If you’ve been a browser through my blog you’ll see that I’m an information junkie. I just can’t help myself – if there’s information out there, I want to look at it! I regularly get journal contents pages sent to me, browse the ‘article in press’ sections of e-journals, use MedWorm RSS and generally get immersed in research.
I’m lucky in a way, because I can access the medical library from my laptop at home or at work, so it’s easy to keep up – what would it be like without this ease of access?
Anyway, the thought crossed my mind that I’m not sure how often other clinicians do this foraging around to find out what is going on in the literature. So today’s post is really about the reasoning loop that I use and when I head off to read about what to do with a specific patient.
These are the times I definitely go searching-
- a patient with a presentation I haven’t seen often (eg Marie Charcot Tooth)
- a patient who is not responding the way I expect (have I missed some important piece of the case formulation?)
- a patient with a combination of symptoms or diagnoses that might influence each other (eg PTSD and chronic pain)
- when I want to confirm that I’m on the right track with an approach (eg using hypnosis and biofeedback to change limb temperature)
- when another team member is using an approach I’m not familiar with (eg motor imagery for CRPS)
- when I want some resources so I can present something in a different way (eg visual layout for goal setting)
And of course, loads of other times!
I also find myself going through the literature when I want to confirm to myself that an old ‘tried and true’ strategy actually has the research to back it rather than folklore! A good example of this is a period of time where I looked for information on activity regulation or ‘pacing’ – sadly there isn’t much published on its efficacy, so it’s much less common for me to use this than I did before I reviewed it! And it’s one of the more common tools of pain management, especially amongst occupational therapists.
I carried this review process out again recently when looking through the literature on goal setting. In this instance I found a lot of support for the process of goal setting – in principle – but fewer examples of outcome studies in chronic pain management. So once again, we don’t actually know whether goal setting makes a difference to outcomes for people with chronic pain.
I think the next phase of work in pain management will be to unpack the ‘cognitive behavioural approach’ and investigate the components to identify which parts ‘work’ and for whom. And I’m not the only one to think this!
The challenge for clinicians in finding research to support their work is that there is little discussion or exploration of how research actually translates to clinical practice. The ‘how to’ part of using a strategy effectively is often not well described in research papers. Some research refers to an administration protocol, but few go into any detail as to how this protocol works, how it was provided to clinicians, how closely clinicians followed it.
I hope that this will be an area I’ll develop in this blog over time – it’s certainly something people who have completed my survey (to the left, at the top of the page!) have asked for.
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For those who may be concerned: I’m not paid to do this, I have no advertising, I have no sponsors, this is not my job! Any opinions expressed are entirely my own, not my employers. It’s a labour of love, helps me review the literature – and link with people who are into pain management as much as I am. Maybe one day I’ll get famous and be paid to do it, in the meantime it’s my pleasure. I hope you enjoy it too.