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How research can support working with patients
3 Plays3 hours ago
In the latest episode of In conversation with the GOsC, our Head of Policy and Education Steven Bettles speaks with Dr Jerry Draper-Rodi, Director of NCOR, Associate Professor at the University College of Osteopathy, and practising osteopath, about how research can inform day to day practice for osteopaths. They discuss how research can contribute to the whole experience of working with patients and how Jerry’s experience has changed how he works. They also speak about Jerry’s role at the National Council for Osteopathic Research (NCOR) and the resources they have available for osteopaths to support their work and CPD.
Find out more about NCOR: https://ncor.org.uk/
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Transcript
Introduction and Roles Overview
00:00:06
Speaker
Hello and welcome to another edition of In Conversation with the GEOSC. I'm Stephen Vettels, Head of Policy and Education at the GEOSC and I'm joined today by Gerry Draper-Rhodi, who's Head of Research and Knowledge Exchange at Health Sciences University, Director of NCORE and who chairs the Research Committee of Osteopathy Europe as well as being a practicing osteopath.
00:00:31
Speaker
So Gerry, you're very welcome. Well, thank you very much, Stephen. Thank you for having me. I'm very glad to be here. And you your role as director of Encore and of Health Science University's Head of Research and Knowledge Exchange and and everything you do really centres you very strongly in in that research academic environment.
00:00:50
Speaker
How do you see research informing day-to-day practice for osteopaths who who maybe aren't in that academic environment or steeped in the the culture of research as as as you are?
Shifts in Research Understanding
00:01:02
Speaker
Yeah, I think my view on that has changed quite a lot in the last few years. So I started dabbling with research, I think around 2009, perhaps.
00:01:13
Speaker
And at that point, um I think I had what I would probably consider now as a bit of a naive view of what research was about. And at that point, I really wanted to evidence how osteopathy can help patients. So I had this sort of really strong view that, you know, what I do with my patients is helping them. And therefore, I need to show the rest of the world how fantastic what we do is And so I i did a few things and then I started my professional doctorate.
00:01:44
Speaker
And during that, we had a one of the units was around reflective practice. And that really, um that was really disruptive in the way I started, manic well, the way was managing patients.
00:02:00
Speaker
um And I became acutely aware, and to say the least, about the fact that when I thought I was being holistic and being person-centered, that in fact there was quite a bit of a gap with what these terms mean and the way was practicing.
00:02:16
Speaker
ah My patients were getting better. My patients were happy. um I you know was quite happy with the care was delivering. ah But it sort of started highlighting things I was not really sure.
00:02:27
Speaker
So my view around research and practice became more of trying to come to research with curious eyes and trying to understand what is happening So rather than trying to prove something more trying to explore and see what might be happening.
00:02:48
Speaker
And I have to say, so that was around, I guess, 2011, 2012. That was um very challenging for practicing because um I started looking into some of our models and some of them I think it's fair to say are very outdated and it left me with a bit of a a
Adapting to Modern Scientific Practices
00:03:11
Speaker
nothing. I wasn't really sure how to deal with that.
00:03:14
Speaker
So I had quite a few years which were quite challenging. um I was still seeing patients, but trying to find ways of explaining what I was doing with my hands that would fit more with current understanding of health and science, um whilst not putting aside the hands-on component, which I think is and important, ah respond to patients' expectations.
00:03:38
Speaker
But at the same time, the theories behind them were not really clear. That was quite difficult. And I was very lucky after my professional doctorate ah to get role at what was then the university. Well, i think it was then the BSO in the research department um and then became UCO and then HSE.
00:03:58
Speaker
um Because that allowed me to continue this exploration. So I was able to continue my work around the biopsychosocial management of non-specific low back pain. but also to collaborate with, you know, like OPHM, the osteopath for the prevention of headaches and migraine or something along those lines. I'm not sure about the the real acronym.
00:04:20
Speaker
Yes,
From Advocacy to Exploration: Equity and Inclusion
00:04:21
Speaker
I think that's the one, isn't it? Yeah. Yeah. And, um, around headache and education for osteopaths. um I did some research on education. So that really ah broadened my view on what we do.
