Indexing diagnostic test accuracy
A new database is helping physiotherapists more easily access research through a website to inform their clinical practice.
The Diagnostic Test Accuracy (DiTA) database builds on the premise of the already established Physiotherapy Evidence Database (PEDro) to maximise the effectiveness of physiotherapy services, by enabling clinicians, researchers and patients to easily access information on the accuracy of diagnostic tests used by the profession.
DiTA indexes evidence, in the form of primary studies and systematic reviews, of the accuracy of diagnostic tests relevant to physiotherapy, while PEDro indexes more than 44,000 randomised trials, systematic reviews and clinical practice guidelines related to intervention.
It uses the same website platform as PEDro to ensure continuity in accessibility, says APA member Mark Kaizik, who developed the database with fellow researchers Professor Mark Hancock, APAM, from Macquarie University, and Professor Rob Herbert, APAM, the founding director of the Centre for Evidence-Based Physiotherapy that produces the PEDro database. Both websites offer free access to the databases and have simple and advanced search functions for studies and trials that are classified using physiotherapy terms.
‘Making an accurate diagnosis is a key step in the process of selecting appropriate clinical interventions for your patient care. To make those accurate diagnoses, we really need the help of research to guide that, yet up until this time we’ve lacked the resource that offered easy access to this much- needed information,’ Mark says.
‘Finding these types of studies is particularly difficult in the way they are indexed and coded on the bigger databases; they are not as easy to find compared with looking for a randomised trial of intervention. And then to find the ones that are physio-specific is more difficult still. So, to pull them all together into the one database for physios to use will hopefully be really helpful for clinicians, which is ultimately the reason we have done this.’
As of early September, DiTA was holding about 1000 primary studies, dating back to 1969, and more than 100 systematic reviews from 1993, indexed in 16 languages across all physiotherapy subdisciplines. Submission of new studies and reviews will ensure the website maintains currency.
‘Additional references will be added, but we have done a fair bit of work to ensure there is a considerable database of information for physiotherapists to access from its launch date. We have gone back and searched other databases as far as possible with this in mind. Before 1990, evidence of the accuracy of diagnostic tests used by physiotherapists was sparse, but the body of evidence has grown rapidly and is now substantial, so there is quite a bank of research for physiotherapists to call on,’ Mark says.
Diagnostic tests are widely used in physiotherapy to detect the presence or absence of specific pathologies, compared with non-diagnostic clinical tests that assess impairment, function or monitor progress, such as those for muscle strength and range of motion. Diagnostic tests aim at increasing the certainty of a particular pathology being present or absent, such as the Lachman’s test to determine injury to the anterior cruciate ligament or a lung ultrasound to identify pneumonia.
Mark has been involved with PEDro for a number of years and, after screening many trials for the database, knew that additional diagnostic test evidence would enhance clinical services offered by physiotherapists. It has taken more than decade for the website to go from inception to launch, with Mark initiating a PhD on the project while also managing his own clinical practice, Bend + Mend, which operates four sites in the Sydney CBD.
‘There’s quite a bit on,’ he says of his competing priorities. ‘It’s a bit of a juggle, but I can see that DiTA is going to fill a gap that I knew existed from my own clinical work. Like all big projects, it takes time to go from development to launch, but it is worth it. I am sure physiotherapists across all fields will find the database beneficial and an easy way to stay across the latest diagnostic testing and then use the results to structure appropriate management plans for their patients.’
The Editorial ‘DiTA: a database of diagnostic test accuracy studies for physiotherapists’ by Mark Kaizik, Mark Hancock and Rob Herbert was published in the July issue of Journal of Physiotherapy.
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