{"id":8268,"date":"2019-01-31T01:28:00","date_gmt":"2019-01-31T00:28:00","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=8268"},"modified":"2019-01-31T01:28:41","modified_gmt":"2019-01-31T00:28:41","slug":"translating-evidence-to-clinical-practice-how-long-is-too-long","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2019\/01\/31\/translating-evidence-to-clinical-practice-how-long-is-too-long\/","title":{"rendered":"Translating evidence to clinical practice: how long is too long?"},"content":{"rendered":"

By Rebecca Blyth<\/strong><\/em><\/p>\n

A ground-breaking study in 2002 suggested that arthroscopic debridement or lavage of the knee joint was no better than placebo surgery[1], yet this is a still a surgical option today.\u00a0 It\u2019s confirmed that the benefits from arthroscopic knee surgery in degenerative knee disease are absent at one to two years follow-up and the surgery has risks[2]. Surgical decompression for subacromial pain faces similar scrutiny.\u00a0A well-designed study showed that there was no clinically significant improvement in those with subacromial impingement symptoms with arthroscopic decompression when compared to no treatment[3].\u00a0As a clinician it can be extremely frustrating to have patients who are unhappy with their post-op outcomes after being under the impression that surgery will \u2018fix\u2019 their issue and pain.\u00a0We as clinicians know that pain is complex and that fixing or removing a structure may have little to no influence on the phenomenon of pain. Now, I\u2019m not here to suggest that there is no place for arthroscopic surgery (having had an arthroscopic ACL reconstruction myself and a positive outcome), but, are we using it far more than the evidence suggests we should and in cases were evidence suggests we should not?<\/p>\n

Beliefs are shifting<\/strong><\/p>\n

I have raised two surgical examples but there are many other treatment techniques still being used in sports medicine despite evidence suggesting limited or no effect.\u00a0 This raises the question, how long is too long before we start implementing evidence into our practice? It comes down to health professionals and patients trusting the evidence more than they trust their own opinions and previous experiences. Cognitive dissonance comes into play as \u2018new\u2019 evidence contradicts practitioners\u2019 beliefs.\u00a0 An orthopaedic surgeon who has performed knee arthroscopies for degenerative menisci for the past 20 years may find it hard to balance this experience with the current evidence suggesting no benefit.\u00a0 There is certainly a shift within sports medicine and I do believe that practitioners are on board with these findings and starting to re-think their practices.\u00a0 A recent blog by a sports doctor <\/a>discussed why surgery was not the best option for his patients medial meniscus tear, despite her being told following MRI that an arthroscopy would be the best treatment[4].\u00a0This is an excellent example of translating evidence into clinical practice, however, we as a sports medicine profession are still offering treatment techniques that are potentially no better than a conservative management plan.\u00a0 Are we not educating our patients well enough about the available options and how these weigh up to one another?\u00a0 Or are our patients not willing to be educated about this and are after the so called \u2018quick fix\u2019 that an arthroscopy will offer?\u00a0 In my opinion it is a combination of the two, humans have an innate desire for the quickest and easiest option available and clinicians are influenced by this and giving patients what they want.\u00a0 How do we change this attitude to achieve the best long-term outcomes?<\/p>\n

Driving change: stop using\u00a0non-evidence-based treatments!<\/strong><\/p>\n

It’s no surprise to anyone that it is difficult to create an attitude and culture change.\u00a0 As clinicians we advise the pros and cons of treatments to patients, but if the patient has a preconceived idea of what treatment they need, this information is not processed.\u00a0 I don\u2019t believe we should be waiting until the day funding bodies and insurers pull funding for arthroscopic surgeries for degenerative knees and certain subacromial conditions.\u00a0 I believe that we as sports medicine practitioners have already synthesised and understand the growing evidence base.\u00a0 Using this knowledge, we should be able to drive the change and reduce the use of non-evidence-based treatments.\u00a0 I still don\u2019t know the answer to my question on how long is too long, but 16 years after the first ground-breaking study in 2002 does seem too long to me.<\/p>\n

Rebecca Blyth<\/strong><\/em>, Physiotherapist.\u00a0 Currently working towards Masters of Sports Physiotherapy at the University of Otago, New Zealand.\u00a0 Special interest sports medicine, particularly football, working in private practice in Auckland, New Zealand. Email: rebeccablyth8@gmail.com<\/a><\/p>\n

\"\"<\/p>\n

Competing interests<\/strong><\/em><\/p>\n

None declared<\/p>\n

References<\/em><\/strong><\/p>\n

    \n
  1. Moseley, J. B., O’Malley, K., Petersen, N. J., Menke, T. J., Brody, B. A., Kuykendall, D. H., Wray, N. P. (2002). A controlled trial of arthroscopic surgery for osteoarthritis of the knee. The New England Journal of Medicine, 347<\/em>(2), 81-88. doi:10.1056\/NEJMoa013259<\/li>\n
  2. Thorlund, J. B., Juhl, C. B., Roos, E. M., & Lohmander, L. (2015). Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. British Journal of Sports Medicine, 49<\/em>(19), 1229. doi:10.1136\/bjsports-2015-h2747rep<\/li>\n
  3. Beard, D. J., Rees, J. L., Cook, J. A., Rombach, I., Cooper, C., Merritt, N., . . . Carr, A. J. (2018). Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet, 391<\/em>(10118), 329-338. doi:10.1016\/S0140-6736(17)32457-1<\/li>\n
  4. Fulcher, M. L. (2018). Surgery for my medial meniscus tear? Retrieved from https:\/\/www.axissportsmedicine.co.nz\/blog\/archive\/surgery-for-my-medial-meniscal-tear\/.Retrieved on 15 September 2018.<\/li>\n<\/ol>\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    By Rebecca Blyth A ground-breaking study in 2002 suggested that arthroscopic debridement or lavage of the knee joint was no better than placebo surgery[1], yet this is a still a surgical option today.\u00a0 It\u2019s confirmed that the benefits from arthroscopic knee surgery in degenerative knee disease are absent at one to two years follow-up and […]<\/p>\n

    Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":8269,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[1536,1164,8202],"class_list":["post-8268","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-decision-making","tag-evidence","tag-evidence-based-practice"],"yoast_head":"\nTranslating evidence to clinical practice: how long is too long? - BJSM blog - social media's leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2019\/01\/31\/translating-evidence-to-clinical-practice-how-long-is-too-long\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Translating evidence to clinical practice: how long is too long? 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