00:04:35
Speaker
um And so from the sort of advocate that I was Initially, I morphed into this sort of curiosity, trying to explore what's happening. um and And then I became again, it went back into advocacy, but not really for demonstrating how the profession is good, although I still think, you know, that there is something.
00:04:58
Speaker
ah very important in where we deliver. So it's not against that, but I i think I'm slightly more neutral when I try to and do when i do projects on our care, clinical care.
00:05:13
Speaker
and The advocacy bit is more around equity, diversity and inclusion where I think there is a clear gap at the moment and I'm trying to find ways of fixing that rather than just exploring this problem.
00:05:26
Speaker
um I also have moved towards some of advocacy work because of Osteopathy Europe, the committee I chair. we We try to respond to issues that might happen at the national level and supporting organizations to work with these sort of issues. So there's a political side of my work.
Integrating Research into Practice
00:05:45
Speaker
But going back to your question, Now I'm much more comfortable into bringing practice and research, but it's been a journey and I can see why um research can be a bit opaque or can be seen as ah threatening by some clinicians sometimes.
00:06:04
Speaker
Yeah. now you still You still work as an osteopath, don't you? Yeah. You work an osteopath as well. That's and and has has you Has your research and your kind of development in that direction over the years changed the way you practice as an osteopath, do you think? Or is it more that it's helped you contextualize what you do? um ah i was thinking about you and maybe the difference between you know if if you were to talk to a patient that you saw when you first qualified one now yeah you know would they would they feel that that you know that you were completely different in the way you approached it or would it actually feel quite the same but what's going on in your head may be different as a result of all of your development over the years so i graduated in 2007 um i think um with the hindsight probably i was a little bit cookie when i first graduated and
00:06:59
Speaker
I was quite paternalistic in the way i was managing patients. And I have say that was in a French context where healthcare is very paternalistic. And therefore, I think um it wasn't surprise for patients. Not that it was maybe ah the right thing to do, but it wasn't ah clashing with their previous experiences of healthcare.
Evolving Patient Communication
00:07:22
Speaker
and So it met their expectations of what... Yes, to some extent, but yeah, because they were exposed only to sort of, you know, that sort of practice. So I think at that time, it was quite a one-way street where lots of information was coming from me to them. The treatment was then delivered from me onto them.
00:07:43
Speaker
And if, you know, we jump into 2025 and we look at treatments or a session or treatment ah with a patient, it's much more a sort of conversation, two-way street, trying to work ah together.
00:07:59
Speaker
um And I think that would be the main difference. Also, i find... and really interesting and a therapeutic point of view to explore their context and environment, which is something I probably wouldn't have done much in 2007.
00:08:17
Speaker
Regarding the treatment, the hands-on aspect um I think it it is likely to be a bit different, or at least my reasoning for it is definitely way different. The sort of, you know, and ah chains of lesions from the ankle going to the knee to the SIJ, SOAS diaphragm and so forth.
00:08:35
Speaker
I think i you know I've left that behind a long time ago. ah But I still you know use my hands, a fair bit of the appointment time, ah provide advice. So you know I think if you were friend of mine in France, Marco Gabouti says, um because he had a sort of similar shift in his practice, he said, you know, if you filled me a long time ago without the sound and now without the sound, it would look similar.
00:09:00
Speaker
But if you put the sound, quite different. To some extent, that's quite true. i think there are other differences too that you know that has happened if you were just looking at the video. But for sure, the sound would be way different.
00:09:14
Speaker
Yeah, that it's and that's interesting, isn't it? that that That shift in perspective. I had the same thing, I think, because i don't I'm still registered. i don't see patients anymore. And I work full time in regulation these days. But I did maintain a small practice throughout many years of kind of working in education.
00:09:32
Speaker
and and ah And I used to reflect a similar thing that, in fact, the i I would think the what what the patient perceives that is happening is probably very similar to when I graduated 20 years ago.
00:09:43
Speaker
But actually what's going on in my head is very different and and with ah much more of an emphasis on the communication and what we're talking about and and those kind of aspects than the, you know, L5 is doing this or that, you know. So, yeah, um yeah, I had a similar sort of... um journey, I guess, in in in in that respect.
What Distinguishes Osteopathy?
