"Push" versus "Pull" for mobilizing pain evidence into practice across different health professions: a protocol for a randomized trial

Joy C MacDermid, Mary Law, Norman Buckley, Robert Brian Haynes, Joy C MacDermid, Mary Law, Norman Buckley, Robert Brian Haynes

Abstract

Background: Optimizing pain care requires ready access and use of best evidence within and across different disciplines and settings. The purpose of this randomized trial is to determine whether a technology-based "push" of new, high-quality pain research to physicians, nurses, and rehabilitation and psychology professionals results in better knowledge and clinical decision making around pain, when offered in addition to traditional "pull" evidence technology. A secondary objective is to identify disciplinary variations in response to evidence and differences in the patterns of accessing research evidence.

Methods: Physicians, nurses, occupational/physical therapists, and psychologists (n = 670) will be randomly allocated in a crossover design to receive a pain evidence resource in one of two different ways. Evidence is extracted from medical, nursing, psychology, and rehabilitation journals; appraised for quality/relevance; and sent out (PUSHed) to clinicians by email alerts or available for searches of the accumulated database (PULL). Participants are allocated to either PULL or PUSH + PULL in a randomized crossover design. The PULL intervention has a similar interface but does not send alerts; clinicians can only go to the site and enter search terms to retrieve evidence from the cumulative and continuously updated online database. Upon entry to the trial, there is three months of access to PULL, then random allocation. After six months, crossover takes place. The study ends with a final three months of access to PUSH + PULL. The primary outcomes are uptake and application of evidence. Uptake will be determined by embedded tracking of what research is accessed during use of the intervention. A random subset of 30 participants/ discipline will undergo chart-stimulated recall to assess the nature and depth of evidence utilization in actual case management at baseline and 9 months. A different random subset of 30 participants/ discipline will be tested for their skills in accessing evidence using a standardized simulation test (final 3 months). Secondary outcomes include usage and self-reported evidence-based practice attitudes and behaviors measured at baseline, 3, 9, 15 and 18 months.

Discussion: The trial will inform our understanding of information preferences and behaviors across disciplines/practice settings. If this intervention is effective, sustained support will be sought from professional/health system initiatives with an interest in optimizing pain management.

Trial registration: Registered as NCT01348802 on clinicaltrials.gov.

Figures

Figure 1
Figure 1
Study Design.
Figure 2
Figure 2
Pain PLUS Intervention. Screenshot of the Pain PLUS main webpage.
Figure 3
Figure 3
Pain PLUS Intervention. Screenshot of an example Pain PLUS email alert.

