Moving forwards: using evidence to transform services

Moving Forward: Physiotherapy for Musculoskeletal Health and Wellbeing is a review recently published by the NHS National Institute for Health Research (NIHR) that brings together evidence from physiotherapy-related clinical research studies funded by the NIHR and other organisations. 

This four-part series will explore how the best available evidence from these studies can be used as a platform to transform services and reduce variation. It demonstrates ways of using evidence for the greatest impact and tailoring the information for different audiences – principles are applicable to all areas of physiotherapy. This first part, written by Dean Phillips, will examine how the NIHR can help you to develop an evidence base for service change. Part two will show how to use evidence to change your individual practice. Parts three and four will look at using evidence to initiate change locally, and how to influence more fundamental systems-level change. 

Getting involved in research

The first step is to participate in studies supported by the UK Clinical Research Network (UKCRN) which provides the infrastructure to allow high-quality research to be undertaken in the NHS. The next step is to develop your own research questions, then design and undertake research studies to address them. Discuss ideas with colleagues, join or set up a journal club, go to local research seminars and national conferences to network. Importantly, ask your patients for ideas about research that would make a difference to them – and involve patients and carers in designing your research study. 

The CSP and James Lind Alliance Priority Setting Partnership recently identified physiotherapy research priorities involving clinicians and patients. 

The top three priorities are:

When health problems are developing, at what point is physiotherapy most/least effective for improving patient results compared to no
physiotherapy?

1. What factors affect this?
2. When used by physiotherapists, what methods are effective in helping patients to make health changes, engage with treatment, check their progress or manage their health after discharge?
3. What are the best ways to deliver physiotherapy services to meet patients’ needs and improve outcomes for patients and services?

Moving Forward has helped to identify specific gaps in musculoskeletal research. We need to better understand how to sustain long-term adherence to physiotherapy-led exercise and physical activity to ensure long-term benefits. Identifying exercise responders from non-responders would help us to target regimens more successfully. We also need to know why some people recover or improve with physiotherapy much quicker than others. The other big gap is prevention research.

The National Institute for Health and Care Excellence also recommends areas for future research. This may help you decide on a specific question that is more likely to be successful when submitting a grant application.

Career pathway 

Research career funding is available through the NIHR Academy. Health Education England (HEE) and the NIHR Integrated Clinical Academic (ICA) programme provides training awards for physiotherapists who wish to develop careers that combine clinical research and research leadership with continued clinical practice and clinical development. These have been designed to support people at various points of their career. Physiotherapists have been very successful in gaining these awards. Clinical fellowships are also possible through the Medical Research Council.

In addition, the NIHR Fellowship programme helps to support individuals to become future leaders in research. Fellowships have been designed to support people at various points of their development, from initial training to senior post-doctoral research.

There are five physiotherapy NIHR academic training advocates who promote NIHR training and career opportunities and support individuals beginning or continuing a research career. 

Research funding

The NIHR also has specific funding programmes to which you can apply. They fund individual projects or a linked programme of research. They will fund any rigorous research design that addresses a question.

Through partner arrangements, physiotherapists can access many of the NIHR funding programmes. In Scotland, specific funding opportunities can also be accessed through NHS Research Scotland, in Wales through the Research Design and Conduct Service and in Northern Ireland via the Health and Social Care, Research and Development (HSC R&D). When considering a grant application, contact the relevant research design support service at an early stage to discuss your ideas. Outside England, this support can be accessed through the organisations above. In England, the NIHR Research Design Service (RDS) can provide you with free advice and support on all aspects of developing a grant application. 

The CSP Charitable Trust provides funding to members for research projects for novice and experienced researchers. See the current call for applications at www.csp.org.uk/prf. Research funding is also available through research charities such as Versus Arthritis. Studies funded by both these organisations are included in the Moving Forward review.

Raising our profile

Physiotherapists have shown they can compete and lead high quality research of national and international importance. Three physiotherapists are currently NIHR senior investigators – among the top clinical health researchers in the UK. We need more high-quality research with involvement of physiotherapists and other Allied Health Professionals (AHPs). The NIHR Clinical Research Network’s AHP Strategy 2018-2020 seeks to increase the visibility of AHPs as research leaders, strengthen research capability and capacity, and support them to deliver visible research impact.

The Council for Allied Health Professions Research (CAHPR) is also helping to raise the profile and increase the influence of physiotherapy and other AHPs in research. Contact your CAHPR regional hub for access to advice and support, as well as learning, sharing, networking and collaboration opportunities. The NIHR and CAHPR have together created the AHP Research Champion scheme. Based in each of the 15 NIHR Local Clinical Research Networks, AHP research champions act as role models and research activists, promoting the work of AHPs and encouraging AHPs to be aware of and involved in research.

Through the NIHR Journals Library, you can see the projects funded by the NIHR as well as the final published reports.

Importantly, with all our research we need to investigate how to implement best evidence into clinical practice and understand any barriers. This will be discussed over the next three instalments. 

Dean Phillips is a physiotherapist in clinical practice and a senior research adviser at the NIHR Research Design Service South. Dean wrote the Moving Forward themed review with input from Tara Lamont – deputy director at the NIHR Dissemination Centre and Tannaze Tinati – researcher

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