The Kettlebell Physio

**Only one more week to go for the first cohort of the Clinician-Led Evidence and Reporting (CLEAR) programme!**

It takes a lot of courage to do this.

To intentionally put yourself in a vulnerable position.
To feel like a beginner and learn a completely new set of skills.
To add this to an already busy work and home life.
To be the first to step forward.
And, ultimately, to put your clinical work out there for others to see.

Most healthcare professionals *claim* to practise evidence-based care.

The clinicians taking part in CLEAR aren’t just claiming it - **they’re showing us.**

Over the past seven weeks, they’ve worked through the evidence surrounding their own clinical cases, critically examined their decision-making, and begun turning that work into case reports that others can scrutinise, learn from and build upon.

Along the way, we’ve also created a couple of resources that are now publicly available.

📋 **CARE-MSK Checklist**
A new checklist to support the reporting of musculoskeletal case reports. You can find it at https://www.clearproject.com.au/ → Research, or access it directly through the CLEAR project on OSF: https://osf.io/h75zj/files/qnvc9

📄 **Plantar Fasciopathy: Exemplar Case Report**
If you’d like to see what a CLEAR case report can look like, I’ve created a worked exemplar alongside the participants over the past few weeks. Inspired by the Fasciitis Fighter, it gave me an opportunity to go through the same process: start with a clinical case, interrogate the best available evidence, and show explicitly how that evidence informs clinical reasoning and care.

You can find the exemplar at clearproject.com.au → Research → Plantar Fasciopathy: Exemplar Case Report.

CLEAR is intended to become a growing community of practice for community-based, MSK-focused health professionals who want their patient care to be informed by the best available evidence, and who are prepared to show what that looks like in practice.

I suspect our first small group of absolute legends will be just as excited to share their case reports as I will be to see them out in the world.

One week to go.

This is too good not to share, and aligns beautifully with what we’re trying to do with CLEAR.

If you identify as an ‘evidence-based’ clinician, this will probably give you the warm fuzzies.

If it doesn’t… well, it might be worth asking why. 🙂

Pre-print:
https://www.researchgate.net/publication/410998226_Physiotherapy’s_Philosophical_Phobia_Will_Be_Its_Demise

Part 1 was about the care itself: the same patient can see different clinicians and be offered very different things. The point wasn’t that every difference is wrong, but that the quality of the evidence should influence what we offer, and how confidently we offer it.

Part 2 then turned the lens onto the research. Evidence is rarely as clean as “the evidence says…”. We have to interpret it, look for uncertainty, question how strong it really is, and stay willing to change our minds.

Part 3 moves into a different kind of messiness: what happens when good care is harder to sell?

Sometimes the most defensible care is not another treatment, another appointment, or a confident promise.

It might be reassurance, education, self-management, monitoring, time, or deciding that more treatment is unlikely to help.

Those decisions can involve a lot of clinical expertise, but that expertise is much harder to see.

This one is also a bit more personal. I know the tension between trying to provide care that feels ethical, evidence-informed and genuinely useful, while also running a business that needs to pay its bills. I wasn’t able to make that work.

Perhaps part of the answer is making the reasoning behind good care more visible - not as a testimonial or a promise, but as something another clinician can examine, question and learn from.

That idea sits very close to the heart of CLEAR.

Geoff Ford Physio Tim Trevail | Jiu-Jitsu Rehab Specialist Kendal Sands Frances Brown
CLEARproject

Every published case report begins with a clinical story worth sharing. But seeing the destination and knowing how to reach it are two different things.

Three weeks ago, CLEAR’s first cohort set out to turn clinical cases grounded in the best available research evidence into published case reports. The destination was clear, even when much of the path ahead was hidden by cloud.

Since then, we have been doing much of the work that readers of the final papers will never see: asking focused clinical questions, finding and appraising the research, and working out what the evidence can, and cannot, support.

At times, it has felt like an uphill struggle: slow progress, with little that yet looks like a paper. But as we begin Week 4, the cloud is starting to lift.

The evidence is organised, and we are now bringing it together with each clinical case to begin writing. We’re not at the summit yet, but we can see more of the path ahead, and how each of those earlier steps has prepared us for what comes next.