00:10:05
Speaker
And yeah you touched on earlier as well about some osteopaths might see research as a bit intimidating or threatening. do you Do you see research as ah as ah as a key to highlighting the differences between osteopathy and other professions or the similarities or a bit of both? You said that that that initial kind of interest in research about you know proving what we do is great.
00:10:30
Speaker
and then it's sort of shifted more to kind of thinking what's actually going on and and how can we enhance that for the benefit of the patient and that's a sort of shift over time I think you know all osteopaths and that could be applied to clinicians but also you know I don't know your plumber or you know their local ah head teacher whatever you know whatever the profession we all use evidence whatever type of evidence, you know, it might be your own experience, it might be what your neighbor said.
00:11:01
Speaker
ah Trish Greenhalgh from Oxford University, she talks about mind lines. So rather than guidelines where, you know, it's something that is on a document and try to see that work and this sort thing, mind lines is much more fluid.
00:11:14
Speaker
And you are informed by a collection of ah sources that will inform how you're going to think about problems and also what the patient tells you about what they had before and that.
Navigating Evidence-Based Practice
00:11:26
Speaker
So it's a very complex dynamic, isn't it, how we are going to way different types of evidence that might be from different epistemological you know stances and we try to make sense of all of that sometimes without really being aware it's sort of happening in the background and you know a solution pops into our mind oh yeah I think we should do that um so you know I think at the end of the day we all use evidence ah then what types of evidence is where it becomes a little bit challenging if we go back to the sort of you know
00:12:00
Speaker
we always go back to Sackett's definition of evidence-based medicine, 1996, I think. um You know, it's looking at the ah best level of evidence. So what could be considered as coming from research, but also the clinician's experience and also the patient's values and preferences.
00:12:17
Speaker
So it's not like research is going to be the only thing that's going to drive the way we ah ah reflect the way we think when we are interacting with patients, but that's going to be one of the components that we can use.
00:12:30
Speaker
and our own experience is valid, important to also inform that discussion and decision with patients. And, you know, patients' preferences and values are obviously key to ensure that the treatment they receive on their body, because at the end of the day, that's, you know, it's them and their body that is, so we are really ah at their service to try to provide the best care for them and what is important for them and what they value life and so forth.
00:12:56
Speaker
ah So it's really mixing all of these things together. so I think sometimes people, when they think about research, a they think about randomized controlled trials. that That's what research is about. And yes, but it's just one aspect of research.
00:13:10
Speaker
But also when we think about evidence, you know, our own experience is some form of evidence that we're going to use. When we go to our regional group and our colleagues, oh gosh, I had a patient with adhesive capsulitis or frozen shoulder last week, and we tried that and it was so good. That next time you see a patient with frozen shoulder, you're likely to think, oh, hang on a minute.
00:13:30
Speaker
you know Jim or Sarah told me that last week. I'll give it go and see what happens. And that is how we inform you know our our way of ah practicing.
00:13:41
Speaker
So, you know, whatever, know, 15 years in my journey with battling with clinical practice and research. I'm really comfortable now with that because I think, you know, all the sources, I use them to inform care.
00:13:56
Speaker
um And there are areas of practice for which we have little evidence or no evidence yet, um which doesn't mean that it doesn't work. It's just that we don't have evidence that it does work or how it works.
00:14:09
Speaker
um And for that, then that's where, you know, using all these sort of um constellation of sources of evidence is going to be really important. So we can sort of triangulate, see if it makes sense and all of this.
00:14:20
Speaker
And other areas like low back pain, you know, we have now good levels of evidence and we can also use whatever Jim and Sarah said last week at the regional group meeting, but that's going to be informed by other types of evidence. So, you know, I think this sort of weighing balancing act um is something that,
00:14:39
Speaker
to some extent, we we all do in our everyday lives. So if an osteopath then becomes aware of existing literature on a topic, it's it's not going to replace any of the rest.
00:14:54
Speaker
It's just going to add another layer or you know another source to try to make sense of how might be the best way to manage this specific patient with this condition in this context and so forth.
00:15:08
Speaker
It's that sort of navigation of complexity and varying degrees of complexity, isn't it? And using everything, you know, the whole of your experience, whether that's two weeks on the register or 30 years on the register, everything kind of goes into the mix coupled with, as you say, you know, in some areas there's good evidence for if you do this, this and this with these conditions, it's tends you know this tends to be the the pattern it's going to follow.
