Research Forum for Allied Health Professions Delivering the research and clinical effectiveness...

Research Forum for Allied Health Professions

Delivering the research and clinical effectiveness agenda: what the allied

health professions can offer

Irene Ilott, Convenor of the RFAHP

Clinical Excellence 2001: Wednesday 5 December


• Introducing the Research Forum: a one-stop shop for the AHPs

• Showcasing AHP research

• Reality check: barriers to creating and using the best available evidence

• Composition

• Achievements: – A joint R&D discussion

paper (May 2001)

– Contributing to research for the Task Group 3 Report

• Time, skills, access, money, “patients first”

• Shortage professions


Ambulance Service Association*,

Arts Therapies Advisory Group,

British Association of Prosthetists and Orthotists,

The British Dietetic Association, British Orthoptic Society*,

British Association/College of Occupational Therapists,

Chartered Society of Physiotherapy,

Institute of Biomedical Science*,

Registration Council of Scientists in Health Care*,

Royal College of Speech and Language Therapists,

Society and College of Radiographers,

Society of Chiropodists and Podiatrists


THE DIVERSITY OF THE ALLIED HEALTH PROFESSIONS

ArtsTherapists

Dietitians Speech &LanguageTherapists

PhysioTherapists

Numbers of state registeredprofessionals as at 1.6.01.

1,789 5,217 7,303 31,235

Number of professors(professional or generic)

Circa 2 1 - 25

Numbers of members with aPhD

21 50-100 74 130

Numbers of teachers in HEIs 66 Circa 33 100 480

UK Institutions which delivervalidated courses

17Post graduate

course

11 15 29

Number of institutions whichsubmitted in 1996 RAE

7 4 10 Unknown

UK Institutions with RAEgrades at 3B and above

1 4 7 2

Value of research funded bythe professional body

0 £2,000 £20,000 everythree years.

£200,000


Research challenges

Research utilisation assumes that primary or secondary research into profession specific interventions or the black box of rehabilitation or service delivery has been undertaken.

This, with a few notable exceptions such as the assessment of elderly people, back pain and stroke rehabilitation, is a false assumption.

An associated factor is that most AHPs work with people with complex, multiple problems as part of a multi disciplinary, inter-agency team. The evaluation of such complex interventions adds to the research

challenge.


Recommendation 1Five year

strategic framework

Recommendation 2Inclusion in policy

Recommendation 6Evaluative culture to improve practice

Recommendation 5 Priority topics

and diverse methods

Recommendation 3Centres, networks and

communities

Recommendation 4 Research capacity

Towards a R&D strategy in the AHPs Discussion paper (May 2001)


Recommendation 1: a strategic approach to overcome complex problems

• A whole system approach: R&D, clinical governance, education and knowledge management

• Tailored to the stage of research development within each of the AHPs

• R&D as an integral, dynamic part of each AHP throughout the UK

• Redress current inequities (Task Group 3 report 2001)

– under funding relative to comparable professions

– under funding relative to size of the professions

– funding skewed to short-term projects “this is dangerous: it is important that high quality research is encouraged” (HEFCE/DH 2001 para 5)


Recommendation 2: including AHPs in R&D policy formulation, implementation and evaluation

• Allied Health Professionals: contributing

– along care pathways or to health communities ie SureStart

– working in health, social care, education, housing, prisons, for voluntary organisations and in other sectors

– offering health promotion, disease prevention, diagnosis, assessment, treatment, rehabilitation, palliative care


Rehabilitation researchin primary care

Walker M F, Gladman JRF, Lincoln NB, Siemonsma, Whiteley T (1999) Occupational therapy for stroke patients not admitted to hospital: a randomised controlled trial. The Lancet, 354 (9175) 278-80

Between 22-60% of people with a stroke are not admitted to hospital and do not receive co-ordinated rehabilitation. The study, a single blind RCT, aimed to assess the efficacy of occupational therapy interventions in encouraging independence in personal and instrumental activities of daily living. Occupational therapy significantly reduced disability and handicap.


Recommendation 3:: establishing sustainable AHP research communities, environments and networks

Hub and spoke model:

“In health-related research, there are many areas - and even whole disciplines and professions - in which there are no centres of excellence or in which the most promising developments are taking place in departments without historically high levels of funding …

to support leading institutions in designated fields in developing mutually beneficial research networks that draw in researchers attached to other institutions” (HEFCE/DH 2001 para 89-91).


Recommendation 4: enhancing the research capability of all AHPs

Research capacity spans the ability to use, collaborate, undertake and lead research

– targets such as 1% of each AHP are research leaders

– to create a self-sustaining, community of researchers

• PPP Healthcare Trust (PPP Foundation) Fellowships and Research Training Partnerships for Nursing and AHPs

• Task Group 3 Report: – Capacity building fund: 7 year, research training, career structures

– Workforce Development Confederations: “training in research skills as a core responsibility” (HEFCE/DH 2001 para 72).


Register of Therapy

Researchers

• 1999 version 624 entries • 2002 update by COT/CSP• potential for all AHPs


Recommendation 5: developing research programmes based on priorities and which value a range of methods

• ethical, rigorous and innovative methods to answer the complex questions about the effectiveness of specific interventions, packages of care and the way services are organised.

• equal value is given to quantitative, qualitative and mixed methodologies and different sources of evidence (empirical, theoretical or experiential).

• perspective of consumers and carers is integral to the whole research process.


Primary research: effective for service users

Sanderson D, Wright D (1999) Final evaluation of CARATS initiatives in Rotherham. York: York Health Economics Consortium with Rotherham Health and Social Services.

A rigorous evaluation of a Community Assessment, Rehabilitation and Treatment Scheme (CARATS) with four different elements run mainly by nursing staff, occupational therapists, physiotherapists and social workers. The results demonstrated the effectiveness for service users, reducing dependency while acknowledging that the establishment of

cost benefit is complex.


Secondary research: assessment and outcome measures

Law J, Boyle J, Harris F, Harkness A, Nye C (1998) Screening for speech and language delay: a systematic review of the literature. Health Technology Assessment, 2 (9).

The NHS R&D Health Technology Assessment Programme funded a systematic review of research on screening for speech and language delay that. The review provides an unbiased summary of the current knowledge about screening for speech and language delay. It has a wide audience, being used by speech and language therapists,

purchasers and providers of health care, and by funders of research.


Recommendation 6: Embedding an evaluative culture into the workplace and routine of all AHP personnel

• Interdependence of audit, evaluation and research

• challenging custom and practice, reducing variations

• personal accountability with organisational support


Evaluating innovative, evidence-based service developments

Chadda D (2001) Help for fragile bones. Frontline, 7 (1) 18-19.

A physiotherapy-led osteoporosis service in Glasgow. It is based upon a national, evidence-based guideline that has been endorsed by the National Osteoporosis Society. The integrated physiotherapy and exercise service was launched in July 2000. The service is being evaluated and the CSP is collaborating with the project to develop a national audit tool.

Chartered Society of Physiotherapy (1999) Physiotherapy Guidelines for

the management of Osteoporosis. CSP: London.


Other challenges for shortage professions

One third of all UK dietetic vacancies advertised in the six months to June

2001 remain unfilled.

The position is more severe in some parts of the UK than others. In the South of England and in the North West only half the jobs advertised were filled.

By contrast, Northern Ireland filled 86% of its vacancies and the South West of England managed to fill 81%.

British Dietetic Association survey of all dietetic managers in the UK, 89% of whom responded.

Research Forum for Allied Health Professions Delivering the research and clinical effectiveness...

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