Centre for Evidence-Based Physiotherapy, School of Physiotherapy
Institution:
The University of Sydney
Teaching and Learning Strategy:
PEDro is the Physiotherapy Evidence Database. It has been developed to give rapid access to bibliographic details and abstracts of randomised controlled trials, systematic reviews and evidence-based clinical practice guidelines in physiotherapy. Most trials on the database have been rated for quality to help users quickly discriminate between trials which are likely to be valid and interpretable and those which are not. [http://www.pedro.fhs.usyd.edu.au/index.html].
The database is endorsed by the World Confederation for Physical Therapy. PEDro averages over 40,000 hits per week and is used by physiotherapists in over 40 countries.
A Google search using the exact phrase 'Physiotherapy evidence database' on January 20 2005 reveals 5,580 hits. One reason for the popularity of PEDro is that we have taken an international focus: the database archives studies in any language and the PEDro interface is translated into seven languages (Portugese, Spanish, Korean, Arabic, French, Italian and German). As well as being popular PEDro is recognised as an authoritative source of evidence. Libraries of the leading Universities around the world, including Harvard, Oxford and Yale Universities, provide access to the database for their patrons. The Cochrane Collaboration encourages reviewers to use PEDro when preparing systematic reviews The Centre has assisted Occupational Therapists and Psychologists to develop similar databases to PEDro for their own professions (OT Seeker, PsychBite) and is working collaboratively with these groups to develop strategies to foster evidence-based practice. PEDro has changed physiotherapy internationally.
Course Name:
Students are introduced to the database in the subject Evidence-Based Physiotherapy through a series of lectures, web-based self-directed learning modules and tutorials. Students are also encouraged to use PEDro within each of the discipline-based professional subjects (eg musculoskeletal physiotherapy) to find answers to questions about treatment effectiveness. To foster transfer of this approach the tutors in the subject Evidence-Based Physiotherapy are drawn from the discipline-based teaching teams.
Year Level:
First Year
Expected Outcomes:
Year Level : (All four years of course)
In this subject students will learn skills required to practice evidence-based physiotherapy. At the completion of this subject you should be able to:
Ask answerable clinical questions about the effects of therapy, prognosis, and the utility of diagnostic tests in physiotherapy
Find key studies that answer your questions
Critically appraise the studies (i.e., determine whether their findings are likely to be valid and what they mean)
Draw reasonable conclusions about therapeutic effectiveness, the utility of diagnostic tests and prognosis
Effective Aspects:
PEDro permits self-paced learning, integration of the principle of evidence-based practice across the total curriculum and allows students to be life-long learners. Because the database is updated monthly and the information is screened for methodological quality students are provided with the most recent high quality information on practice.
Evaluation:
We have surveyed students using the University unit of study evaluation and surveyed graduate physiotherapists at professional conferences.
Evaluation Outcomes:
Students enjoy using PEDro and this is maintained once they graduate.
Plans for Changes/Developments in Future:
There have been three major initiatives/changes from the original project.
The School has assisted Occupational Therapists and Psychologists to develop similar databases to PEDro for their own professions (OT Seeker, PsychBite) and is working collaboratively with these groups to develop strategies to foster evidence-based practice.
To assist health consumers to be able to access high quality information on physiotherapy treatment effectiveness we are developing a consumer version of PEDro. This will be launched in 2005.
To make the resource truly international the database now archives studies in any language and the PEDro interface has been translated into seven languages (Portugese, Spanish, Korean, Arabic,French, Italian and German).
