The Importance Of Researching The Research
- William Fishco DPM FACFAS
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Patients constantly ask us about success rates for various surgeries and other treatment protocols. We often reiterate what we have been taught somewhere in training but can’t really find the source of it. Patients can easily relate to percentages. For example, we commonly tell our patients that 95 percent of people with plantar fasciitis get better without surgery. Where does that information come from?
Do your patients ask you about platelet-rich plasma (PRP) injections for Achilles tendinitis? How do you respond? You may tell them that it is somewhat experimental or suggest that it is not covered by insurance to skirt around the issue. Wouldn’t it be better to refer to a reliable published report?
How do you obtain scientific, evidence-based medical information relevant to your daily practice? You may learn through scientific seminars and meetings, reading current literature in our journals, getting information from product vendors or through reading textbooks.
Textbooks are somewhat limiting because they are outdated before they are published. I know firsthand that it takes between three and five years to publish a textbook. Even though you may be reading a book published in 2013, the information — especially the references — is a few years old. Textbooks have their role in educating the masses but are limited with current information.
You can read current journal articles but there are limitations to every research study you read. Just because a paper is published doesn’t mean it has much validity. Certainly, the conclusions of the latest article that you read detailing “the best” fixation for a Lapidus bunionectomy cannot be deemed “dogma.”
We all attend seminars. Hopefully, the presenter is giving you current information with associated references. If the lecture is scientific in nature versus a clinically illustrated lecture on surgical technique for example, try to get a copy of his or her references so you can do your own research on the topic.
What can you do from home on your computer to stay clinically informed? The first thing is to learn what makes a good research study and then determine how much validity is in the data. I am going to give you a simple cheat sheet on evaluating research.
* Understand the levels of clinical evidence. Published articles are rated Level I-V. The highest quality rating is Level I (such as a randomized trial or prospective study) and Level V has the lowest level of evidence such as an expert’s opinion. Accordingly, higher-level rated studies have more validity.
* Use the U.S. Library of Medicine (NIH) database for research. It is free and simple to use (see www.ncbi.nlm.nih.gov/pubmed ). Here you can use their search engine for a wide array of topics. Have you ever wondered what the literature says about laser treatments for toenail fungus? Now you can find out by searching “laser” and “onychomycosis.”
Searching the literature can take time and you may need to go through hundreds of articles critically analyzing them. None of us has the time to do that in clinical practice. If we were in academia, that is another story.
* Know how to research the research. There are a couple of important types of studies that research the research. The first is a meta-analysis. This is a statistical tool that synthesizes results from different studies to determine patterns and relationships. For example, one can draw conclusions regarding a particular surgical treatment.
The second type of study is a systematic review. This is another tool you can use to review previously published studies to help make conclusions. The beauty of this research is that it only includes the published works with the highest levels of evidence and highest qualities of research. This research would certainly exclude case reports and expert’s opinions.
Now with the understanding of a systematic review, you can go to the Pubmed website and query “systematic review and ASTYM for Achilles tendinosis” or whatever information that you want to find. You will be amazed at some of the conclusions of these reports. Remember, when making decisions in practice, you should combine your own personal experience with the conclusive evidence in the literature. You can be confident that conclusions from a systematic review are genuine and reliable. Remember, the vast body of literature changes every day. In order to stay current, relevant and on the top of your game, you need to do more than go to a mandatory meetings to keep your license active.
The next time that you propose a surgery or a patient asks you about the results or percentages of a procedure, you can tell the patient with confidence. Otherwise, you will most likely be giving your patient an on-the-fly ballpark figure based upon your experience with that particular surgery or condition. If you have only been in practice for five years or less, it is hard to be confident with your answer. Even if you have been in practice for 40 years, you may need to comment on a new procedure in which you cannot draw from your four decades of work.
Staying current with the research and maintaining a critical eye on the research takes the guesswork out and is the right thing to do for your patients.