Systematic Reviews – Part 2 Translating Evidence to Practice and Policy David Scalzitti, PT, PhD, OCS Lunch and Learn November 5, 2014

Review of Part 1 Identify the uses of systematic reviews Differentiate systematic reviews, meta-analyses, and clinical practice guidelines Identify/perform valid methods for a systematic review (up to developing the protocol and developing the search strategy)

Conduct the Search Record keeping ▫Spreadsheets Reference management software ▫RefWorks ▫EndNote Removing duplicates

Screen and Select Relevant Papers Screening ▫Title/Abstract Eligibility ▫Full Text Sensitive strategy Reliability of screening Transparency Reproducibility

Selection of articles for review. Van Til L et al. PHYS THER 2013;93: ©2013 by American Physical Therapy Association

Appraise Selected Studies Evaluate methodological quality ▫Cochrane Risk of Bias Tool ▫Other quality rating scales Complete evidence table

Date of download: 9/10/2013 Copyright © 2012 American Medical Association. All rights reserved. From: Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis: A Meta-analysis JAMA. 2013;310(7): doi: /jama Characteristics of Included Studies Figure Legend :

Analyze and Synthesize Findings Report results of systematic review according to PICOTS question(s) ▫Meta-Analysis: may be performed if sufficient data which can be combined exists  If sufficient data does not exist perform a qualitative synthesis ▫Clinical Practice Guideline: combine results of systematic review with a recommendation

Date of download: 9/10/2013 Copyright © 2012 American Medical Association. All rights reserved. From: Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis: A Meta-analysis JAMA. 2013;310(7): doi: /jama Forest Plot of Effect Size for Heel Wedge InterventionsWeights are from a random-effects analysis. SMD indicates standardized mean difference. Figure Legend :

Funnel Plots

Resources for Creating a Cochrane Systematic Review Instructions ▫handbook.cochrane.orghandbook.cochrane.org Glossary ▫ Training ▫training.cochrane.orgtraining.cochrane.org Multimedia ▫ Software ▫tech.cochrane.org/revman/downloadtech.cochrane.org/revman/download

Teaching

Policy Among the purposes of clinical guidelines (from the Orthopaedic Section Revised Heel Pain Guideline): ▫Provide a description to policy makers, using internationally accepted terminology, of the practice of orthopedic physical therapists. ▫Provide information for payers and claims reviewers regarding the practice of orthopedic physical therapy for common musculoskeletal conditions. ▫Create a reference publication for clinicians, instructors, students, interns, residents, and fellows regarding the best current practice of orthopedic physical therapy. Statement of Intent ▫These guidelines are not intended to be constructed or to serve as a standard of medical care.

Practice Implementation does not end with publication. (Oxman et al 1995) Clear recommendations, that are non- controversial, and are evidence-based are more likely to be used. (Grol et al 1998) Multifactorial methods to disseminate and implement. (Feder et al, 1999)

Practice Dissemination in multiple forms

Practice Trustworthiness Institute of Medicine Practice-Guidelines-We-Can-Trust.aspx AGREE Appraisal of Guidelines Research & Evaluation National Guidelines Clearinghouse

Practice Trustworthiness

Practice Clear Recommendations

Practice Multifactorial methods Education and monitoring Active learning strategies Identification of barriers Electronic medical records Outcome databases Examples and brainstorming Outcomes Interventions

ANY QUESTIONS? Systematic Reviews Part 2 Translating Evidence to Practice and Policy