK
Tel: +44 (0)1273 523307
Fax: +44 (0)1273 523305
Email: ben.skinner@bsuh.nhs.uk
Website: www.KnowledgeShare.nhs.uk

Received date: 10 March 2006; Accepted date: 10 March 2006

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The Core Standards of Physiotherapy Practice 2005 state that: ‘research forms an essential part of practice.Whilst every practitioner will not necessarily be engaged in generating new evidence through research, all practitioners will use research evidence in some form to inform their own clinical practice’.


The Core Standards of Physiotherapy Practice 2005 state that: ‘research forms an essential part of practice. Whilst every practitioner will not necessarily be en-gaged in generating new evidence through research, all practitioners will use research evidence in some form to inform their own clinical practice’.[1] These stan-dards also make Reference to the importance of clinical audit in professional physiotherapy practice, with continuing professional development focusing on the need to improve the quality of patient care.

Clearly, for any professional group, the process of engaging with research and using it to improve prac-tice can be greatly aided by the use of online infor-mation resources. However, a recent study from the British Journal of Nursing, comparing the sources of knowledge used by nurses and physiotherapists, found that in both groups the internet was among the least used sources of information.[2] Doing ‘what has always worked’ ranked more highly. This is unfortunate, and a number of possible barriers to evidence-based prac-tice are indicated, including the difficulty in finding research-based information, and the difficulty in judging its quality.

Although it may be true that physiotherapists and other rehabilitation therapists are not as well served in terms of information resources as some of the healthcare professions, there are still a considerable number of useful sites to be found. Most of the resources that I’ve chosen include an element of quality assess-ment; they digest and appraise the primary research so that understanding results, identifying implications, and determining validity and reliability is made easier for the practitioner. One final barrier, identified in this paper, is that ‘people tend to use sources that they know and trust ... and opt for human rather than electronic sources’.[2] For this reason I have identified a number of sites that will put the reader directly in touch with other therapists working in their field.

Chartered Society of Physiotherapy: Error! Hyperlink Reference not valid.k

I suspect most of the readers of this article will already be members of the Chartered Society of Physiotherapy (CSP). However, reluctant as I am to begin by preach-ing to the converted, it would be wrong to write about online resources for rehabilitation without putting the CSP’s website first and foremost. This is a fundamental site, brimming with useful links, documents, contacts and interactive facilities, and hopefully I will be able to pick out one or two things that the reader is not already familiar with.

The CSP is the UK professional and educational body for physiotherapists and physiotherapy assist-ants, and also acts as a trade union. Its front page presents the latest news about the society, as well as recent press releases that they have produced, and for more in this vein see the ‘News and events’ section, which also includes formal responses to UK govern-ment consultations, various newsletters produced by the CSP and their events diary.

For those interested in enhancing quality in physio-therapy the ‘Effective practice’ section is the first place to turn. There is a section on ‘Audit’, with links out to national audit information and a database of local audit projects going on around the country. There is a small, but growing, collection of physiotherapy-specific clinical guidelines, which have been endorsed by the society. These can be found under the ‘Clinical guidelines’ section, along with links out to guidelines from the National Institute for Health and Clinical Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN). ‘Effective practice’ also includes sections on research, clinical effectiveness, standards of practice and more, each with a brief introduction to the topic for those unclear about the definition and scope of these terms.

The ‘Outcome measures’ section (also to be found under ‘Effective practice’) seems to be a particularly valuable and popular area. This contains a database of measurement scales and tests for use on patients – standardised tools for evaluating the effectiveness of a course of physical therapy. The tests are not available in full, but Reference are given for where they can be found, as well as where to find information on their reliability, responsiveness and validity.

There are considerably more resources on this site than I can talk about in this short space. The reader may want to look out for the section for patients on what physiotherapy is, how to access treatment, and where to find a physiotherapist in their locality. There is also a collection of patient information leaflets that can be printed out or ordered from the society. In addition, members of the CSP have access to a team of qualified library and information professionals. Their section of the site contains a variety of publications pointing users to key health and physiotherapy web-sites, as well as access to their catalogues of journals and books.

National Physiotherapy Research Network

This is another initiative of the CSP to which I wanted to draw particular attention. The National Physio-therapy Research Network has taken a bottom-up approach by creating regional research clusters known as ‘hubs’, which are based in universities around the country but linked with local clinicians. The intention is to encourage physiotherapists to get involved in research, and to provide support to one another, whether they are experienced researchers or new to this side of the profession. The local hub can provide peer review, mentoring schemes, information on local research resources, advice on funding, and more. If this is of interest, contact details for the hub facilitators can be found on the CSP site under the ‘Research’ section.

InteractiveCSP: www.interactivecsp.org.uk

InteractiveCSP (iCSP) is an innovative website, created by the CSP, which allows members to con-tribute content and manage sections of the site. At the time of writing, the site is in a pilot form but will be officially launched at the end of March 2006. Users are able to indicate the subject areas that interest them and will then see only the information that is of relevance, and will receive regular bulletins containing new information in their area. There are forums available for discussions, and space for special interest groups to include their own content.

The point of iCSP is to gain support from one’s peers and to connect people based on shared interests.

Resources such as this (and my own, similar, ‘Know-ledgeShare’ service) have huge value when used to their full potential.

High-quality physiotherapy research

PEDro – www.pedro.fhs.usyd.edu.au/index.html

PEDro is the Physiotherapy Evidence Database, which was set up in 1999 by the Centre for Evidence-Based Physiotherapy (CEBP) in Sydney. It is a regularly updated database of high-quality research in physio-therapy, containing bibliographic details (and in some cases abstracts) of randomised controlled trials, sys-tematic reviews and clinical guidelines. There are web links to further details, and full text where available.

