Streamlining the journey of research into clinical practice: making your patients and practice flourish

By Charles G. Fisher, Janneke I. Loomans, Olesja Hazenbiller

In today’s fast-paced personal and professional environments, maintaining excellence in spine care is not merely an option but a necessity for clinicians dedicated to the highest standards of care. However, operationalizing and sustaining this commitment is challenging, reflecting the complexities inherent in Knowledge Translation (KT). The new article series “Streamlining the Journey of Research into Clinical Practice” will review articles by the AO Spine Knowledge Forums published in the Global Spine Journal (GSJ) are designed to help clinicians incorporate cutting-edge research into their practice more quickly and efficiently.

Although KT is difficult to define due to its broad scope, it can be simply described as the process of moving research findings into clinical practice. While this seems straightforward, it is an area where clinical and health services research often falls short, resulting in missed opportunities for patients and unnecessary costs to healthcare systems. Alarmingly, research indicates that it takes an average of 17 years for scientific evidence to be adopted at the clinical level.

The first quarter of the 21st century has seen rapid advancements in spinal surgical practices and Evidence-Based Medicine (EBM). Breakthroughs in research and technology have transformed the management of spine patients across various pathologies, including deformity, degenerative conditions, trauma, oncology, and spinal cord injury. Innovations in diagnostics, minimally invasive techniques, implants, biologics, navigation, robotics, and artificial intelligence have all contributed to improved patient outcomes and safer care. However, this rapid progress, coupled with the exponential growth in clinical and basic science research, has made KT an increasingly daunting task.

EBM was developed to manage this growth, serving as a gatekeeper for the transition of clinical research into practice. But has this made the KT process any easier? While techniques for critically evaluating medical evidence have been refined, incorporating these principles into daily medical and surgical practice remains a challenge. Clinicians are expected to acquire this knowledge, critically appraise the literature, and apply findings to clinical practice. In reality, however, most clinicians lack the time, motivation, or specialized training to perform these tasks. EBM has successfully taught the importance of patient-reported outcomes and the hierarchy of study designs, but expecting busy clinicians to do more is often unrealistic.

EBM involves integrating clinical research into therapeutic decision-making. Building on the foundation established by Cochrane in 1972, the hierarchy of "best evidence" was introduced in the 1990s, providing a powerful tool for appraising the quality and applicability of evidence to patient care. While these principles became the cornerstone of EBM, pragmatism gradually tempered academic idealism, reintroducing the importance of clinical expertise and patient preferences in the evaluative process. Today, EBM is defined as an approach to healthcare that combines valid, relevant, and applicable evidence with patient conditions and preferences, all within the context of clinical experience and expertise. Thus, evidence-based practice involves a critical evaluation of scientific literature, informed by clinical expertise and a strong commitment to patient-centeredness and humanistic values.

This evolution led to the development of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group, which provides a framework for basing clinical recommendations. These recommendations, anchored by the quality of scientific evidence but modified by patient preferences, risk/benefit analysis, feasibility, and resource implications, can be strong or conditional. Various professional societies have adopted these guidelines, although organizational EBM often lacks clear direction, frequently concluding that "more research is needed," which may not be helpful for busy clinicians making critical patient care decisions.

In the GSJ’s “Streamlining the Journey of Research into Clinical Practice” articles, we will use the current GRADE system to provide clinicians with strong or conditional recommendations for incorporating research findings into clinical practice. These recommendations will be generated by AO Spine Knowledge Forums, consisting of key opinion leaders and methodologists, ensuring the proper application of the GRADE approach. The focus will be on studies deemed worthy of incorporation into clinical practice, serving as a KT tool to enhance both patient care and clinical practice.

Spine surgery is a challenging specialty, requiring not only technical skills but also complex decision-making and risk management. A surgeon’s training, technical abilities, tacit knowledge, and experience significantly influence their practice, making the introduction of changes more demanding compared to other medical or surgical fields. KT for surgeons varies depending on their setting, whether they are community or academic surgeons, and their career stage. While the complexities of KT cannot be solved in one effort, the GSJ’s articles aim to help clinicians make their practices and patient outcomes better.

Article details

Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish
Charles G. Fisher, Janneke I. Loomans & Olesja Hazenbiller
DOI: 10.1177/21925682241254810
First Published: May 15, 2024
Global Spine Journal

About the Authors

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Janneke Loomans, PhD, earned her doctorate in Pediatric Hematology from the University of Amsterdam. She has a passion for generating knowledge and particularly enjoys how collaboration can significantly amplify knowledge. With the rise of promising new technologies capable of treating genetic diseases like Hemophilia, and recognizing the challenges faced by current healthcare systems, she chose to support the development of digital solutions that can transform the future of healthcare. Janneke has designed and coordinated cutting-edge research projects and clinical studies, providing essential clinical evidence for digital medical technology. Beyond technological advancements, Janneke believes that healthcare systems require human-driven care. This belief fuels her involvement with the Leading Doctors Foundation, where she investigates interventions aimed at improving physician well-being.

Currently, Janneke serves as a Senior Project Manager in the Clinical Operations team at the AO Foundation’s Innovation Translation Centre. She oversees the Spine clinical study portfolio and co-leads the AO Knowledge Translation initiative, aiming to bridge the gap between research evidence and its practical application. Her work is dedicated to ensuring that innovative medical research leads to tangible improvements in patient care.

Olesja Hazenbiller is a Senior Research Project Manager at the AO Foundation, where she manages multiple research projects in the field of musculoskeletal health, with a particular emphasis on spinal trauma and spinal cord injury. Currently, she is responsible for the AO Spine Knowledge Forum Trauma & Infection research portfolio and co-leads the AO Knowledge Translation Task Force together with Janneke Loomans.

With a master’s degree in biomedical engineering and a project management professional designation, Olesja is passionate about applying her scientific and technical expertise along with best project management practices. Her goal is to enhance patient care through high-quality research that is both relevant and impactful. To ensure that project outcomes effectively reach end users, Olesja incorporates integrated and end-of-project Knowledge Translation concepts in her projects, to accelerate the uptake of results for the benefit of patients and clinicians.

Charles Fisher is a professor and the former Head of the Division of Spine Surgery and Combined Neurosurgical & Orthopaedic Spine Program at Vancouver General Hospital and the University of British Columbia. His practice is confined to adult spine surgery with subspecialty interests in spine trauma and oncology. He has a master’s degree in Health Care and Epidemiology and is the former President of the Canadian Spine Society. In 2019 Dr Fisher was awarded the North American Spine Society's Leon Wiltse Award, recognizing excellence in leadership and research in spine care.

Dr. Fisher has research interests in spine trauma, oncology, and evidence-based medicine. He is Past Chairperson of AO Spine Research Commission and AO Spine Knowledge Forum Tumor (AOKFT) an international group of spine oncology surgeon thought leaders committed to advancing the understanding of spine oncology through education and multicentre research. He was the lead author of the SINS classification for metastatic spine disease, now broadly adopted by both spine surgical and oncology disciplines. Dr. Fisher is on the advisory board of the Canadian Spine Outcomes and Research Network (CSORN); a multicentre research network and registry he formally chaired and initiated in 2013. He currently chairs the AO Task Force on Knowledge Translation and is on the advisory board of AOKFT.