Tidy's Physiotherapy, 15e (Physiotherapy Essentials)

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Professionally led clinical guidelines The CSP has established a process for the endorsement of clinical guidelines. The criteria for assessing whether the quality of a guideline warrants endorsement can be found in an appraisal instrument devel- Appendices 513 Glossary of Common Research Terms 514 Common Medical Abbreviations 517 Points on Critical Evaluation of a Research Paper 519 Ranges of Joint Motion (typical normal values) 520 Clinical Interest Groups: worldwide web addresses 521 and Sharon Baines, lecturers at the University of Salford; Judith Chapman, lecturer at the University of Southampton; Sue Barnard, lecturer in physiotherapy at the University of Southampton; Rod Moore, of Medical Dynamics; Pauline Davey, assistant communications manager at the National Osteoporosis Society; Mr R. F. Adam FRCS MChOrth, consultant orthopaedic surgeon; Fiona Cobbold, senior physiotherapist, and Mike Somervell and Julie Butler, senior occupational therapists, at the Southport & Ormskirk Hospital NHS Trust; Reinier van Mierlo, superintendent physiotherapist at the Royal Preston Hospital; Carol Barnes, senior physiotherapist at Stepping Hill Hospital, Stockport; and the medical photography department at Whiston Hospital. Thanks also go to Andrew and Justine Arlow for their encouragement and advice. I should also like to thank all my colleagues at the University of Salford School of Health Care Professions for their support; the physiotherapy staff at Wrightington and Ormskirk Hospitals; and the unsung heroes of our profession - the physiotherapy assistants with whom I have worked over the years and who have kept me functioning on numerous occasions. My thanks go to my wife, Sue, for always having picked me up whenever I have fallen down. Finally, thank you to our three little girls Alison, Claire and Jessica for helping me to believe in magic again and never complaining when they were buried under a mountain of paper during the final months of this project!

Tidy's Physiotherapy good' and of government to protect the public. In addition, the public has become more litigious, suing doctors and trusts more readily for mistakes, drawing money away from front-line clinical services. So clinical governance is about re-building the public's confidence in health services, providing high-quality and effective care and, above all, reducing the risk of harm through negligence, poor performance or system failures. Definition Clinical effectiveness was defined by the Department of Health in 1996 as 'the extent to which specific clinical interventions, when deployed in the field for a particular patient or population, do what they are intended to do - that is, maintain and improve health and secure the greatest possible health gain from the available resources' (NHS Executive 1996). • Is the practitioner sufficiently skilled to apply the intervention safely and effectively? • Was the practitioner an effective communicator? • Did the practitioner give the patient an opportunity to fully describe the symptoms and the impact of the problem on the person's life, and to ask questions? • Did the patient have enough information to be able to give informed consent? • Were other options discussed, that may have been more acceptable to the patient, even if less effective? • Would treatment in a hospital setting mean a long, exhausting and expensive journey for the patient? • Would the patient feel intimidated by a hospital environment? • Would treatment have been more effective if it had been provided closer to home, for example in the GP's surgery or health centre? • Would treatment have been more relevant if it had been given in a patient's own home, to be able to develop a programme tailored to the person's lifestyle and environmental needs? • Wherever treated, did the patient have adequate privacy, warmth and comfort? • How long did the patient have to wait for treatment - will delay affect the effectiveness of the interventions? The answer to each of these questions can have an impact on the patient's ability to benefit from an intervention, however effective the research evidence might suggest an intervention is. This also illustrates the complexity of the clinical reasoning process, where highly skilled judgements have to be made based on a consideration of the whole person, physically, emotionally and within society, as well as the environment, practitioner skills and resources available, in order to provide truly effective treatment. So while evidence-based practice is a key component of clinical effectiveness, clinical effectiveness also takes account of a range of other influences that couldClinical audit is a cyclical process involving the identification of a topic, setting standards, comparing practice with the standards, implementing changes, and monitoring the effect of those changes (CSP 2000). Further information about clinical audit can be found in an information paper published by the CSP (2002f) and in Principles for Best Practice in Clinical Audit published by NICE (2001).

