Answering questions put forward by local musculoskeletal pain clinicians in the UK

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Jordan J1, Stevenson K2, Lewis R3, van-der-Windt D1
1Arthritis Research UK National Primary Care Centre, Keele University, Keele, UK, 2Physiotherapy Department, University Hospital of North Staffordshire, Stoke on Trent, UK, 3Health Library, Clinical Education Centre, University Hospital of North Staffordshire, Stoke on Trent, UK

Background: A multidisciplinary group of clinicians with academic partners in North-west England was established to develop critically appraised topics (CATs) addressing questions on musculoskeletal care generated in practice. CATs are disseminated locally to healthcare practitioners, managers and commissioners to inform decision-making. Objective: To examine the evidence used in these CATs and assess the contribution of Cochrane Reviews. Methods: Local clinicians and managers suggest questions, usually relating to the effectiveness and implementation of interventions. Questions are refined and a health librarian conducts a systematic search, which is then critically appraised by the team. Highest quality evidence that directly addresses the question is selected and the CAT is written with a clear clinical bottom line before being disseminated locally. Results: Of 23 CATs that have now been developed, nine (39%) original questions were addressed in at least one systematic review, six of which were Cochrane Reviews. A further four questions were partially answered by systematic reviews, for example one CAT focused on the effectiveness of stabilisation exercises for shoulder impingement, however the review selected as best evidence addressed exercise in general. For two other CATs at least one RCT related to the question asked. However, eight (35%) CAT questions could not be answered with certainty either because only low quality, or no research was found. Conclusions: Around a third of musculoskeletal pain clinicians questions had no high quality evidence with which to answer them. Researchers may not address many decisions that clinicians have to make and clinicians may find it difficult to interpret published evidence and apply it to their own practice, illustrating that there is still a research/practice divide. However, providing the evidence, e.g. from Cochrane reviews, is available and given the right support, local groups can help translate research for other clinicians in a way that is timely and accessible.