References

    1. Gummesson C, Atroshi I, Ekdahl C, Johnsson R, Ornstein E. Chronic upper extremity pain and co-occurring symptoms in a general population. Arthritis Rheum. 2003;49:697–702. doi: 10.1002/art.11386.
    1. Ramage-Morin PL. Chronic pain in Canadian seniors. Health Rep. 2008;19:37–52.
    1. Verhaak PF, Kerssens JJ, Dekker J, Sorbi MJ, Bensing JM. Prevalence of chronic benign pain disorder among adults: a review of the literature. Pain. 1998;77:231–239. doi: 10.1016/S0304-3959(98)00117-1.
    1. Von Korff M, Crane P, Lane M, Miglioretti DL, Simon G, Saunders K. et al.Chronic spinal pain and physical-mental comorbidity in the United States: results from the national comorbidity survey replication. Pain. 2005;113:331–339. doi: 10.1016/j.pain.2004.11.010.
    1. Phillips CJ, Schopflocher D. Chronic Pain: A Health Policy Perspective. Wiley-Blackwell, Weinham; 2008. The economics of Chronic Pain.
    1. McPhillips-Tangum CA, Cherkin DC, Rhodes LA, Markham C. Reasons for repeated medical visits among patients with chronic back pain. J Gen Intern Med. 1998;13:289–295. doi: 10.1046/j.1525-1497.1998.00093.x.
    1. Fischer S, Huber CA, Furter M, Imhof L, Mahrer IR, Schwarzenegger C. et al.Reasons why people in Switzerland seek assisted suicide: the view of patients and physicians. Swiss Med Wkly. 2009;139:333–338.
    1. Webster LR, Bath B, Medve RA. Opioid formulations in development designed to curtail abuse: who is the target? Expert Opin Investig Drugs. 2009;18:255–263. doi: 10.1517/13543780902751622.
    1. Wolfert MZ, Gilson AM, Dahl JL, Cleary JF. Opioid analgesics for pain control: Wisconsin physicians’ knowledge, beliefs, attitudes, and prescribing practices. Pain Med. 2010;11:425–434. doi: 10.1111/j.1526-4637.2009.00761.x.
    1. Veale DJ, Woolf AD, Carr AJ. Chronic musculoskeletal pain and arthritis: impact, attitudes and perceptions. Ir Med J. 2008;101:208–210.
    1. Watt-Watson J, McGillion M, Hunter J, Choiniere M, Clark AJ, Dewar A. et al.A survey of prelicensure pain curricula in health science faculties in Canadian universities. Pain Res Manag. 2009;14:439–444.
    1. Douglass MA, Sanchez GM, Alford DP, Wilkes G, Greenwald JL. Physicians’ pain management confidence versus competence. J Opioid Manag. 2009;5:169–174.
    1. Finestone AS, Raveh A, Mirovsky Y, Lahad A, Milgrom C. Orthopaedists’ and family practitioners’ knowledge of simple low back pain management. Spine (Phila Pa 1976) 2009;34:1600–1603. doi: 10.1097/BRS.0b013e3181a96622.
    1. Bishop A, Foster NE, Thomas E, Hay EM. How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists. Pain. 2008;135:187–195. doi: 10.1016/j.pain.2007.11.010.
    1. Todd KH, Sloan EP, Chen C, Eder S, Wamstad K. Survey of pain etiology, management practices and patient satisfaction in two urban emergency departments. CJEM. 2002;4:252–256.
    1. Zenz M, Zenz T, Tryba M, Strumpf M. Severe undertreatment of cancer pain: a 3-year survey of the German situation. J Pain Symptom Manage. 1995;10:187–191. doi: 10.1016/0885-3924(94)00122-2.
    1. Plaisance L, Logan C. Nursing students’ knowledge and attitudes regarding pain. Pain Manag Nurs. 2006;7:167–175. doi: 10.1016/j.pmn.2006.09.003.
    1. Byrd PJ, Gonzales I, Parsons V. Exploring barriers to pain management in newborn intensive care units: a pilot survey of NICU nurses. Adv Neonatal Care. 2009;9:299–306. doi: 10.1097/ANC.0b013e3181c1ff9c.
    1. Valente SM. Research dissemination and utilization improving care at the bedside. J Nurs Care Qual. 2003;18:114–121. doi: 10.1097/00001786-200304000-00004.
    1. Peng P, Stinson JN, Choiniere M, Dion D, Intrater H, LeFort S. et al.Role of health care professionals in multidisciplinary pain treatment facilities in Canada. Pain Res Manag. 2008;13:484–488.
    1. Zailinawati AH, Teng CL, Kamil MA, Achike FI, Koh CN. Pain morbidity in primary care - preliminary observations from two different primary care settings. Med J Malaysia. 2006;61:162–167.