The Bachelor of Physiotherapy with Honours is run concurrently over the last two years of the Bachelor of Physiotherapy. As honours degrees are recognized nationally and internationally as the first formal level of research education, this honours program aims to develop foundation skills in all aspects of research processes including ethical action, critical analysis, research methodologies, data collection, management and analysis, and dissemination of results through submission of an academic thesis, presentation and publication. The knowledge and skills expected of higher research degrees (Masters by Research and PhD) form the basis for a realistic and strategic educational experience.In 2001 a new model for the Bachelor of Physiotherapy was commenced and the new model for the Bachelor of Physiotherapy with Honours commenced in 2002. Changes within the new program were based on feedback from previous honours students, supervisors, academic staff and the community. The Honours program currently consists of two courses. Physiotherapy Honours Preparation which is commenced and completed over the third year of the Bachelor of Physiotherapy program. Honours students undertake Physiotherapy Honours Preparation (4.5 units) instead of Ethics and Health (4.5 units) within the Bachelor of Physiotherapy. The second course is Physiotherapy Honours Thesis (9.0 Units), which is completed during the fourth year of the Bachelor of Physiotherapy program). Honours students undertake Physiotherapy Honours Thesis (9.0units) instead of two 4.5 unit courses (Physiotherapy Project U and Occupational Health and Safety). Therefore at any given time during the academic year, there are third year (commencing honours students) and fourth year (completing honours students).
The teaching and learning strategies incorporated within this program include:
Physiotherapy Honours Preparation (Third year)
3 week summer school (Group based) - Lecture, tutorials, computer based activities, group development of research proposal and presentation. This program includes honours students and Masters by coursework students.
Selection of an honours topic (Supervisory team based 1 student: 2 supervisors). Potential honours projects are called for each year from within the School of Health Sciences and the wider clinical physiotherapy community. The call for potential honours projects from the physiotherapy community aimed to address two clear needs. Firstly, interest from clinical physiotherapists wanting to be actively involved in research but without sufficient time and resources and in some cases, sufficient skills to undertake research in their work site. Secondly, there was a need for honours students to undertake useful and meaningful research projects which prepared them for higher research degrees and to be competitive for scholarships. This format was introduced in 2002 and has been extremely successful for both the School of Health Sciences and the collaborating clinical affiliations.
Table 1: Summary of Honours enrolments for the Honours program
Year
Total number of students within honours program
Number of fourth year students completing honours
Number of third year students commencing honours
Total number of potential projects offered
Projects offered by clinical affiliations
2002
23
6
17
25
20
2003
37
15
22
30
19
2004
32
17
15
29
15
Table 2: Examples of potential honours projects submitted by the clinical physiotherapy community
Topic
Clinical affiliation
The reliability and responsiveness to change of the Elderly Mobility Scale for acute hospital patients.
Flinders Medical Centre
Reliability of chest wall circumference as a measure of pulmonary hyperinflation in children with cystic fibrosis.
The Management of third and fourth degree tears at the WCH is this best practice?
Passive movements: A survey of Australian Intensive Care Units
Women's and Children's Hospital
Intensive treadmill training for ambulatory children with cerebral palsy.
Crippled Children's Association
A qualitative study of uses and perceived benefits of hydrotherapy
Sports Med Inc.
Private Hospital
Students negotiate and decide upon the research project from the topics offered. Supervisory requirements are then discussed and finalized. Supervisory teams always include an academic staff member with previous experience in successful supervision of honours students. The supervisory team assists the student to develop and finalize a succinct research proposal (written and oral presentation). All proposals are assessed by two independent reviewers (academics). Honours students are provided with opportunities to develop skill in reviewing one of their peer's proposals.
Supported by:
Ongoing meeting between the honours program director and honours cohort
Online resources specific for Physiotherapy Honours Preparation including provision of all appropriate policies and codes of conduct, roles and responsibilities of students and supervisors, requirements and processes for ethical approval, requirements and assessment guidelines for research proposal (oral and written) including examples of previous honours proposals (assessed and unassessed) for both quantitative and qualitative research approaches. Additional resources are provided within the online course site (such as direct online versions of all forms and referencing software (Endnote).
Physiotherapy Honours Thesis (Fourth year)
Honours students work under the support and supervision of their supervisory teams to complete the data collection, analysis and write up the research in the form of an academic thesis based on the requirements for thesis within the research degree programs.
The supervisory team works collaboratively to write a manuscript suitable for submission to a relevant peer reviewed journal. Each manuscript is critically reviewed by two independent assessors and feedback provided to the team. Each honours student is assessed on their ability to critically review another student's manuscript.
Honours students work under the support and supervision of their supervisory teams to prepare an oral presentation appropriate for national or international conferences and where-ever possible, teams are encouraged to submit abstracts for presentation at national and international conferences.
