Date: 05 November 2018
Chris Brookes (pictured right at the CRN Wessex Awards) is a team lead physiotherapist at Dorset County Hospital. Working in a busy physiotherapy department, Chris and his colleagues service over 7000 patients a year.
In 2016, Chris became a Principal Investigator (PI) on an NIHR funded multi-centre trial comparing hospital based rehabilitation with rehab in patients’ own homes. Here, he offers an insight into his first role as PI and how he balanced this role alongside his clinical work and managerial responsibilities.
“The Oxford Clinical Trials Unit were looking for a PI for the CORKA trial, exploring rehabilitation for patients that have undergone a knee arthroplasty,” explains Chris. “Originally, we were thinking that one of the orthopaedic surgeons would take on that role. However, when we started to look at the details, we realised that it was a trial focusing more on the rehabilitation after surgery, rather than the surgical procedure itself.
“I was approached by the research team to see if I’d be interested. I didn’t say yes initially because I had a few questions around the likely commitment. Never having been a PI before, I wasn’t 100% sure what the role would involve so I had some more discussions around this. The key thing to consider was my role as a physio and the time pressures that exist, with regards to waiting lists and access times. The research team assured me that they’d do a lot of the heavy lifting and the majority of the paperwork. I’d be there both in an advisory role to sign things off and as a resource if there were any issues to discuss with regards to the post-operative rehabilitation.
“On this basis I was happy to go ahead. Obviously, I made sure that I had the support of my line manager and she was aware that there was going to be a bit of a time commitment there. We scheduled regular half an hour meetings every week with Dennise Hill, the research nurse who completed the majority of the data collection, so that she could come to me with any queries about recruitment and how to get people onto the study. We did really well with recruitment and with a target of 30 participants, we met our target and the recruitment ratio was good.
“One of the strengths of the study was that it was the first opportunity for our trust to work in collaboration with Dorset HealthCare, our local community trust, on research delivery. This is because the control arm of the study was delivered as traditional physiotherapy in the department, however the intervention arm was home delivered rehabilitation by physiotherapists and physiotherapy assistants. As a department that doesn’t deliver any community based physiotherapy, we weren’t able to deliver the intervention arm and likewise Dorset HealthCare couldn’t deliver the traditional post-operative physio. Realistically, the only way we could get involved in the study was to work together, and so the trial was set up with a PI in each site.”
Despite balancing two busy roles, Chris felt that the role of PI was complementary to his clinical work:
“The roles worked together well and I think that’s because the research team kept to their word and they did a lot of the heavy lifting. I had to complete the Good Clinical Practice training before I took on the role but after that we got going with the trial and we had half an hour a week to look through the recruitment. Also on an ad hoc basis, the research team might have been emailing or coming to find me to discuss an issue that had arisen. For example, there were a few potential adverse events that we had to look into, where people came in with other medical problems that had to be investigated.
“It was a really interesting process to be involved in and it wasn’t something that impacted negatively on my regular day to day work. I think it was probably a little bit easier for me to be a PI in a team lead role because I already had a reasonable amount of flexibility with regards to the managerial time. I think if I was working in a 100% clinical role it would have been a bit trickier.”
Having successfully delivered his first study as PI, Chris would like to take on the role again in the future and is keen to encourage other allied health professionals to do the same.
“If anybody is thinking of becoming a PI, they should take the opportunity if they can. I think it really opens your eyes to how research works. I’d be very keen to take on the role of PI again if it was an area that I was interested in within physiotherapy. I’d relish the opportunity. At the moment, I’m completing my masters but I’ll certainly look to get involved again. Within the next 18 months I’d be keen that we, as a department, did a little bit more research.
“I’d definitely recommend becoming a PI because it really gives you an insight into the research process and has lots of potential benefits to the department in terms of improving people’s awareness of research, how it works and the processes that go on. It also starts to make you question some of the things that we traditionally do. The CORKA study is looking at whether the way that we deliver physiotherapy in the hospital is the best way, and that’s not something I’d necessarily considered that deeply before the study came along.
“We should hopefully have some kind of an answer when the results are published as to whether to continue doing it the way we’re doing it or whether to put more resource into community services. It’s very interesting and starts to open your eyes to other possibilities. There’s lot of other areas where you start to think that perhaps we could do things slightly differently. Sometimes we don’t know what is the best way, a lot of what we do is custom and practice, a lot of it has evolved gradually over the years from the initial surgeons who first did these operations and decided what the post-operative procedures would be. In some areas, such as ACL reconstructions, we’ve got lots of research and a lot of evidence about what we should do, but for some operations that evidence isn’t necessarily there.
“It’s so important that we prove what the effective interventions are, the things that are going to work. There’s still a lot of things that happen in the NHS that are considered best practice or expert opinion but we just haven’t got the evidence base there to back up what we’re doing. As budgets get squeezed and cost pressures come on we need to be able to answer these questions so we know what we should be spending our resources on and that’s where research plays a part. Certainly within our department we try to be as evidenced based as we can, but the jury’s out on a lot of interventions, so the more good research there is, the more effective we will become.”
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