From evidence to best practice in the management of fractures of the distal radius in adults: working towards a research agenda

Hdl Handle:
http://hdl.handle.net/10149/58210
Title:
From evidence to best practice in the management of fractures of the distal radius in adults: working towards a research agenda
Authors:
Handoll, H. H. G. (Helen); Madhok, R. (Rajan)
Affiliation:
University of Teesside. School of Health and Social Care. Research and Development Office.
Citation:
Handoll, H. H. G. and Madhok, R. (2003) 'From evidence to best practice in the management of fractures of the distal radius in adults: working towards a research agenda', BMC Musculoskeletal Disorders, 4 (27), pp.1-15.
Publisher:
BioMed Central
Journal:
BMC Musculoskeletal Disorders
Issue Date:
27-Nov-2003
URI:
http://hdl.handle.net/10149/58210
DOI:
10.1186/1471-2474-4-27
Abstract:
Background: Fracture of the distal radius is a common clinical problem, particularly in older white women with osteoporosis. We report our work towards evidence-based and patient-centred care for adults with these injuries. Methods: We developed a systematic programme of research that built on our systematic review of the evidence of effectiveness of treatment interventions for these fractures. We devised schemata showing 'typical' care pathways and identified over 100 patient management questions. These depicted the more important decisions taken when progressing along each care pathway. We compiled a comprehensive document summarising the evidence available for each decision point from our reviews of randomised trials of treatment interventions. Using these documents, we undertook a formal and structured consultation process involving key players, including a patient representative, to obtain their views on the available evidence and to establish a research agenda. The resulting feedback was then processed and interpreted, using systematic methods. Results: Some evidence from 114 randomised trials was available for 31 of the 117 patient management questions. However, there was sufficient evidence to base some conclusions of effectiveness for particular interventions in only five of these. Though only 60% of those approached responded, the responses received from the consultation group were often comprehensive and provided important insights into treatment practice and policy. There was a clear acceptance of the aims of the project and, aside from some suggestions for the more explicit inclusion of secondary prevention and management of complications, of the care pathways scheme. Though some respondents stressed that randomised trials were not always appropriate, there was no direct overall criticism of the evidence document and underlying processes. We were able to identify important core themes that underpin management decisions and research from the feedback of the consultation exercise. Conclusions: Overall, this project is an important advance towards evidence-based and patient-centred management of adults with distal radial fractures. It exposes the serious deficiency in the available evidence but also provides a template for further action. As well as being a valuable basis for viewing and informing current practice, the insights gained from this project should inform a future research agenda.
Type:
Article
Keywords:
distal radius; fractures; adults; osteoporosis; women
ISSN:
1471-2474
Rights:
Open access BMC publication. Author can archive publisher's version/PDF. For full details see http://www.sherpa.ac.uk/romeo/ [Accessed 13/01/2010]
Citation Count:
7 [Scopus, 13/01/2010]

Full metadata record

DC FieldValue Language
dc.contributor.authorHandoll, H. H. G. (Helen)-
dc.contributor.authorMadhok, R. (Rajan)-
dc.date.accessioned2009-04-01T10:46:02Z-
dc.date.available2009-04-01T10:46:02Z-
dc.date.issued2003-11-27-
dc.identifier.citationBMC Musculoskeletal Disorders; 4 (27): 1-15-
dc.identifier.issn1471-2474-
dc.identifier.doi10.1186/1471-2474-4-27-
dc.identifier.urihttp://hdl.handle.net/10149/58210-
dc.description.abstractBackground: Fracture of the distal radius is a common clinical problem, particularly in older white women with osteoporosis. We report our work towards evidence-based and patient-centred care for adults with these injuries. Methods: We developed a systematic programme of research that built on our systematic review of the evidence of effectiveness of treatment interventions for these fractures. We devised schemata showing 'typical' care pathways and identified over 100 patient management questions. These depicted the more important decisions taken when progressing along each care pathway. We compiled a comprehensive document summarising the evidence available for each decision point from our reviews of randomised trials of treatment interventions. Using these documents, we undertook a formal and structured consultation process involving key players, including a patient representative, to obtain their views on the available evidence and to establish a research agenda. The resulting feedback was then processed and interpreted, using systematic methods. Results: Some evidence from 114 randomised trials was available for 31 of the 117 patient management questions. However, there was sufficient evidence to base some conclusions of effectiveness for particular interventions in only five of these. Though only 60% of those approached responded, the responses received from the consultation group were often comprehensive and provided important insights into treatment practice and policy. There was a clear acceptance of the aims of the project and, aside from some suggestions for the more explicit inclusion of secondary prevention and management of complications, of the care pathways scheme. Though some respondents stressed that randomised trials were not always appropriate, there was no direct overall criticism of the evidence document and underlying processes. We were able to identify important core themes that underpin management decisions and research from the feedback of the consultation exercise. Conclusions: Overall, this project is an important advance towards evidence-based and patient-centred management of adults with distal radial fractures. It exposes the serious deficiency in the available evidence but also provides a template for further action. As well as being a valuable basis for viewing and informing current practice, the insights gained from this project should inform a future research agenda.-
dc.publisherBioMed Central-
dc.rightsOpen access BMC publication. Author can archive publisher's version/PDF. For full details see http://www.sherpa.ac.uk/romeo/ [Accessed 13/01/2010]-
dc.subjectdistal radius-
dc.subjectfractures-
dc.subjectadults-
dc.subjectosteoporosis-
dc.subjectwomen-
dc.titleFrom evidence to best practice in the management of fractures of the distal radius in adults: working towards a research agenda-
dc.typeArticle-
dc.contributor.departmentUniversity of Teesside. School of Health and Social Care. Research and Development Office.-
dc.identifier.journalBMC Musculoskeletal Disorders-
ref.assessmentRAE 2008-
ref.citationcount7 [Scopus, 13/01/2010]-
or.citation.harvardHandoll, H. H. G. and Madhok, R. (2003) 'From evidence to best practice in the management of fractures of the distal radius in adults: working towards a research agenda', BMC Musculoskeletal Disorders, 4 (27), pp.1-15.-
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