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.

Barriers to Physiotherapists' Use of Professional Development Tools for Chronic Pain: A Knowledge Translation Study.

Purpose: The Pain Science Division (PSD) is a special interest group of the Canadian Physiotherapy Association that serves physiotherapists who have an interest in better understanding and managing patients' pain. The PSD developed evidence-based resources for its members with the goal of improving patient care by supporting professional development. However, online metrics tracking access to these resources indicated that access was low. The purpose of this study was to identify the barriers PSD members encountered to the use of PSD resources and to recommend interventions to address these barriers guided by the Theory and Techniques Tool (TTT). Method: We distributed an online survey to PSD members across Canada. We used the TTT, a knowledge translation tool, to guide the design of the questionnaire and identify actionable findings. Results: Response rates from 621 non-student members and 1,470 student members were 26.9% and 1.4%, respectively. Based on the frequency of practising physiotherapists' (n = 167) agreement with items in the TTT, the primary barriers to use of the PSD resources were forgetting that the resources were available and forgetting to use them. Conclusions: The TTT can be used to identify barriers to use of professional development tools.

Objectif : la division science de la douleur (DSD) est un groupe d'intérêt de l'Association canadienne de physiothérapie destiné aux physiothérapeutes qui souhaitent mieux comprendre et gérer la douleur des patients. La DSD a préparé des ressources fondées sur des données probantes pour ses membres afin d'améliorer les soins aux patients grâce au perfectionnement professionnel. Cependant, les mesures virtuelles qui surveillent l'accès à ces ressources ont révélé que cet accès était limité. La présente étude visait à établir les obstacles auxquels se sont heurtés les membres de la DSD pour utiliser les ressources de la DSD et à recommander des interventions afin d'écarter ces obstacles en fonction de l'outil Theory and Techniques (TTT). Méthodologie : les chercheurs ont distribué un sondage en ligne aux membres de la DSD du Canada. Ils ont utilisé le TTT, un outil d'application des connaissances, pour orienter la conception du questionnaire et déterminer les résultats réalisables. Résultats : le taux de réponse des 621 membres non étudiants et des 1 470 membres étudiants s'établissait à 26,9 % et à 1,4 %, respectivement. D'après la fréquence d'accord des physiothérapeutes en exercice (n = 167) avec les points du TTT, l'oubli de l'existence des ressources ou l'oubli de les utiliser étaient les principaux obstacles à l'utilisation des ressources de la DSD. Conclusions : le TTT peut être utilisé pour déterminer les obstacles à l'utilisation d'outils de perfectionnement professionnel.

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

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.

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

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.

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.

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 > 0.90); intra-rater reliability after relocating landmarks was high (ICCs > 0.80); reliability between therapists was moderate to high (0.60 > ICCs < 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.

The reliability and validity of the computerized double inclinometer in measuring lumbar mobility.

STUDY DESIGN: Repeated measures reliability/validity study. OBJECTIVES: To determine the concurrent validity, test-retest, inter-rater and intra-rater reliability of lumbar flexion and extension measurements using the Tracker M.E. computerized dual inclinometer (CDI) in comparison to the modified-modified Schober (MMS). SUMMARY OF BACKGROUND: Numerous studies have evaluated the reliability and validity of the various methods of measuring spinal motion, but the results are inconsistent. Differences in equipment and techniques make it difficult to correlate results. METHODS: Twenty subjects with back pain and twenty without back pain were selected through convenience sampling. Two examiners measured sagittal plane lumbar range of motion for each subject. Two separate tests with the CDI and one test with the MMS were conducted. Each test consisted of three trials. Instrument and examiner order was randomly assigned. Intra-class correlations (ICCs 2, 2 and 2, 2) and Pearson correlation coefficients (r) were used to calculate reliability and concurrent validity respectively. RESULTS: Intra-trial reliability was high to very high for both the CDI (ICCs 0.85 - 0.96) and MMS (ICCs 0.84 - 0.98). However, the reliability was poor to moderate, when the CDI unit had to be repositioned either by the same rate (ICCs 0.16 - 0.59) or a different rater (ICCs 0.45 - 0.52). Inter-rater reliability for the MMS was moderate to high (ICCs 0.75 - 0.82) which bettered the moderate correlation obtained for the CDI (ICCs 0.45 - 0.52). Correlations between the CDI and MMS were poor for flexion (0.32; p<0.05) and poor to moderate (-0.42 - -0.51; p<0.05) for extension measurements. CONCLUSION: When using the CDI, an average of subsequent tests is required to obtain moderate reliability. The MMS was highly reliable than the CDI. The MMS and the CDI measure lumbar movement on a different metric that are not highly related to each other.

Radial nerve mobilization reduces lateral elbow pain and provides short-term relief in computer users.

STUDY DESIGN: Prospective Experimental Study. BACKGROUND: Computer users may be at risk of lateral elbow pain. It is theorized that adverse mechanical tension can arise in the radial nerve with sustained keyboarding due to sustained static work of the elbow extensor muscles. Neural mobilization has been suggested as a potential treatment. PURPOSE: The purpose of this study was to evaluate the effect of neural mobilization of the radial nerve on a single occasion in terms of its ability to reduce lateral elbow pain. METHODS AND ANALYSIS: Forty-one computer professionals (Mean age 46.7; S.D. 12.77), who had experienced lateral elbow pain for a mean of 2.87 months were recruited. The participants rated the pain using a verbal, numeric rating scale (NRS). Radial nerve tension was tested using the Upper limb Tension Test (ULTT) for radial nerve in both upper extremities. The radial nerve was mobilized using a series of 8 oscillations and repeated 3 times with a one minute rest in between. The NRS and ULLT were repeated after treatment and the scores compared using a paired t-test by the first author. RESULTS: The mean NRS scores decreased significantly from 5.7 (1.1) to 3.8 (1.4) (p<0.000; t value=8.07). CONCLUSION: A single session of 3 neural mobilization resulted in a reduction of pain in computer users with lateral elbow pain. A long-term randomized trial is needed to determine the effects sustained over-time.

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.