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We would like to support patients with musculoskeletal pain in identifying and judging the quality of the research evidence that may guide their care. This would allow them to take an active role in decisions about their care. This patient group would be supported by clinical peers who have a track record in undertaking this work, including clinicians, researchers and librarians. It will be called the ‘Peer Supported Evidence into Practice Group’.

We have established a very successful and award winning network of clinical peer groups who already undertake this work. They look for the best evidence to underpin clinical care across Shropshire and Staffordshire. This network consists of clinicians who manage patients with musculoskeletal disease (physiotherapists, occupational therapists, podiatrists, rheumatologists), academic researchers, systematic reviewers and librarians. We seek areas for improvements, clinical inconsistencies or clinical questions. Some examples include: does hydrotherapy help musculoskeletal pain, do back exercise help improve pain and do injections help shoulder pain?

We search for the best research evidence to answer this problem, appraise it for quality and deliver a ‘clinical bottom line’ to answer the question and share extensively. As our network consists of clinical leaders and researchers, improvements in clinical delivery can be undertaken or further research considered. Peer support, mutual learning, and co-creation across disciplines and care boundaries are fundamental to the success of the group.

We are known locally as the CAT group (as we use Critically Appraised Topic methodology). It was established in 2003 as part of an innovation led by Kay Stevenson (Consultant Physiotherapist/Senior Knowledge Mobilisation Fellow). At that time it was recognised that research evidence in musculoskeletal disease was being published but taking considerable time to filter into practice, 17 years on average. Clinicians had a no structured support, or skills in finding and appraising the quality of the literature to assist in the planning of their clinical care.

Our network has provided a solution for many of these issues. We have developed expertise and credibility as our outputs have resulted:

·       swift improvement in the clinical care of patients with musculoskeletal disease

·       funded research to answer clinical questions where no research has been found

·       the production of summaries of key evidence for local Commissioning Groups to inform their decision making

·       national presentations and publications.

 

We have seen an increase in the number of attendees across the region with at least 80 key individuals providing peer support to each other to undertake this process. In 2016 this network won the British Society of Rheumatology Outstanding Clinical Practice Award. In addition a new General Practice nursing group has been established in 2016.

Despite our success, there is one key element missing, our patients. We now want to provide peer support to a group of patients who would follow the same process as our established clinical group. They would identify important questions about their musculoskeletal condition, search and understand the evidence. They would then co-produce a written headline for patients with that condition. This would be shared on our existing website and could be used by patients in consultations about their care, it may assist them on campaigning for improvement in care or in the debate around commissioning of services. It would empower the patient group to a greater say in their care.  At a recent event 14 patients said they would be interested in being part of such a group.

The peer support that we would provide to the patient group would be to assist them in highlighting key areas of interest and refining that to formulate answerable questions. Our librarian would need key induration to support a literature search and so the peer support wold assist them to generate this key information. This may include type of people who have this problem (population), the type of intervention or treatment they might receive, any comparison and the outcome of interest for example pain or function. Peer support from our clinicians and librarians would then be given to assist the patient in judging the quality of the research evidence they find, and determining if care should be changed as a results or that if more research is needed. Together they would produce a ‘patient headline’. This would tell patients with this condition what the latest evidence had revealed.

We plan to:

·       Pilot a Peer Supported Patient CAT group

·       Provide training, mentorship, peer support to the group

·       Utilise the Q community network to establish areas that would have an interest in replicating this model.

·       Create a virtual network to share the key findings and output of their work.

·       Explore the use of social media in sharing the results of the group with a  broader network

·       Work with key stakeholders to support the further roll out of this initiative e.g. Arthritis Research UK MSK Champion network due to be established in 2018

How you can contribute

  • • Identify those in the Q community with expertise around patient engagement, education and facilitation
  • • The Q community to identify potential geographical locations which would have an interested in hearing about and working towards establishing this model to improve practice and research
  • • Identify members of the Q community who have an imaginative/creative method of sharing information via social media that is tried and tested

Comments

  1. Interesting proposal – it would be useful to hear how patients approach the question of what counts as ‘evidence’ and how would experiential information be integrated against scientific data. After training this first cohort of patients, would you then provide them with support so they can continue to provide peer support for other patients who may want to be involved in this process?

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