    1. Scascighini L, Toma V, Dober-Spielmann S, Sprott H. Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes. Rheumatology (Oxford) 2008;47:670–678. doi: 10.1093/rheumatology/ken021.
    1. Thomsen AB, Sorensen J, Sjogren P, Eriksen J. Economic evaluation of multidisciplinary pain management in chronic pain patients: a qualitative systematic review. J Pain Symptom Manage. 2001;22:688–698. doi: 10.1016/S0885-3924(01)00326-8.
    1. Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. Cochrane Database Syst Rev. 2003. p. CD002193.
    1. Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults. Cochrane Database of Systematic Reviews. 2003. p. CD002194. update of Cochrane Database Syst Rev. 2000;(3):CD002194; PMID: 10908529]. [Review] [23 refs.
    1. Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary rehabilitation for chronic low back pain: systematic review. BMJ. 2001;322:1511–1516. doi: 10.1136/bmj.322.7301.1511.
    1. MacDermid JC, Graham ID. Knowledge translation: putting the “practice” in evidence-based practice. Hand Clin. 2009;25:125–143. doi: 10.1016/j.hcl.2008.10.003.
    1. Doran DM, Haynes RB, Kushniruk A, Straus S, Grimshaw J, Hall LM. et al.Supporting Evidence-Based Practice for Nurses through Information Technologies. Worldviews Evid Based Nurs. 2010;7:4–15. doi: 10.1111/j.1741-6787.2009.00179.x.
    1. Dorsch JL, Aiyer MK, Meyer LE. Impact of an evidence-based medicine curriculum on medical students’ attitudes and skills. J Med Libr Assoc. 2004;92:397–406.
    1. Bennett S, Hoffmann T, McCluskey A, McKenna K, Strong J, Tooth L. Evidence-based practice forum - Introducing OTseeker - (Occupational therapy systematic evaluation of evidence): a new evidence database for occupational therapists. Am J Occup Ther. 2003;57:635–638. doi: 10.5014/ajot.57.6.635.
    1. Dysart AM, Tomlin GS. Factors related to evidence-based practice among U.S. occupational therapy clinicians. Am J Occup Ther. 2002;56:275–284. doi: 10.5014/ajot.56.3.275.
    1. Jette DU, Bacon K, Batty C, Carlson M, Ferland A, Hemingway RD. et al.Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83:786–805.
    1. Denmark D. The evidence-based advantage. The proper use of EBM in CPOE can enhance physician decision-making and improve patient outcomes. Health Manag Technol. 2008;29:22. 24–22, 25.
    1. Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J. et al.Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293:1223–1238. doi: 10.1001/jama.293.10.1223.
    1. Gilmore AS, Zhao Y, Kang N, Ryskina KL, Legorreta AP, Taira DA. et al.Patient outcomes and evidence-based medicine in a preferred provider organization setting: a six-year evaluation of a physician pay-for-performance program. Health Serv Res. 2007;42:2140–2159. doi: 10.1111/j.1475-6773.2007.00725.x.
    1. Heselmans A, Van de Velde S, Donceel P, Aertgeerts B, Ramaekers D. Effectiveness of electronic guideline-based implementation systems in ambulatory care settings - a systematic review. Implement Sci. 2009;4:82. doi: 10.1186/1748-5908-4-82.
    1. Lugtenberg M, Zegers-van Schaick JM, Westert GP, Burgers JS. Why don’t physicians adhere to guideline recommendations in practice? An analysis of barriers among Dutch general practitioners. Implement Sci. 2009;4:54. doi: 10.1186/1748-5908-4-54.
    1. Dubouloz CJ, Egan M, Vallerand J, von Zweck C. Occupational therapists’ perceptions of evidence-based practice. Am J Occup Ther. 1999;53:445–453. doi: 10.5014/ajot.53.5.445.
    1. Goldhahn S, Audige L, Helfet DL, Hanson B. Pathways to evidence-based knowledge in orthopaedic surgery: an international survey of AO course participants. Int Orthop. 2005;29:59–64. doi: 10.1007/s00264-004-0617-3.
    1. Judd MGP. Examining the use of evidence-based practice resources among physiotherapists in Canada. University of Ottawa, Ottawa, Ontario; 2004. MSc.
    1. Kamwendo K. What do Swedish physiotherapists feel about research? A survey of perceptions, attitudes, intentions and engagement. Physiother Res Int. 2002;7:23–34. doi: 10.1002/pri.238.
    1. Palfreyman S, Tod A, Doyle J. Comparing evidence-based practice of nurses and physiotherapists. Br J Nurs. 2003;12:246–253.
