Barbara Richardson

Background. The current emphasis on evidence based physiotherapy focuses on building knowledge through systematic review of quantitative inquiry studies. Knowledge that provides a framework for practice can help practitioners to decide when and how to use this evidence in their practice contexts. Purpose. This paper argues for increased attention to metasynthesis of qualitative inquiry research studies to help identify an underpinning professional knowledge base of physiotherapy that is relevant to day to day practice and education, and to emphasize an epistemological dimension of physiotherapy practice as a socially embedded professional activity. Methods. An outline of knowledge development in physiotherapy is followed by an explanation and description of the process of metasynthesis and an evaluation of the value of metasynthesis to physiotherapy practice and education. Argument. Integration of substantive knowledge from metasynthesis of individual qualitative inquiry studies, can generate middle range theory to give a degree of abstraction which can provoke broader questions and insights to re‐conceptualize issues of practice. Conclusions. The methodological approach of metasynthesis can lead to broader and deeper conceptualization of the quality of professional activities which are fundamental to integrating research evidence in successful physiotherapy service delivery. Copyright © 2010 John Wiley & Sons, Ltd.

Objective: The Department of Health is reviewing the effectiveness of accident and emergency (A&E) departments. This study aimed to compare health and economic effects of physiotherapy initial assessment and management with routine practice in an A&E department. Methods: Randomised controlled trial and cost and consequences study. Patients presenting at A&E were eligible if suspected at triage to have soft tissue injury without fracture. The efficacy end point was “days to return to usual activities”. Secondary end points included patient satisfaction with their care and further health outcomes and cost data. Results: 766 of 844 (915) patients were randomised. The median days before return to usual activities (available for 73% of those randomised) was greater in the physiotherapist group (41 days compared with 28.5 days; hazard ratio 0.85 p = 0.071). The physiotherapy group expressed greater satisfaction with their A&E care (on a scale of 1 to 5, median was 4.2 compared with 4.0, pConclusion: There is evidence that physiotherapy leads to a prolonged time before patients return to usual activities. This study shows no clear danger from physiotherapy intervention and long term outcomes may be different but given these findings, a best estimate is that introducing physiotherapist assessment will increase costs to the health service and society. Routine care should continue be provided unless there is some reason why it is not feasible to do so and an alternative must be found.

As multidisciplinary collaboration in both clinical and research settings is becoming a key aspect of contemporary health care, strategies to enhance interprofessional interaction in postgraduate research programmes can offer important experiences to facilitate ongoing interprofessional relationships. This paper provides a retrospective appraisal of a strategy which used computer-mediated communication to develop a virtual community network, known as'health_voice' accessed through a web page. The rationale for developing the network is presented, and the process of designing and establishing the web-site through an action research approach is described The outcome of the strategy is reviewed with regard to the relationships between the real' and 'virtual' community. Reflections on the developmental process contextualise the initiative within a concept of a community-of-practice. It is acknowledged that the use of a virtual arena for communication within a research community involves a cultural change in the dynamics of higher degree teaching and learning. Future plans to further embed the virtual environment within a postgraduate research culture are given.