How do MSK podiatrists interpret evidence in practice? - Initial findings

Rationale
Podiatry has accepted Evidence Based Practice as a model of clinical practice. The focus of the profession has been to improve the research evidence for podiatric treatments to enhance the security and development of their role in healthcare provision (Vernon 2003). There has been a large amount of research into the effectiveness of functional orthoses as a treatment for MSK conditions, yet this does not give a podiatrist clear answers. A Cochrane review into the effectiveness of functional orthoses suggests that orthoses are effective in the treatment of certain MSK conditions, for example, plantar fasciitis and reducing pain associated with the first metatarsal-phalangeal joint (Hawke 2008). Other Cochrane reviews of MSK conditions; patellofemoral pain (Hossain et al 2011), prevention of running injuries (Yeung et al 2011) and Morton’s neuroma (Thomson et al 2004) show that orthoses have limited effects on these conditions.

Research into the affect of evidence on practice appears to fall into two broad categories, research utilisation and knowledge transfer/translation. Research utilisation only looks at the use of research evidence in practice, this clearly is not the only evidence that is used in practice. Knowledge transfer/translation has been defined as a potential solution to the gap between knowledge and practice in order to realise the benefits of research in improved health outcomes measures (Scott et al 2011). Evidence for clinical practice is complex and is made up of research evidence, clinical experience, local information and circumstances and patient experience and preferences (Rycroft-Malone et al 2004) and which of these podiatrists use in practice will be explored in this study.

Method
This is a qualitative study using a hermeneutic approach to gain an understanding of the meaning of evidence to MSK podiatrist in practice. The data will be collected in semi-structured interviews with 20 MSK podiatrists. Data analysis will be undertaken using a hermeneutical approach. The initial step of analysis will be to develop thematic categories to code the transcripts; this form of editing analysis style is widely used in phenomenological and hermeneutic studies (Polit & Beck 2004). Analysis will begin with listening to the audio files, then analysis of each individual transcript by reading then re-reading and re-listening. During this process the researcher will refer back to the reflexive journal to revisit his thoughts and impressions from the original interviews. Each transcript will then be coded with the thematic categories. Significant statements will be extracted from the transcript and matched to the themes. This will then be interpreted into a restatement of meaning. The meanings for each transcript will be then integrated together to give overall theme clusters, which will form the basis for the discussion (Holloway & Wheeler 2002, Polit & Beck 2004).

Findings and Discussion
Initial findings from the analysed interviews will be presented.
References
Hawke F, Burns J, Radford JA, du Toit V. (2008) Custom-made foot orthoses for the treatment of foot pain. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006801. DOI: 10.1002/14651858.CD006801.pub2.
Holloway I., Wheeler S. (2002), Qualitative Research in Nursing, 2nd edition, Oxford UK, Blackwell Science Limited
Hossain M, Alexander P, Burls A, Jobanputra P. (2011) Foot orthoses for patellofemoral pain in adults. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD008402. DOI: 10.1002/14651858.CD008402.pub2.
Polit D.F., Beck C.T. (2004), Nursing Research: Principles and Methods, 7th edition, Philadelphia PA, Lippincott Williams & Wilkins.
Rycroft-Malone J., Seers K., Titchen A., Harvey G., Kitson A. & McCormack B. (2004) What counts as evidence in evidence-based practice? Journal of Advanced Nursing 47(1), 81–90
Scott et al (2011) A protocol for a systematic review of knowledge translation strategies in the allied health professions. Implementation Science 6:58.
Thomson CE, Gibson JNA, Martin D.(2011) Interventions for the treatment of Morton’s neuroma. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003118. DOI: 10.1002/14651858.CD003118.pub2.
Vernon W. (2003) Evidence-based practice, British Journal of Podiatry, 6(2), 35
Yeung SS, Yeung EW, Gillespie LD. (2011) Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001256. DOI: 10.1002/14651858.CD001256