of Evidence Based Orthotic Practice
Directory of Evidence BasedOrthotic Practice (DEBOP) Good morning This morning there has been a last minute change in presenter for this presentation. My name is Fiona Monaghan and I am one of the co-ordinators for the DEBOP project I am going to give a short presentation on DEBOPs journey and its relevance to MSK. DEBOP has no relevance or relation to the song mmmhbop by Hanson! I listened to the song last night on you tube and its been on repeat ringing in my head ever since! Fiona Monaghan DEBOP Project Co-ordinator Chris Rowley OrthoticMSK National Lead Project sponsor 1 Scottish Orthotic Clinical Leads (SCOL) Working Group
SCOL initially started the project in 2014 in was being undertaken in staffs own time. it was due to deliver in 2016 and would have been too late to enable services to feed into the MSK work on-going in boards. 2 National Orthotic MSK Lead applied for funding in
May 2014 Awarded 22,500 in October 3 Project to be Delivered in
6 months by March 2015 Foot and Ankle Hip, Knee, Upper limb 4 Chris Rowley DEBOP Project Lead Nikki Munro DEBOP Co-ordinator
DEBOP TEAM Chris Rowley DEBOP Project Lead Nikki Munro DEBOP Co-ordinator Fiona Monaghan DEBOP Co-ordinator Christopher Cox DEBOP Researcher Simon Dickinson - DEBOP Researcher 5 Where did we start? SIGN are the experts at providing evidence based guidance in Scotland so this was the obvious first place to consider. Sign 50 is the gold standard for undertaking this type of work, so we used it. MECE MECE is a list. According to MECE, any list should be:
According to MECE, any list should be: Mutually exclusive the members of the list should exclude each other, i.e. be distinct Collectively exhaustive the members of the list should exhaust the relevant field, i.e., contain everything that belongs on the list. Mece was a technique we used at the very start just to try to capture everything that we did in each topic area, we started with foot and ankle then went on to repeat the process with knee, hip and upper limb. Mece is a way of capturing a list of as many items as can be thought of hence mutually exclusive, collectively exhaustive. just means that there are no duplicates. This is an example of one of the MECE exercises for foot and ankle and once we had captured all conditions we felt we dealt with, we grouped them into areas of presenting condition You can see here that originally we had included oedema, and although we did the literature search for this we decided it did not belong on an MSK directory, however the work has been done and we can always develop a stand alone treatment directory for oedema at a later time. So good old post it note brain storming. PICOs Once we had defined our presenting conditions and all the differential diagnoses included in these, in order to start a literature search we needed to develop PICOS for each area. PATIENT, INTERVENTION, COMPARISON, OUTCOME PICO stands for see above and its a recognised way of defining your literature search Here is an example of how we brainstormed one of our PICOs on a white board and then how we captured each one on a spreadsheet. We did not use the comparison column as are not comparing one type of treatment to another. Searches So our next stage was to run searches for each clinical presentation There are 3 categories' of search To be sure we did not miss anything we also requested through the library service a level 2 search in each area We did compare how many results we got and in all cases the library search was more extensive. Filtering One of the most repeated phrases in orthotics (and I may have used this myself in the past) is there is no evidence Now I only with this were the case in foot and ankle!!! Our first search on forefoot returned 1100 abstracts and we had to limit this with more exclusions and managed to reduce it to only 300 or so, and this is this search here if you wanta look. In each area we needed to filter down the abstracts to make sure they were relevant to orthotics before going to find the full text articles. For this we all used and agreed template so the methodology was consistent. Obtaining Full Text of Papers
Having then identified relevant articles we wanted to critically appraise To make it easier for us the share the job of critical appraisal we saved all the online references to a shared refworks account Critical Appraisal Methodology checklists from SIGN were used to score the evidence in critical appraisal. Develop Algorithms So having all our critically appraised evidence to hand we started to build our treatment algorithms Once we had brainstormed these on paper then converted them to an electronic version we began to build them in clinical knowledge publisher which is an online tool designed and supported by NHS NES This is how the lead page of the directory looks
This is how the lead page of the directory looks. Clinical presentation then below FOREFOOT, MIDFOOT, REARFOOT, KNEE, HIP AND UPPER LIMB. Then click on one of the regions.. There are 7 regions under FOOT AND ANKLE, Forefoot, Midfoot, Hindfoot, Plantar Heel, Posterior Heel, Lateral Ankle and Drop Foot. This is plantar heel and displays the nodes related to orthotic treatment for Plantar Heel. 80% of the articles can be accessed as full texts either directly or by using Athens log in on the host site. Others can be accessed through the British library through the Knowledge network. The red flags which were completed have been removed as they are not required in a directory. That work has not been lost and has been stored and can be circulated if required. Coordinated Journal Club
Available to everyone Dynamic Document Can be updated Same URL Coordinated Journal Club To conclude the project initially was a protocol bid but this has been concluded as a directory of evidence based orthotic practice.The purpose is to make it accessible to all nationally and not be board specific. It is then up to the boards or areas to link this where they want within their own pathways which may involve protocols which can be contributed by health care professionals in that area. This is the reason that the project is not a pathway nor a protocol. The directory is currently out with SCOL for consultation until the end of July and the directory document will then be live/launched on the 1st August via the National MSK heads group and disseminated from this point. It is a live dynamic document which is continuously updated with new evidence and this is updated with an aligned orthotist co-ordinated journal club. Thank you