    1. Schaafsma F, Hulshof C, van Dijk F, Verbeek J. Information demands of occupational health physicians and their attitude towards evidence-based medicine. Scand J Work Environ Health. 2004;30:327–330. doi: 10.5271/sjweh.802.
    1. Thiel L, Ghosh Y. Determining registered nurses’ readiness for evidence-based practice. Worldviews Evid Based Nurs. 2008;5:182–192. doi: 10.1111/j.1741-6787.2008.00137.x.
    1. Ulvenes LV, Aasland O, Nylenna M, Kristiansen IS. Norwegian physicians’ knowledge of and opinions about evidence-based medicine: cross-sectional study. PLoS One. 2009;4:e7828. doi: 10.1371/journal.pone.0007828.
    1. O’Donnell CA. Attitudes and knowledge of primary care professionals towards evidence-based practice: a postal survey. J Eval Clin Pract. 2004;10:197–205. doi: 10.1111/j.1365-2753.2003.00458.x.
    1. Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME. Answering physicians’ clinical questions: obstacles and potential solutions. J Am Med Inform Assoc. 2005;12:217–224.
    1. Ely JW, Osheroff JA, Ebell MH, Chambliss ML, Vinson DC, Stevermer JJ. et al.Obstacles to answering doctors’ questions about patient care with evidence: qualitative study. BMJ. 2002;324:710. doi: 10.1136/bmj.324.7339.710.
    1. Griffiths JM, Bryar RM, Closs SJ, Cooke J, Hostick T, Kelly S. et al.Barriers to research implementation. Br J Community Nurs. 2001;6:501–510.
    1. Verbeek JH, van Dijk FJ, Malmivaara A, Hulshof CT, Rasanen K, Kankaanpaa EE. et al.Evidence-based medicine for occupational health. Scand J Work Environ Health. 2002;28:197–204. doi: 10.5271/sjweh.665.
    1. Krahn J, Sauerland S, Rixen D, Gregor S, Bouillon B, Neugebauer EA. Applying evidence-based surgery in daily clinical routine: a feasibility study. Arch Orthop Trauma Surg. 2006;126:88–92. doi: 10.1007/s00402-005-0095-0.
    1. Dirschl DR, Tornetta P III, Bhandari M. Designing, conducting, and evaluating journal clubs in orthopaedic surgery. Clin Orthop Relat Res. 2003;413:146–157.
    1. Fliegel JE, Frohna JG, Mangrulkar RS. A computer-based OSCE station to measure competence in evidence-based medicine skills in medical students. Acad Med. 2002;77:1157–1158. doi: 10.1097/00001888-200211000-00022.
    1. Maher CG, Sherrington C, Elkins M, Herbert RD, Moseley AM. Challenges for evidence-based physical therapy: accessing and interpreting high-quality evidence on therapy. Phys Ther. 2004;84:644–654.
    1. McCluskey A. Occupational therapists report on low level of knowledge, skill and involvement in evidence-based practice. Aust Occ Ther J. 2003;50:3–12. doi: 10.1046/j.1440-1630.2003.00303.x.
    1. Ely JW, Osheroff JA, Ebell MH, Chambliss ML, Vinson DC, Stevermer JJ. et al.Obstacles to answering doctors’ questions about patient care with evidence: qualitative study. BMJ (Clinical research ed ) 2002;324:710. doi: 10.1136/bmj.324.7339.710.
    1. Coomarasamy A, Taylor R, Khan KS. A systematic review of postgraduate teaching in evidence-based medicine and critical appraisal. Med Teach. 2003;25:77–81. doi: 10.1080/0142159021000061468.
    1. Taylor RS, Reeves BC, Ewings PE, Taylor RJ. Critical appraisal skills training for health care professionals: a randomized controlled trial [ISRCTN46272378] BMC Med Educ. 2004;4:30. doi: 10.1186/1472-6920-4-30.
    1. Newman M, Papadopoulos I, Sigsworth J. Barriers to evidence-based practice. Intensive Crit Care Nurs. 1998;14:231–238. doi: 10.1016/S0964-3397(98)80634-4.
    1. Stevenson K, Lewis M, Hay E. Do physiotherapists’ attitudes towards evidence-based practice change as a result of an evidence-based educational programme? J Eval Clin Pract. 2004;10:207–217. doi: 10.1111/j.1365-2753.2003.00479.x.
    1. Upton D, Upton P. Knowledge and use of evidence-based practice by allied health and health science professionals in the United Kingdom. J Allied Health. 2006;35:127–133.
    1. Upton D, Upton P. Knowledge and use of evidence-based practice of GPs and hospital doctors. J Eval Clin Pract. 2006;12:376–384. doi: 10.1111/j.1365-2753.2006.00602.x.