Supported by:
Group meetings between honours program director and honours cohort throughout the semester as required by the students
Online provision of detailed materials and resources specifically related to the assessable components - preparing and writing the thesis, planning, developing, writing and reviewing manuscripts for publication, preparing oral presentations.
Workshops on "How to write a manuscript" and "How to review a manuscript"
Workshops on strategic career planning including assistance with preparing for submitting applications for scholarships and higher research degrees.
Course Name:
Bachelor of Physiotherapy with Honours (program)Courses: Physiotherapy Honours Preparation and Physiotherapy Honours Thesis
Year Level:
Third Year
Expected Outcomes:
Year Level : (Physiotherapy Honours Preparation - Year 3 (REHB 3010)Physiotherapy Honours Thesis - Year 4 (REHB 4012))
On completion of this program students will be able to:
formulate specific and appropriate research questions;
demonstrate literacy skills in information technology by accessing and critically reviewing literature relevant to the designated project.
provide evidence of skills in scientific writing, which recognises broad advantages and disadvantages of specific research methodologies and conveys a clear understanding of the principals of evidence-based practice and the hierarchy of evidence
discuss the principles of subject selection including sample type, inclusion and exclusion criteria and the relationships between sample size and statistical errors where appropriate;
outline common forms of quantitative and qualitative research designs including single subject, repeated measures, cross-over, parallel group, survey and questionnaire;· demonstrate an ability to determine variables (confounding, independent and dependent), discuss the appropriateness of measurement outcomes and demonstrate an understanding of the principles of reliability and validity
provide evidence for data management and analysis as well as appropriate justification of the analysis for the designated project
create a coherent and appropriate discussion of the results of the designated project including limitations to the project and areas for further consideration.
demonstrate an understanding of the role of ethics in research by writing a specific proposal for ethical approval;
avail themselves of opportunities to present and publish work arising from the thesis
In addition, the University of South Australia aims to produce graduates who clearly demonstrate a number of qualities. These graduate qualities, with respect to the Bachelor of Physiotherapy with Honours are outlined within the following Table. (Note; this table is presented within the online materials for the two honours courses).
Graduate quality
In relation to your course
Operates with and upon a body of knowledge
This course will develop an understanding of a wide variety of research related issues (design, approaches, and data management) and skills in the development, completion of and dissemination of your research project. You will develop a specific body of knowledge in the area related to your project and a broader understanding of research related skills. For example research approaches data management and handling, software programs, referencing, authorship and publication processes.
Preparation of lifelong learning toward personal development and professional practice
Students will develop a solid foundation in the processes and practices relevant to planning, conducting and reporting research. The usefulness of completing an honours degree in terms of your career plan and opportunities available to you will be explored. Students wishing to be mentored towards a strategic career pathway will have the opportunity to seek this assistance.
Effective problem solver applying logical, critical and creative thinking
Students will progressively review and problem-solve through the specific components of their research project including project planning, identification of appropriate research milestones and submission of a thesis and manuscript. Critical and practical skills will be developed through data collection and compilation of the thesis/manuscript. Students will be encouraged to use an evidence based approach to all planning and resources.
Can work both autonomously and collaboratively
Students will work collaboratively with their research supervisors in order to complete a viable and defensible research project. Both students and their supervisors have a responsibility to contribute to the research process and authorship of a manuscript for submission to a peer-reviewed journal. Independent activity under the guidance of a supervisor will be required as the main means of completing this research project.
Committed to ethical action and social responsibility
All student and supervisors are required to undertake all research activity with due diligence to the ethical implications of the study. All students will be required to have approval from Human Research Ethics Committee (HREC) of the University of South Australia as well as any other external institution involved in the research. Students /supervisors have a social responsibility to provide the results of their study to the subjects involved and disseminate these findings to the wider community through either oral presentations or publication.
Communicates effectively
Effective communication will be required between students and supervisors throughout this course. The majority of the work included within this course will be undertaken within small research teams consisting of the student and supervisor/s. Formal assessment of the student's ability to communicate their research proposal is planned in both written and oral modes. All students will be provided with the opportunity to communicate the results of their study to the wider scientific community through the preparation of a manuscript suitable for submission to a peer-reviewed journal.