The database is populated using explicit inclusion criteria, via regular searching of the research databases and links with the Cochrane Collaboration. What makes this such a useful resource is the fact that each trial included on the site is rated according to the PEDro scale, a tool which systematically measures the internal validity, or ‘believability’ of a piece of research, as well as its external validity, or ‘meaningfulness’. Articles are given a mark out of ten that lets you quickly identify the strongest evidence. Evidence-based practice means that we should be constantly searching out the best evidence, not simply that which is most con-venient or exciting, and this site aids this process for physiotherapists.

There is an advanced search that allows the user to narrow down results by publication type, condition, body part, or therapy, or restrict to the most recently published documents, or those that have a high score on the rating scale. You can also search by author or keyword as you would expect. Finally, the site also includes a short tutorial on how to determine whether a piece of research is of a high standard, with refer-ences to further information on the subject.

For additional (non-appraised) research articles the most important bibliographic databases to be aware of are the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Allied and Complemen-tary Medicine Database (AMED), both of which cover physiotherapy, occupational therapy, podiatry and other aspects of rehabilitation. They include journal articles published since the mid-1980s and are updated frequently. Access to these databases is free to NHS staff through the use of an Athens password. If you don’t have one already, register for an Athens password at www.athens.nhs.uk by clicking on ‘Self registration’ and filling in the online form. Once you’ve done that you can get to both CINAHL and AMED through the ‘My Athens’ link from the same site and choosing ‘Dialog DataStar’ from the list of resources. For training on how to use these databases effectively contact a local NHS library service.

Musculoskeletal Specialist Library: www.library.nhs.uk/musculoskeletal

The National Library for Health gets a mention in most of my Web alerts, and this month I’d like to focus attention on their specialist libraries. These collect and make available important new information resources that will be of interest to specialists in particular disease areas. The front page of the Musculoskeletal Specialist Library highlights the latest musculoskeletal-related systematic reviews to be added to the Cochrane Library, as well as the most recently published national guidelines in this area. It also has side-bars containing relevant news in drug information and forthcoming conferences.

The various documents collected by this site are currently divided into: guidance and pathways, evi-dence, news, patient information, and so on, and just as with PEDro there are specific and transparent inclusion criteria. The section headings may change after a site redesign, due in April 2006, but the content should remain the same. The ‘Evidence’ heading refers to research that has been pre-appraised, so there is extra input alerting you to whether a particular article is credible or not, and the ‘Patient information’ section is of course particularly useful. All of these documents can be easily searched, or browsed by condition (for example you can see all the documents on major inflammatory diseases or drill down further to retrieve only those concerning rheumatoid ar-thritis). The site is intended for all professions working with musculoskeletal issues, but if you wish to limit the documents to physiotherapy, occupational ther-apy or podiatry then you can do so under the ‘Disease management’ heading.

Networking and sharing good practice

Electronic resources to support collaboration and discussion between professionals seem to be gaining in popularity at the moment, and understandably so. Do Once and Share (www.informatics.nhs.uk/doas), from the NHS Health Informatics Programme, is a high-profile initiative aimed at encouraging group working and sharing best practice across the UK healthcare community, but there are a whole range of opportunities for networking and communication available online, and many (such as iCSP mentioned above) are physiotherapy specific.

World Confederation for Physical Therapy: www.wcpt.org

One of the main strengths of the World Confederation for Physical Therapy’s (WCPT’s) website is its collec-tion of forums, which allow physiotherapists to dis-cuss a whole range of issues with their colleagues internationally. Visitors to the site are able to view past discussions, and are able to register for free if they wish to contribute. A relatively long-running forum on international working and study has recent con-tributors asking about many topics, from registering in New Zealand to finding temporary employment in Belize. Newer forums include a range dedicated to evidence-based practice; there is one for discussion on implementing or developing clinical guidelines and the possibility of developing international guidelines, and others on critical appraisal, outcome measures, evidence-based practice research and collaboration.

You will also find a programme of international conferences in physiotherapy, and a number of WCPT publications that inform, represent and support the profession internationally, some of which are available to download.

Another method of online collaboration is through discussion lists, whereby you subscribe and receive suggestions, questions, and notifications from other members direct to your email. In the UK a large number of these are run by the Joint Information Systems Council (JISC), initially aimed at the aca-demic research community, but in practice used by a vast number of healthcare staff from the NHS and beyond. Discussion lists are an aid to collaboration, and a way to make new contacts and stay current with the latest developments in your area of interest. You can browse archives of previous discussions, and subscribe to key lists, by going to JISCmail at www.jiscmail.ac.uk/index.htm. The lists that are likely to be of most use to physiotherapists are: ‘Physio’, ‘Manual-Therapy’ and ‘Sport-Med’.


As can be seen, there are many opportunities to access physiotherapy-specific information online. As well as guidelines, standards and resources to support pro-fessional development, there are many routes to the research literature, including research that has been quality assured. Using the web to network and gain support from colleagues outside of your normal work environment is becoming ever more popular, and there are numerous sites that aid this process as well. For those who still feel unsure about navigating the web and judging the usefulness and quality of websites, the Resource Discovery Network Virtual Training Suite is always worth a look. There is a section written especially for allied health professionals, which can be found at  www.vts.rdn.ac.uk/tutorial/allied, and I recommend it for anyone who would currently rather stick with what they have always done than use the net as a source of knowledge.


This month I would like to thank Ron van Heuvelen and Matt Daly from the physiotherapy department of Lewes Victoria Hospital, as well as the Information Services at the Chartered Society of Physiotherapy, for their suggestions.