by Joe Steel
In this article from the Physio interview preparation series, we'll have a look at a skill often challenged in physio interviews, both during the actual interview and sometimes in the writing component: your ability to talk about a paper you've read (and critiqued) recently.
"What paper have you read recently and how has it influenced your practice?"
Wait a minute...
Of course, you must have actually read and critiqued a paper beforehand to be able to talk about it. The art of critiquing a paper can be hard to master, however there are ways to make it easier.
First of all, it is important to ensure you have a structure or template in place to ensure that you are systematic when appraising studies. Instead of reading through endless journal articles trying to decipher the good and bad bits of the study, structure will help you ask yourself all the important questions about how good a study actually is.
The CASP (Critical Appraisal Skills Programme) website for instance has some really helpful tools and templates that are free to access online, including their "Checklists" and "Appraisal sheets". They have been designed by EBP experts to help everyone like you and me to make sense of evidence. These tools help you critically appraise any kind of study, and all of us use them in our practice, because half of the work is already done! You can download them directly from their website: CASP Checklists.
Alright, back to the initial question...
"What paper have you read recently and how has it influenced your practice?" The key here is to remember to give your critique of the article, not just a summary. In an interview setting, when time is limited, we advise to use the "3 WHATS - HOW" template: What article? What I liked about it? What I didn't like about it? How has it influenced my practice? In the example below we'll use this article (do have a quick read so you can fully understand the critique).
Bernhardt et al. (2008) 'A Very Early Rehabilitation Trial for Stroke (AVERT)'
- Summarise the goal of the paper in one sentence: A paper looking at a very early mobilisation protocol <24h compared to a “usual” care group.
- Summarise its results in 3 sentences max: The results showed that significantly less patients in the “early” mobilisation group had favourable Modified Rankin Scale scores at 3 months compared to “usual care” group. Other secondary outcomes (Ability to walk 50m unaided, and proportion of patients achieving unaided walking by 3 months) were not significantly different for each group. There was a suggestion that haemarrohagic strokes may do less well with early mobilisation but this was not statistically proven.
What we did like?
- Looking into a practice which has become increasingly recommended in guidelines for the management of the acute stroke patient.
- Part of on-going series of trials over the last 10 years in to stroke care
- Published in a well-respected peer reviewed medical journal (The Lancet)
- Well carried out: blinded patients and assessors, 2 very homogenous groups for age, sex, type of stroke, premorbid physical wellbeing, function and social setup – shows robust randomisation, very large multicenter trial (56 centres in 5 countries – broad spectrum of population)
- Led by physiotherapists and nursing staff (as opposed to medics)
What we didn’t like?
- Primary outcome measure = “a favourable Modified Rankin Scale score 0-2” at 3 months
- Usual care group ended up being mobilized in first 24h,
- ?did trial protocol influence the usual care protocol
How has it influenced our practice?
It has made us question whether more and sooner is always better. It has made us think about careful patient selection and assessment when mobilizing stroke patients for the first time, the impact of treatment timing/dosage. It has also made us think about the stroke guidelines which we think are quite vague in relation to specifics of early mobilisation, and has got us interested in this particular area. We’re looking forward to seeing the further analysis of the data especially in terms of the dose response relationship. Lastly, it has made us realise that research and evidence don’t always match clinical and best practice guidelines – that neither should be taken as gospel and a careful analytical approach should be used to assess the impact for your own practice.
For each seminar, students receive (as well as the general pack) an interview pack specific to the area, including interview questions and answers, key articles and references and tips for the job. These are now available to buy separately.