Demonstrates international perspectives
A review of international and national literature relevant to the proposed research will be required within the thesis and manuscript.
Effective Aspects:
Open, frequent and collaborative discussion between students, supervisors and program coordinator
Real world projects, embedded in real clinical issues which result in useful outcomes
Experienced and dedicated supervisory teams
Quality management practices (independent review of research proposals (written ad oral), honours thesis, final oral presentations and manuscripts)
Mentoring students through collaboration for presentation and publication processes as a means of providing direct experience with the graduate world of physiotherapy
Detailed online resources with a one stop shop for all administrative requirements
Inclusion of strategic career planning sessions and mentoring
Evaluation:
Each course (Physiotherapy Honours Preparation and Physiotherapy Honours thesis) is evaluated at the end of each course using an online evaluation form and face to face focus groups.
The Honours Program is evaluated using a purpose written evaluation form on completion of the final year of the program. To date, students have provided overwhelming support for the program. A complete copy of responses to the evaluation form is available on request. Examples of responses from 2002-2003 cohort include:
1. 1)much improved knowledge of research design, methodology and appraising other research/articles 2)improved organisation, motivation and communication skills
2. It forces you to work independently and helps you to further understand research methods and findings - a very important aspect when reading literature to help determine best practice standards.
3. The clear expectations, individual projects (and designs), excellent supervision and always someone to ask questions of at any time- whether individual supervisors or someone else from the uni
4. Honours preparation and facilitating the development of abilities to undertake independent research.
6. Guidelines for what is required very clear. Excellent experience with supervisors.
7. Supervisors Opportunity to learn research skills over and above the undergraduate course
8. Quality of supervisors and range of topics
Question 26 : I have learned skills which will be valuable in my career regardless of whether I undertake further research or not. (100% responded as Agree or strongly agree)
Feedback from clinical affiliations undertaken informally through phone follow-ups and informal focus groups. Overwhelmingly positive from all clinical affiliations and clinical supervisors.
Follow-up of graduates from the Bachelor of Physiotherapy in terms of research outcomes -see Table 3
Table 3: Honours Program statistics since commencement
Year
Students invited
Students accepted / enrolled
Attrition / WD / preclude
Completed
Grades
Publications (C1 and E1)
Presentations
(state / national) E3
PhD
1990 - 1991
11
11
0
11
1 Honours I
9 Honours IIA
1 Honours IIB
1
1
1 α
1991 - 1992
7
7
1
6
1 Honours I
5 Honours IIA
1992 - 1993
7
7
0
7
2 Honours I
2 Honours IIA
2 Honours IIB
2
2
1993 - 1994
9
9
0
9
4 Honours I
3 Honours IIA
1
1
1994 - 1995
16
14
4
9
5 Honours I
4 Honours IIA
2
7
1995 - 1996
13
10
4
6
4 Honours I
4 Honours IIA
2
10
1 β
1 ψ
1996 - 1997
24
(1 sc)
12
0
12
5 Honours I
5 Honours IIA
2 Honours IIB
1
3
1997 - 1998
10
(1 sc)
7
1 (preclude)*
6
2 Honours I
4 Honours IIA
2
1
1 β
1 ψ
1998 - 1999
17
(2 sc)
9
0
9
3 Hons I
5 Hons 2a
2
3
1999 - 2000
22
(1sc)
12
2
10
7 Hons 1
3 Hons 2a
3
3
2000 - 2001
16
(3 sc)
13
3
13
7 Hons 1
6 Hons 2a
7
3
1 ψ
2001 - 2002
22
(2 Sc)
6
0
6
6 Hons 1
2
7
1 β
2002 New Hons program commences
2002 -2003
23
(2 Sc)
17
2
15
13 Hons 1
2 Hons 2a
13
1 σ
2003 -2004
27
(3 Sc)
22
5
3
1 β
2004 - 2005
23
(3SC)
15
1 σ
All students achieving accredit (65 -74) or above in every first and second year course within the first two years of the Bachelor of Physiotherapy are automatically offered entry to the honours program. Students not meeting this requirement can make a case for special case (sc) consideration which is reviewed on a case by case basis.
* preclusion - student failed to successfully complete a clinical course and therefore could not continue in the honours program.
