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  • CoHSTAR Pilot Study Deadline June 1

    A deadline is fast approaching for Center on Health Services Training and Research (CoHSTAR) opportunities to develop pilot studies that would help set the stage for larger efforts to advance a wide range of health services research. Letters of intent are due by June 1, 2019.

    The selected pilot studies would address research questions in CoHSTAR's 4 areas of specialization—analysis of large data sets, rehabilitation outcome measurement, cost-effectiveness, and implementation of science and quality improvement research—and the CoHSTAR Pilot Study Program webpage lists examples of specific types of studies that would qualify for funding. Each pilot study will receive $25,000 in funding for direct costs.

    APTA was a major financial contributor to the development of CoHSTAR, having donated $1 million toward the center's startup in 2015. In addition to APTA’s $1 million donation, funding for CoHSTAR also came from APTA components, individual PTs, foundations, and corporate supporters.

    Study Identifies 11 Guideline-Based Recommendations for Musculoskeletal Pain

    A multidisciplinary group of researchers, including physical therapists (PTs), has identified a core set of 11 clinical practice guideline (CPG) recommendations for treating adult musculoskeletal (MSK) pain, according to a new article in British Journal of Sports Medicine (BJSM). Authors hope the recommendations will assist emergency and primary care clinicians in providing evidence-based care, as well as help consumers make informed health care decisions.

    Authors write that while "care that is more concordant with CPG recommendations results in better patient outcomes and lower costs," providers across disciplines too often do not practice according to guidelines, resulting in overuse of imaging, surgery, and opioids, and a failure to provide patient education and advice. There are many reasons for this, according to authors: CPGs often are not "user-friendly"; they often lack guidance on how to implement recommendations in practice; and different guidelines for a single condition may include conflicting recommendations.

    To help bridge these "evidence-to-practice gaps"—and help consumers understand what best practice looks like—authors examined 44 CPGs addressing 3 of the most common areas for MSK: spinal pain; hip/knee pain, including hip/knee osteoarthritis; and shoulder pain. The CPGs reviewed were published within the last 5 years, included information on how they were developed, and were published in English. Researchers excluded guidelines that focused on a single treatment modality, traditional medicine, traumatic MSK pain, specific diseases such as inflammatory arthritis, and those that required payment to access.

    Included in the analysis was the Academy of Orthopaedic Physical Therapy guideline "Low back pain: clinical practice guidelines linked to the international classification of functioning, disability, and health."

    Authors performed an AGREE II analysis on each CPG. A guideline was classified as "high-quality" if it received an AGREE II score that was at least half of the maximum possible score in 3 separate areas: rigor of development, editorial independence, and stakeholder Involvement.

    The 11 consistent recommendations include:

    1. Care should always be patient centered. Patient-centered care, according to authors, is characterized by effective communication, individualized care, shared decision making, and prioritizing patient preferences.
    2. Patients should be screened for serious pathology or "red flag" conditions. Providers should screen for causes of pain such as infection, malignancy, fracture, inflammation, neurological deficit, as well as conditions that mimic MSK pain.
    3. Psychosocial factors should be included in a patient's assessment. Providers should assess patients for psychosocial factors—such as depression, anxiety, kinesiophobia, and recovery expectations—that may affect their prognosis, in order to develop an appropriate plan of care.
    4. Radiological imaging is unnecessary in most cases. Many guidelines discourage the use of radiological imaging, except when a more serious pathology is suspected, the patient is not responding to treatment, or the imaging results are "likely to change management" of the patient's condition.
    5. Assessment should include physical examination to assist in diagnosis and classification. Physical assessments mentioned in the CPGs include tests for mobility/movement, strength, position and proprioception, and neurological function.
    6. Providers should evaluate patient progress and use validated outcome measures. In the CPGs authors examined, outcome measures assessed patients' pain intensity, functional capacity and activities of daily living, and quality of life.
    7. Patients should receive individualized education about their condition and treatment options. Authors recommend patient education to "encourage self-management and/or inform/reassure patients about the condition or management."
    8. Treatment should address physical activity and exercise. All of the CPGs reviewed included recommendations on either general or specific exercise and physical activity to increase mobility, strength, and flexibility.
    9. Manual therapy should be used only as an adjunct treatment. Seven CPGs included manual therapy as a "could-do" element of care, but only as part of a more comprehensive plan of care.
    10. Nonsurgical care should be the first line treatment. Unless a "red flag" condition indicates otherwise, patients should receive nonsurgical care before considering surgery.
    11. Treatment should facilitate return to work. Providers should encourage patients to remain active and engage with appropriate social service supports, employers, and health providers to enable a patient to return to work.

    Looking beyond the clinical application of the recommendations, authors suggest that a "broader strategy" for policy makers and health services researchers "could be the continued development of the common recommendations into a set of quality indicators that could be used for reporting or to benchmark care quality."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.