For students and clinical professionals who are learning to better themselves in the field of their study. This book is the latest in its release and is a trademark of . Written by carefully selected global experts, practicing physicians, and educators in the various sub-disciplines of medicine and surgery. A must read for everyone. Responsibility to patients This chapter has already discussed the importance of the individual physiotherapist as well as the profession as a whole maintaining the attributes of professionals. Trust is perhaps the most essential characteristic with which to develop a sense of partnership with patients that, in turn, will optimise the benefits of intervention. For physiotherapy, many of the other hallmarks for building and securing trust are set out in the profession's Rules and Standards; for example • to provide safe and effective interventions (safety of application as well as safe and effective) - Rule 1 and Core Standards 4, 8, 16 • to treat patients with dignity and respect - Rule 2 and Core Standard 1 • to provide patients with information about their options for treatment/interventions - Rule 2 and Core Standard 2 • to involve patients in decisions about their treatment (informed consent) - Rule 2 and Core Standard 2.

Physiotherapy Management of Ankylosing Spondylitis 273 Juliette O'Hea 14 Management of Respiratory Diseases 291 Stephanie Enright 15 Cardiac Disease J. P. Moore

More information about evidence-based practice can be found in Bury and Mead (1998), or at http: //www.nettingtheevidence.org.uk/, a catalogue of useful electronic learning resources and links to organisations, which facilitate evidence-based healthcare. See also the section 'Sources of Critical Appraisal Tools' towards the end of this chapter. CLINICAL EFFECTIVENESS Clinical effectiveness as defined by the Department of Health sounds very much like evidence-based practice • doing things you know will be effective for a particular patient or group of patients. But the fact that an intervention has been proved to work in research studies, in a relatively controlled environment, does not necessarily mean that it will work for a particular patient. Both patients and practitioners are unique beings, and there are many additional factors, practical and behavioural, that need to be considered to ensure the patient gets the maximum benefit from an intervention. Evaluating the process of care (clinical audit) In order to evaluate the process of care, it is necessary to have a reliable benchmark with which to compare your practice. Earlier, the importance of the local implementation of nationally developed standards and evidencebased clinical guidelines was discussed. These provide such a reliable benchmark. Clinical audit is a tool with Contributors Physiotherapy in Rheumatology Rachel Lewis MCSP SRP HT Physiotherapy Department, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK Physiotherapy Management of Ankylosing Spondylitis Juliette O'Hea MCSP MSc PG Dip (Rheum) Rheumatology Practioner, Salisbury District Hospital, Odstock Road, Salisbury, Wiltshire, UK Management of Respiratory Diseases Stephanie Enright PhD MPhil MSc PG Cert MSCP Senior Lecturer, School of Health Care Professions, University of Salford, Salford, UK Cardiac Disease /. P. Moore PhD Academic Unit of Cardiovascular Medicine, University of Leeds, UK Physiotherapy in Thoracic Surgery Anne Dyson Grad Dip Phys MCSP SRP Senior Physiotherapist, Cardio Thoracic Centre, NHS Trust, Liverpool, UK The Research Process Lynne Goodacre PhD SROT Postdoctoral Research Associate, Lancashire Postgraduate School of Medicine and Health, University of Central Lancashire, Preston, Lancashire, UK Upper and Lower Joint Arthroplasty Ann Birch BA (OU) MCSP SRP Senior Physiotherapist, Wrightington Hospital, Hand and Upper Limb Surgery Unit, Wigan, Lancashire, UK

Evidence obtained from a systematic review or meta-analysis of randomised controlled trials Evidence obtained from at least one randomised controlled trial Evidence obtained from at least one well-designed controlled study without randomisation Evidence obtained from at least one other type of well-designed quasiexperimental study Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities Definition Clinical governance is a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish (Secretary of State for Health 1998). While this definition has been used in England, similar interpretations of the term have been made in Scotland, Wales and Northern Ireland. Some books are available as e-books, select View Online to view electronic versions. You will need to login with your university login to access these. 2. Find journal articles