00:15:30
Speaker
But other other um other cases are much more... complicated and people are complicated and it's about that it's about that relationship and the the interaction isn't it between a practitioner and a patient and how how they both bring something to that and that and i suppose that's What always interested me about the, um about osteopathy as such, it was, it was that kind of relational aspect and the, it you know, your, your, the, the role that you fulfill as a practitioner in trying to help someone navigate a particularly challenging part of their lives, whether that's something massive and existential or whether it's,
00:16:07
Speaker
their knees a bit painful and and they want to go skiing or something, you know, that, that, that's, that's, that, that sort of human interaction was something that I always found interesting.
Practitioner-Patient Relationship
00:16:18
Speaker
And I think that's kind of, that, that's the sort of fundamental part of trying to, you know, that, that informs a lot of practice, isn't it? It's just trying to sort of, trying to help someone, as you, as you said.
00:16:31
Speaker
you're completely right that, you know, this sort of um relation relational um ah conversation aspect of, ah you know, our encounters is really key.
00:16:45
Speaker
um And that's going to, you know, I'm trying to sort of Going back to what I was saying earlier, there are some aspects where we have clear evidence it works well, others where we don't really know.
00:16:59
Speaker
um I think that's also part of the discussion we're going to have with the patients. you know So when a patient is coming to us and they have, again, let's say you know low back pain or some sort of musculoskeletal issues, um you know the the evidence is you know getting quite robust on these aspects.
00:17:16
Speaker
And that's something we can say about you know what we expect the benefits are going to be and stuff like that. And when they come for something which is a bit more unusual and the evidence is not really ah robust or clear, well, that's where we're going to well, we don't really know. But, you know, in my experience, I've had a few patients and some of them had benefited.
00:17:37
Speaker
Others, it's not really clear. That's where we are. And then the patient can make the decision whether it's something they want to invest time and money and all of that, or if they want to go elsewhere. So, again, you know, it's...
00:17:50
Speaker
This sort of challenge that we have is not unusual. any healthcare care practitioners, whatever your background, is going to face areas of their practice for which evidence is low or not yet existing.
00:18:04
Speaker
and you convey that information. There's nothing we can do about that you know at the moment when when we are facing the patient. As a profession, there are lots of things
NCOR and ENCORE Initiatives
00:18:14
Speaker
we can do. We can invest into research, we can upskill the profession so that we have... And and we're seeing that at the moment. you know It's really beautiful.
00:18:22
Speaker
There are loads of osteopaths taking post-grad MSCs, taking PhDs, taking part in research projects. So, you know, with ENCORE we do PROMS, patient-reported outcome measures.
00:18:33
Speaker
Lots of osteopaths are collecting data in their clinic. We've started the ENCORE Research Network. We have more than 600 osteopaths who are members who are helping to collect data in the sort of real world osteopathic practice.
00:18:48
Speaker
So, you know, we can see that the engagement his research has really boomed in the last, I don't know, 10, 15 years, perhaps. So there are lots of things we can do, but when we are facing the patient and we don't have that information, that's fine. We just explain that. And yeah yeah I think everyone would have said that situation.
00:19:06
Speaker
Exactly. And yeah i was I was going to, in in the in the context of all that we've discussed, um I and you've you've just you've just sort of beaten me to it actually I was going to ask about NCOR's of um working in in that in that space a bit really because um NCOR it sounds when you say the National Council for Osteopathic Research it sounds like there's lots of people kind of beavering away in a university department and it really isn't that is it it's kind of it's kind of A couple of people. Exactly. So it's a small ah but dedicated team. Yeah. and So it's ah three of us working in Encore.
00:19:48
Speaker
in so um So I'm the director. And then there's Dr. Carol Fawkes, who's been with Encore for nearly 20 years. And ah Dr. Daniel Bailey, who's been with us for a couple of years now.
00:20:03
Speaker
And um we have obviously a board of trustees who are ensuring that the governance is right. But the sort of executive team, it's Carol, Dan and myself.
