We recently had a paper published by the British Journal of Occupational Therapy.  Acceptance of papers for publication is always a cause for celebration – getting the findings from our research out to those who can use it is one of the things that we are most passionate about.

But this paper was even more special.

And the reason for that, is that this paper is the result of an ongoing mutually beneficial collaboration with a group of local clinicians (Ginny Humphreys, Jo Jex and Tanya King) and the Peninsula Cerebra Research Unit for Childhood Disability Research (PenCRU).

As a team of methodologists we spend a lot of time providing advice and support to other researchers keen to undertake systematic reviews.  Our Search and Review clinics are available to anyone wanting advice on undertaking systematic reviews.  Most projects will include clinicians on the team but they are usually led by academics.

This project was different.

Ginny, Jo and Tanya have been determined to help families and children make good decisions about postural support systems for a number of years.  Previously, Ginny provided clinical input to a Cochrane Review of sleep positioning systems to reduce hip migration in children with cerebral palsy conducted by our group and PenCRU.

CaptureSadly, we were only able to include evidence from two low quality randomised cross-over trials in the Cochrane Review and neither provided useful information about whether the systems helped reduce hip migration.  Whilst this was a methodologically robust piece of research it contributed very little to the decision making process for clinicians and families.

For Ginny, Jo and Tanya this wasn’t enough.  They needed to do more.  And so when the Posture and Mobility Group put out a request for leadership of a best practice guide, they took up the challenge and initiated a further review with wider inclusion criteria which could provide clinicians and families with a clearer critique of the available (low quality evidence) and enable discussions and decision making.  They are using the findings from the review as a basis for obtaining expert consensus for good practice.  Two rounds of a Delphi-type process are already completed and will be presented at the Posture and Mobility annual conference in summer 2018 for ratification.

Ginny, Jo and Tanya had little (or no) previous experience of conducting systematic reviews but they led and directed the project from start to finish, with members of PenCRU and the Evidence Synthesis Team providing methodological support and advice when requested!  A huge contrast with the more usual model of academics leading and performing day-to-day reviewing tasks and discussing clinical issues at intervals as the project unfolds.

Ginny says “This has been a very unusual experience and sometimes felt (in a good way) more akin to writing a PhD! Clinicians are normally so taken up with the day-to-day work with patients that this sort of project may seem undoable but I am lucky to have had the time to spend on it. The help in searching for literature, presenting the findings, editing the paper and steering the project to conclusion was invaluable throughout. The advice from the researchers at the University of Exeter Medical School at the start provided a much more rigorous attention to detail in the methodology than Tanya, Jo and I had intended at the time and ultimately enabled a more robust and publishable study. The collaboration was always convivial and conducted with much patience, wisdom and generosity for which we are very grateful.”

Sharon Blake one of the PenCRU researchers who worked on the project added “It was a pleasure to work on this project and as an early-career researcher I learnt a lot from explaining and reflecting on the ‘doing’ rather than ‘doing the doing’. Although ‘doing’ parts of the review process and providing concrete examples appeared to be a particularly helpful advisory approach. As was combining a drive for high standards (reflecting recognition and belief in the team’s capabilities) with a positive motivating attitude that the review would be completed. Not at all dissimilar to PhD study! With a practitioner background myself I understand the challenge for clinicians to work in this way with researchers, so I am grateful for the opportunity to focus on answering research questions that matter in practice and hope that we can continue to find ways to work collaboratively with clinicians, patients and their families”.

Ginny Humphreys, Tanya King, Jo Jex, Morwenna Rogers, Sharon Blake, Jo Thompson-Coon, and Christopher Morris (2018) Sleep positioning systems for children and adults with a neurodisability: A systematic review. British Journal of Occupational Therapy First Published June 21, 2018. https://doi.org/10.1177/0308022618778254

The abstract of the paper is freely available – a full copy is available on request.

Photos by Tirza van DijkSagar PatilNik MacMillan, Hope House Press, Thought Catalog  and Hans-Peter Gauster on Unsplash

It takes two flints to make a fire – Louisa May Alcott