** candidates that go part-time will be recorded within the cohort that they originally started in.
'sc' = special consideration applicant numbers included in total
α = completed or completing PhD at UniSA without scholarship
β = completing or completed PhD on Australian Postgraduate Award scholarship at UniSa
σ = completing or completed PhD on scholarship at UniSA
ψ =completing or completed PhD at a university other than UniSa
Evaluation Outcomes:
New program commenced in 2002. To date, the honours program appears to be successfully achieving its aims.
There has been a considerable increase in the number of eligible students accepting the offer to undertake the honours program since ~ 2000
Increase in research outputs from the honours program (Table 3 shows the peer reviewed publications (C1) and peer reviewed conference presentations (E3) to date.
Consistent interest and articulation from Honours program into PhD with full scholarship since 2000. This is likely to be a direct result of proactive mentoring and strategic moves to facilitate honours students to publish and present their findings resulting in improved ranking in scholarship assessments.
While not evident in the data presented to date, there has been a growing interest from past honours students for entry to the PhD program within School of Health Sciences and requests for assistance with applying for scholarships.
Plans for Changes/Developments in Future:
2004 marks the first year of inclusion of the manuscript writing task. This task will be undertaken collaboratively within the supervisory teams. Each Honours student will be required to review and critique another student's manuscript. No additional changes to the program will be made this year.
Formal feedback concerning the honours program from clinical affiliations and clinical supervisors via an online form is planned for 2004.
Ongoing follow-up of research outcomes for all honours cohort will continue
A formal investigation into the career paths of past honours students is planned for 2005
Associate Professors Marie Williams and Karen Grimmer
Institution:
University of South Australia
Teaching and Learning Strategy:
Our teaching approaches include lectures, small group learning and problem solving, ownership of outcomes, practical skill development and participation in assessment. We teach our students that research has many different approaches and that there is value in all of them. We also show students that statistics are tools to assist in summarising and understanding data, an approach that has particularly assisted in breaking down barriers to reading the research literature. We embed different methods of teaching into our research training model to ensure that students attain as many graduate qualities as possible.
Practical research activities include collecting data from children on school premises. Six measurement stations are used and the students then participate in data amalgamation at the end of data collection. The first station is the questionnaire station, which includes assigning appropriate (pre-set) ID numbers to participants, reconfirming their previously written informed consent on the day of testing, refamiliarising them with the study process and checking that questionnaires have been appropriate completed. The other stations collect data related to the child's assigned ID number, on anthropometric data, school backpack contents, weight and design, child's balance and coordination, child's muscle performance (strength and endurance), hypermobility and standing posture.
Data handling and analysis is also taught. Each student learns to record data appropriately on child identity, and to enter this data accurately using MS Excel. Validation techniques are taught, whereby students check their data entry for accuracy before presenting it to senior research staff for inclusion in the overall dataset.
Students work in small groups for all activities, which teaches them team management skills. They work together to set their research questions based on required data items, and with the assistance of senior research and teaching staff, identify the research design and statistical analysis required to answer the research question. They all have a responsibility to contribute to the final research report, in the manner expected of professional research groups (i.e. taking ownership of each step in producing the research report) (ref JAMA conditions for authorship)
Course Name:
Research Project U is a 4th year course in the Bachelor of Physiotherapy where the emphasis is on providing students with knowledge about research methodology but also providing students with active involvement in data collection. The overall aims of the course is to provide students with the opportunity to be actively involved in a major research project. By doing so, students developed group skills in compiling, critically reviewing and analyzing information (both data and scientific concepts) and written and verbal, particularly scientific communication skills.
Year Level:
Fourth Year
Expected Outcomes:
This program gives undergraduate students a hands-on experience of research endeavors, as they join an existing research project with well developed structures and processes. Whilst they do not have responsibility for research design or overall organization, they are integrally responsible for the year-to-year running of the project. This gives them a sense of ownership over research activities and outcomes for their particular year group. Student outcomes are learning about measurement issues (including data recording, reliability and error), learning to work in small groups, setting research questions on a specified set of data, identifying the appropriate statistics to answer the research question, and writing up the findings in a research report which could be submitted to a peer reviewed journal .
