1. Development of a Community SPIRIT ‘The Journey so Far’ Alun E Morgan MPhil Student

2. Overview of Presentation Background Overview of MPhil Systematic Review Methodology Results Next Steps

3. Background What is SPIRIT? Why undertake this study? Professional and Personal interest Started with Clinical Question Strategic and Political Agenda Governance requirements

4. Overview of MPhil Aims The overall aim is to investigate how the SPIRIT can be modified for use in the community setting. Specific Objectives are; 1. To undertake a critical, systematic review of the literature. 2. To identify additional interventions that are specific to the community physiotherapy setting. 3. To develop a version of SPIRIT that can be used for stroke patients within a community setting. 4. To develop a user booklet that will provide definitions of the interventions used in the community setting. 5. To validate the tool for use within SE Wales Community Physiotherapy Services. 6. To identify whether the tool is acceptable for use within the clinical setting.

5. Systematic Review Methodology Aim & Search Question Search Strategy Identification of Sources Screening and review Strategy

6. Aim & Search Question To identify and assess all publications relating to physiotherapy interventions in stroke with particular emphasis on those relating to recording tools or treatment schedules used within the community setting. Have any tools or approaches been developed / used to record physiotherapy interventions in stroke, particularly for use in the community setting?

7. Search Strategy (1) Identify concepts/themes from the search question Identified 4 sets Set 1: Diagnostic terms relating to Stroke Set 2:Mode of interventions relating to PT Set 3: Methods of recording Set 4:Environment/community related

8. Search Strategy (2) Translate into Terms which will be recognised by Database Mesh/Key words/Index Terms OECD Filter Refined search using Boolean Operators OR/AND Expert advice from Librarian is essential!

9. Sources Electronic Databases Grey Literature Conference proceedings Experts in field Hand search of retrieved publications

10. Screening Strategy (1) Inclusion and exclusion criteria Simple screening tool devised Refined Search identified papers for review 2 physiotherapists undertook review (15 papers) independently (blinded to each others review) Critical Appraisal Skills Programme - CASP tool http://www.phru.nhs.uk/pages/PHD/CASP.htm

11. Screening strategy (2) Synthesised reviews using matrix Topic/Aims and Clinical focus Settings and Participants Research Methods/Design Findings Strengths/Weakness/Trustworthiness Usefulness

12. Framework for Synthesis Meeting to discuss Framework for synthesis used to combine comments and identify common themes/questions.

13. Results 185 Papers identified 24 articles identified from initial screen 15 Studies which had developed schedules/lists/taxonomies 5 studies which had produced recording tool 2 related to community interventions but no recording tool

14. Themes Rationale for Studies Clinical Setting and Participants Methodology and design Reliability/Robustness Usefulness of studies Level of detail - Granularity Generalisability to own setting Format of the recording tools

15. Next Steps Confirmed the relative lack of research in the field of recording stroke interventions in the community Confirmation of methodology for next phase of study Identified a number of questions for Semi Structured interviews Why treat people in their home environment? What skills does a physiotherapist require? What problems are do patients present with? What interventions does the physiotherapist use in the home environment? Overview of documentation process Links with Assessment and treatment and how do we capture in documentation Role for schedules in documentation Aims Dosage Clinical reasoning

16. Vision Clinical documentation which is useful within the clinical setting, is easy to use and has utility for the clinician and patient (and potentially for other professionals) Has transparency of interventions being described Complies with legal requirements Enables prospective collection of meaningful information for research and evaluation without the need for additional manipulation or assumption (research friendly) Standardised and concise Professional readiness for electronic patient records