Over the coming weeks, we will continue sharing the journey as we bring research evidence and clinical stories together, develop them into case reports, prepare them for submission and, we hope, see them published.

Swipe through to see the full 12-step CLEAR pathway.

Avoid a desk rejection. Strengthen your manuscript before submission. Improve your chances of getting through peer review with fewer revisions.

If you’re writing a health sciences paper and want feedback from the perspective of an experienced journal editor and peer reviewer, ask Reviewer 2.

Reviewer 2 examines the manuscript before submission, looking at study design, methods, statistics, reporting, interpretation, ethics, transparency and alignment with the supporting evidence. It then provides structured, practical feedback to help you improve the paper.

It may also be useful for health sciences journal editors facing a high volume of submissions: helping identify major problems early, distinguish stronger manuscripts from weaker ones, provide authors with more useful feedback and avoid sending unsuitable papers out for review.

‘Reviewer 2’ has a notoriously difficult reputation. *This one* is constructive, thorough and surprisingly friendly.

Evidence-based practice sounds simple: follow the evidence.

But once you start reading research, things become much less straightforward. Studies differ in quality, results can be presented in misleading ways, conclusions can overreach the data, and even systematic reviews have to be critically appraised.

For me, being ‘evidence-based’ has become less about finding the answer and more about asking better questions.

How good is this evidence? How certain are we? Does the conclusion fairly reflect the findings? And how should all of this influence the conversation with the person in front of us?

I don’t think good evidence-based clinicians simply follow research. They question it, interpret it, acknowledge uncertainty, and remain willing to change their minds when better evidence emerges.

That is not a weakness. I think it is one of the defining characteristics of evidence-based practice.

How has your understanding of what it means to be ‘evidence-based’ changed over time?





physio

Evidence-based practice is messy.

I’ve been thinking a lot about what it actually means to be an ‘evidence-based’ clinician.

Most of us probably like to think that evidence influences the care we provide.

But the same person, with the same problem, can see different clinicians and be offered completely different care.

There may be ‘evidence’ for all of it. But that evidence is not necessarily equally good, and it may not support each option with equal confidence.

So perhaps the more useful question is not simply:

Is there evidence for what I do?

But:

Did the quality of the evidence genuinely influence what I offered?

I’d be interested to know what others think.

Part 1 of a new series on the messiness of evidence-based practice.

physio

Another week, another GPT for you. This one was a real b280 in the s7104/4 though!
I’ll explain.

Those are ICF codes for “pain in the neck” — remember the International Classification of Functioning, Disability and Health?

If your training was anything like mine, the ICF was presented as a model to be applied to every clinical case…
…and then was never seen or heard of again after graduation.

Perhaps your experience was different. Anyway, I recently came across a special issue led by Prof Todd Davenport (published in 2013), which made a case for physical therapists using the ICF when reporting case reports.

Before that, Todd and colleagues had published two worked examples using the ICF in case reports: DOIs: 10.2522/ptj.20080113 | 10.2519/jospt.2010.3264

Evidently, neither clinician-authored case reports nor routine use of the ICF have been widely adopted. I trust CLEAR will be encouraging that horse to take off, rather than flogging a dead one.

For anyone unfamiliar with the ICF, it is a World Health Organization framework for describing functioning, disability, and health; a shared language for clinical care and interdisciplinary communication, encouraging a BPS, person-centred approach.

Routine in principle, but not routine in practice. More commonly used in rehab settings, but even then the literature suggests its use has been limited (PMID: 24986707).

Still, I figured it might be a useful addition to the CLEAR project, for those keen to use it, and possibly for your case notes right now, to describe the person, not just a pathology. Given the coding system, I can see potential value for future reporting too.

Davenport presents two formats; a table and a figure. The TL;DR is this: ChatGPT is currently not “good enough” to recreate the figure cleanly without a lot of manual formatting pain, so, after many many hours of hair pulling, I shelved that idea.

This GPT now focuses on recreating the table. You enter the case details step by step (without identifiable patient information), and it produces an ICF-informed case profile in either a copy-editable table format or as an image, plus a corresponding case description.
Give it a go. Feedback welcome!