Merging research and advanced clinical knowledge: An illustration from paediatric hand therapy

Ms Rose Biggins1

1The Royal Children’s Hospital, Melbourne, Parkville, Australia

 

Aim: Occupational therapists within tertiary centres commonly treat medical conditions rarely seen in the community. Research for these conditions can be sparse, of poor quality and with varied recommendations. Similarly, clinical practice can be based on historical traditions, rather than from evidence. To help inform practice for camptodactyly, a congenital hand condition, this project aimed to develop a practice brief by combining a synthesis of research evidence with advanced clinical knowledge.

Method: A clinical question was developed using a PICO framework and electronic databases were searched. Validity and reliability of studies were evaluated using the Critical Appraisal Skills Program and level of evidence was assigned using NHMRC guidelines.  Findings from the literature review were analysed against current and historical clinical data and practice.

Results: A search of three electronic databases yielded six studies. All were retrospective case series (NHMRC Level IV) of mixed methodological quality. Data synthesis developed recommendations, which were analysed against historical data and practice. A practice brief was developed outlining recommended assessment procedures and options for intervention.

Significance of the findings to allied health: In all clinical settings it is important for AH clinicians to use the evidence cycle to inform best practice. However, in settings that commonly see rare conditions, expert and historical knowledge can be an invaluable source for best outcomes. A staged process enables examination of current literature, analysis of findings and synthesis of results to combine with advanced clinical knowledge to ensure expert management.