Involving clinical stakeholders in the systematic review process: exercises for low back pain

Article type
Authors
Hayden J, Reardon R
Abstract
Background: Cochrane systematic reviews should address issues that are meaningful to people making decisions about healthcare. Despite this expectation, a common criticism is that the outcomes, results and their presentation are often not relevant to policy makers, clinicians, or the individual with the disorder in question. One attempt to bridge this gap has been through the growth of the emerging practice of knowledge transfer & exchange (KTE).

Objectives: To present a framework for involvement of clinical stakeholders in the systematic review process, including its development and implementation, its practical application within an individual review and important observed outcomes.

Methods: The Institute for Work & Health (IWH), a research organization that hosts the Cochrane Back Group, has considerable experience in KTE. Clinical 'knowledge-broker' networks have been created which facilitate a two-way exchange of information, ideas and experience between researchers and clinical decision-makers. A broker network composed of physiotherapists identified by their peers as being 'educationally influential' (PT EIs) participated in the analysis, interpretation and dissemination of a recently updated Cochrane systematic review on exercise therapy for treatment of low back pain.

Results: 61 randomized, controlled trials of exercise therapy were included in the review. The interventions and populations studied were heterogeneous. The PT EIs interacted with the review authors, participating in presentations, focus group meetings, and discussions at several points in the systematic review process. The value of the clinical stakeholder involvement was two-fold: improving the clinical relevance and applicability of the review, and assisting in the transfer of systematic review knowledge to clinical practice. With these experiences a framework was developed which will facilitate incorporation of this process into future systematic reviews.

Conclusions: Cochrane reviews should address issues that are meaningful to clinical decision-makers; this is facilitated by active inclusion of key stakeholders in the systematic review process. We will discuss our experiences involving clinicians in a systematic review, and important observed outcomes of the process.