Effective Aspects:
This project collects data from primary school and high school students. It commenced as a cross-sectional study in 1998, in which data on approximately 1300 students was collected from 12 Adelaide high schools. Since 1999, it has been a longitudinal study, in which the same information is collected from the same students each year throughout their school life. The high school study finished in 2003, when the cohort of students completed their hight schooling. The primary school project is ongoing.
The project:
incorporates learning activities that assist each student to ask questions, plan methods of testing questions and locate, access and interpret information to assist in sustaining or refuting supporting arguments (logical, critical and creative thinking, acquisition and development of skills in information literacy for lifelong learning)
provides a professional and authentic work environment where both individual and group performance such as peer evaluation are necessary and valued (working both collaboratively and autonomously, communicating effectively)
offers assessment activities relevant to the graduate working environment-for example, scientific writing for professional publications, data management, participation in meetings-as well as highlighting key issues within research practice (effective communication, problem solving, logical and critical thinking, ethical practice)
Evaluation:
Internal evaluation is by student feedback (using CEI and SET instruments), focus groups and individual written responses. Students evaluate the effectiveness of their small groups as part of the course evaluation process (worth 15% total marks), and employer feedback is sought by questionnaire.
External evaluation is made by consulting industry partners on their perceptions of the success of the project, for instance the Dept of Education and Children's Services (the overarching body) and each of the five schools in which data collection takes place. We invite parents of children to attend test days in the schools, and we receive feedback from them regarding their perceptions of the value of the project, and the interaction of our students with the school students.
Evaluation Outcomes:
Based on feedback from employers of our graduates over the last few years, we are pleased that our research training efforts appear to be producing young health professionals who are comfortable undertaking research activities within a department/practice, and who can lead by example. Over the past five years the general common responses include:
About 90% of students agreed or strongly agreed that "The subject, to date, has clarified and broadened my understanding of research processes"
74% of students agreed or strongly agreed that "I feel I have a strong grasp of the need for reliability testing procedures"
84% agreed or strongly agreed that "I have a good understanding of how much work is required in designing accurate and effective research protocols"
78% agreed or strongly agreed that "Prior to this subject I did not know how to use computer spreadsheets such as EXCEL".
Common written comments submitted by students undertaking this course over the past five years include: " a good introduction to research...working in a group with other groups...enjoyable...insight into research...lots of practical skills... can actually see research in action-will make reading research articles a little less dreary...learning team work...dedication of staff members ...learning how to manage a project."
Plans for Changes/Developments in Future:
This project has been running since 1998. Each year small refinements are made to the way the project is introduced to students, and in the ways that they are trained in the requisite research techniques, based on student and peer feedback, and on project director and course coordinator's increasing skills in presenting the research training material, and organising the data collection processes. Changes include presenting the commercial and academic outputs of the project to each year group of student researchers to give them a bigger picture of the research outputs, giving them more time to practice computer skills, providing mentoring to small groups whilst setting their research question and determining the statistical tests that underpin it.
After 7 year, with completion of the high school data and a potential of 4 further years of data collection in the primary school, it was considered the ideal time to consider the future the course conducted in this way. Decisions need to be made about whether the same study could be conducted in other schools or whether specific aspects could be further investigated or whether a further large study along similar lines but addressing entirely different questions could be sought. The question was also raised about whether students could achieve the same objectives using an on-line format of delivery.
We will continue to refine the teaching and mentoring aspects of this project, in line with best practice teaching and learning activities, and based on student feedback. .
In 2004 Semester 1 the students collected data at Magill Primary School in accordance with the outline presented here. In 2004 Semester 2 there will a trial of delivering the course online in its entirety. The aims, objectives and assessment of the course will remain the same with emphasis on the group experience, accessing information, data entry and analysis skills and the writing of a scientific report. Student will form themselves into groups and separate online discussion areas will be made available for each group.
Data previously collected will be made available for completing the scientific report. Course co-ordinator and other support will also be incorporated. An evaluation form has been designed and will be completed by all students and the responses to the Semester 1 and 2 formats of delivery will be compared. Where responses between students in the two semesters differ markedly or seem contentious or ambiguous, further discussion, is planned in a focus group format to explore these issues further.