00:20:15
Speaker
and And we all have different roles and things like that, but they are I think to some extent, NCORE has two aims. One of them is to support our stakeholders into engaging more with research, maybe conducting research, collaborating with each other um so that the evidence base gradually increases for the profession, but also is used by the profession.
00:20:41
Speaker
So our stakeholders including GIO, the Osteopathic Foundation, but also the Osteopathic Education Institutions in the UK. um And another aspect is around conducting and disseminating research to mostly osteopaths.
00:20:57
Speaker
And for that, I've already mentioned PROMS, the ENCOVE Research Network, but we have journal clubs. um So we we do, obviously, on social media, we share posts and things like that. But so we we um really try to engage with the osteopaths so that it's easier ah for them to to engage with research, to gains skills into understanding what is a good for example systematic review or what are the pitfalls in another one so um we have these dual rules supporting organizations and also supporting the profession and you produce some some great resources as well I'm ah i'm often asked by osteopaths about you know a clinical audit or resources on particular conditions and things like that and they they're not aware that you know that the sort of you know the the quality of information that's available readily available
00:21:55
Speaker
to uh to everyone for patients and for um for practitioners on the encore website so i often point people in that direction yeah so i have to say i think we we were a little bit um um to blame for that because the website used to be quite dated and it was a bit of a maze to try to work out where the information was.
00:22:16
Speaker
So we worked with a fantastic webmaster a couple of years ago and we refreshed the whole website and we're going through another audit of the website at the moment. um So now it's much easier. and There's a ah part of the website which is for patients with information really dedicated to them and another part which is more for clinicians and where there are lots of information And yeah, regarding clinical audit, we did ah an an interesting exercise last year where we invited osteopaths to take part.
00:22:46
Speaker
It was part of the I.O. roadshows. We did a clinical audit around cervical pathology that was mimicking MSK pain.
00:23:00
Speaker
um so we um proposed to osteopaths to join that project and we collected data from 150 bit more maybe osteopaths on around 600 patients. um so we are finalizing now the audit cycle so we'll have all the data and we'll submit that for publication.
00:23:20
Speaker
But that was really, the engagement was fantastic and you know I think being blunt people think clinical audit is really dull and not really useful um and but it all depends on the topic you choose isn't it and for something like that um so what used to be cervical artery dysfunction and now it has another word which i you know i can't really remember it's around sort of you know uh artery arterial can't remember henna um And the you know that is something that is really interesting clinicians, because I think we're all worried that it could happen to one of our patients.
00:23:56
Speaker
And for them to look at what they are currently doing and what the standards are, where the sort of gap is and what they can do towards you know meeting that gap to ensure that they are safe for their patients, but also for themselves. you know and that was ah highly valued so all of these resources even though we're not collecting data any anymore all of the resources are on our website and osteopaths can still do the clinical audit with their own data and finish the cycle and use that as an objective activity for their cpd return so yeah we have lots of resources on our website which i think are quite helpful yeah yeah and i think it's important for a profession like osteopathy where a lot of people working quite
00:24:40
Speaker
isolated practice, and if everyone was employed but in big employers, this stuff would get filtered down by their managers and the, the, the, that doesn't really, that doesn't really happen so much in osteopathy, does it Um, and, uh, so yeah, having that kind of accessible information available, I think it's, um, it serves a ah really useful purpose.
00:25:03
Speaker
Um, Yeah, well, Gerry, look, thank thank you so much for talking us through some of this today. I mean, hopeful hopefully people will get a sense of who you are as ah as a person, as a clinician, as as well as a researcher and the sort of the contribution contribution that you've the that you continue to make ah ah in in in this area. I think it's it's something for me that um that that that notion of what research is and, like you said, that transition from the ah
00:25:33
Speaker
earlier days when you were kind of thinking we need to prove that osteopathy works and ah to to that kind of more what is going on here sort of approach that that sort of just keep being curious about what's happening while you just get on with it is is is uh is is really interesting and reassuring as well and the kind of the the way in which everyone can can think about it build it into their practice Stephen Ward- then it it it informs it, but it doesn't overwhelm it and I think all of those those those things are really helpful to think about, so thank you for talking to us today and thank you for the work that you're doing.
00:26:14
Speaker
Stephen Ward- Thank you Stephen, thank you very much.