Typically, it takes 17 years for clinical research to become standard healthcare practice.

When new interventions (treatments or services) do make it into healthcare practice, there is no guarantee that they will stay the same and work as well as they did in the research that generated them.

To give patients faster access to new health innovations while keeping the effectiveness of interventions, new approaches are needed.

The goal of this project was to come up with and test a way to speed up the process of putting evidence-based physiotherapy interventions from clinical trials into everyday practice – an ‘implementation operating model’.

Researchers based in the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, collaborated with colleagues from the University of Exeter to develop this work, supported by funding from the NIHR ARC OxTV and the Mireille Gillings Foundation (University of Exeter).

What they did

After identifying the target intervention, our implementation operating model involves:

  1. Using the knowledge gained from a clinical trial, along with input from patients and the public, to co-create a digital learning and implementation package. This includes groups of patients and health professionals in the UK, Turkey, India, Japan, Canada and Brazil.
  2. Using feedback and service evaluations to monitor clinical effectiveness and repeatedly refine and improve the digital package.
  3. Making the digital package freely available with ongoing evaluation, including information about reach and the experience of learners through embedded questionnaires.
A screenshot of the future learn website page showing the "Helping patients recover from breast cancer treatment: a programme to prevent shoulder problems" programme
Helping patients recover from breast cancer treatment: a programme to prevent shoulder problems, on

Key findings

Service evaluations conducted for two of the digital packages (back pain and Rheumatoid arthritis) demonstrated that when health professionals completed the digital package and then provided the intervention to patients, clinical outcomes were similar to trial results. Thus, demonstrating that effectiveness had been maintained.

What does this mean?

Using a digital learning and implementation strategy means that we can share effective interventions rapidly with clinicians so that the benefits can reach their patients in a much shorter time frame than through traditional means, such as relying on published papers.

The digital learning and implementation package for recovery after breast cancer surgery was available within six weeks of publication of clinical results.

The comprehensive learning packages mean that clinicians have access to high-quality training to maintain fidelity of the treatments as they are translated from a clinical trial into real-world clinical practice.

Real-world impacts

We have reached 20,000 learners to date. The digital learning packages are freely available and can be accessed at any time from any location making them highly accessible.

Although the majority of packages are designed for health professionals, we know that many people living with health conditions also complete the courses. Universities are also using the learning packages with their students.

This work is continuing to expand with digital training packages being developed for recently completed NIHR-funded physiotherapy trials of interventions for older people with spinal stenosis (BOOST Trial) and rotator cuff disorders (GRASP Trial).

We are evaluating a digital package designed for people with rheumatoid arthritis so they can access a hand exercise programme directly via the internet to make this programme accessible to as many people as possible.