Research clinical setting (COURSE-14 WCPT)

Learning objective 1: understand the value of using randomised trials to guide practice
Learning objective 2: describe key features that reduce bias and increase usefulness of trials
Learning objective 3: apply the results of a trial to an individual patient

Description:

Evidence-based practice is physical therapy informed by relevant, high-quality clinical research (1). The best type of clinical research to evaluate the effects of intervention is the randomised controlled trial (or systematic reviews of randomised controlled trials) (1). The good news for physical therapists wanting to use trials to guide their practice is that there are now over 30,000 published trials evaluating physical therapy interventions (2).

Challenges faced by physical therapists include: choosing the best trial to read; making sense of the methods and results reported; and applying the results to an individual patient. Trials use a series of methods in order to reduce bias (or enhance the robustness) of the results, including how subjects are allocated to groups, how outcomes are collected, and how data are analysed and reported. Unfortunately, not all trials implement and/or communicate these important design features - just 36% of trials evaluating physical therapy interventions contain 6 or more of 10 design features known to reduce bias or provide results in a way to aid clinical decision-making (2). Clinicians need to understand these design features, and be able to identify them quickly in articles reporting trial results, in order to select and understand the best trial to answer their clinical questions.

In this workshop, participants will develop knowledge and skills in using randomised controlled trials to guide clinical practice. The value of randomised trials will be explored. We will delve into some key design features used in trials, including random allocation, concealed allocation, intention to treat analysis, reporting of between-group comparisons, and blinding of therapists, subjects and assessors.

Participants will gain practical experience in reading and appraising published reports of trials, considering features such as their methodological quality and the precision of the trial's estimates of the treatment effect. Participants will also practise explaining the trial's results to patients in terms that they will understand in order to foster joint clinical decision-making. 
Common mistakes in interpreting published reports of trials will also be discussed, including: 
- considering only hypothesis testing (p-values) instead of effect estimation (confidence intervals);
- considering only whether a quality criterion is unmet without considering its potential to cause bias in the specific study under consideration (eg, lack of blinding may introduce less bias depending on the nature of the outcome measure);
- common misinterpretations of some quality criteria (eg, intention-to-treat analysis).

The workshop will actively engage conference delegates from around the globe by offering the discussion and practical content in five languages (English French, German, Spanish and Portuguese).

Implications / Conclusions: 

Developing skills in reading randomised controlled trials will enable physical therapists to select and understand the best trials to guide their clinical practice.