    1. Dahm P, Poolman RW, Bhandari M, Fesperman SF, Baum J, Kosiak B. et al.Perceptions and competence in evidence-based medicine: a survey of the American urological association membership. J Urol. 2009;181:767–777.
    1. Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E. et al.Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006;144:742–752.
    1. Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA. 1998;280:1339–1346. doi: 10.1001/jama.280.15.1339.
    1. Haynes RB, Holland J, Cotoi C, McKinlay RJ, Wilczynski NL, Walters LA. et al.McMaster PLUS: a cluster randomized clinical trial of an intervention to accelerate clinical use of evidence-based information from digital libraries. J Am Med Inform Assoc. 2006;13:593–600. doi: 10.1197/jamia.M2158.
    1. Holland J, Haynes RB. McMaster Premium Literature Service (PLUS): an evidence-based medicine information service delivered on the Web. AMIA Annu Symp Proc. 2005;2005:340–344.
    1. Ho K, Chockalingam A, Best A, Walsh G. Technology-enabled knowledge translation: building a framework for collaboration. CMAJ. 2003;168:710–711.
    1. Ho K, Bloch R, Gondocz T, Laprise R, Perrier L, Ryan D. et al.Technology-enabled knowledge translation: frameworks to promote research and practice. J Contin Educ Health Prof. 2004;24:90–99. doi: 10.1002/chp.1340240206.
    1. Ho K, Lauscher HN, Best A, Walsh G, Jarvis-Selinger S, Fedeles M. et al.Dissecting technology-enabled knowledge translation: essential challenges, unprecedented opportunities. Clin Invest Med. 2004;27:70–78.
    1. Johnston JM, Leung GM, Fielding R, Tin KY, Ho LM. The development and validation of a knowledge, attitude and behaviour questionnaire to assess undergraduate evidence-based practice teaching and learning. Med Educ. 2003;37:992–1000. doi: 10.1046/j.1365-2923.2003.01678.x.
    1. Lokker C, Haynes RB, Wilczynski NL, McKibbon KA, Walter SD. Retrieval of diagnostic and treaWilcz; Wtment studies for clinical use through PubMed and PubMed’s Clinical Queries filters. Journal of the American Medical Informatics Association. 2012;18:652–659.
    1. MacDermid JC, Solomon P, Law M, Russell D, Stratford P. Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol [NCT00298727] Implement Sci. 2006;1:14. doi: 10.1186/1748-5908-1-14.
    1. Norman GR, Davis DA, Lamb S, Hanna E, Caulford P, Kaigas T. Competency assessment of primary care physicians as part of a peer review program. JAMA. 1993;270:1046–1051. doi: 10.1001/jama.1993.03510090030007.
    1. Salvatori P, Baptiste S, Ward M. Development of a tool to measure clinical competence in occupational therapy: a pilot study? Can J Occup Ther. 2000;67:51–60.
    1. Upton D, Upton P. Development of an evidence-based practice questionnaire for nurses. J Adv Nurs. 2006;53:454–458. doi: 10.1111/j.1365-2648.2006.03739.x.
    1. Cunnington JP, Hanna E, Turnhbull J, Kaigas TB, Norman GR. Defensible assessment of the competency of the practicing physician. Acad Med. 1997;72:9–12.
    1. Goulet F, Jacques A, Gagnon R, Bourbeau D, Laberge D, Melanson J. et al.Performance assessment. Family physicians in Montreal meet the mark! Can Fam Physician. 2002;48:1337–1344.
    1. Soper D. The Free Statistics Calculators Website-Online Software. 2010.
    1. Gomez E. Tap the Internet to strengthen evidence-based oncology nursing practice. ONS News. 2000;15:7.
    1. Leach MJ, Gillham D. Evaluation of the evidence-based practice attitude and utilization SurvEy for complementary and alternative medicine practitioners. J Eval Clin Pract. 2008;14:792–798. doi: 10.1111/j.1365-2753.2008.01046.x.
    1. Verbeke G, Molengerghs GS. Linear Mixed Models for Longitudinal Data. Springer-Verlag, Berlin; 2001.
    1. McKinlay RJ, Cotoi C, Wilczynski NL, Haynes RB. Systematic reviews and original articles differ in relevance, novelty, and use in an evidence-based service for physicians: PLUS project. J Clin Epidemiol. 2008;61:449–454. doi: 10.1016/j.jclinepi.2007.10.016.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren