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The value of clinical research can be lost in translation and implementation. One often overlooked issue is whether clinicians can determine if their patient is similar to research participants and, ipso facto, whether the clinician treating that patient will have the same effects as what was reported in a research study. We present five questions and clinical tips for clinicians.
Who are the research participants?
The characteristics of a research study’s participants can be considered their ‘clinical phenotype’. The field dedicated to more precisely matching treatments to clinical phenotypes is ‘precision medicine’.1 Defining clinical phenotypes is a challenge in musculoskeletal research because a gold standard diagnostic test is commonly absent. For example, the single leg decline squat is provocative for anterior knee pain but is not diagnostic for patellar tendinopathy.2 Even where clinicians agree that a patient group has the same condition (eg, rotator cuff tendinopathy), different clinical phenotypes (eg, positive vs negative empty can test) within that group means the population is heterogenous. This may mean that subgroups of patients will respond differently to interventions.
Do not rely on the title or abstract of a paper. Review the methods section for details on more precise clinical phenotypes (or not), including how the condition was diagnosed and other features, such as physical activity, education, cognitive or socioeconomic characteristics.3 Does your patient …
Twitter @myles_physio, @tendonpain
Contributors All authors have contributed substantially to the manuscript and approved the manuscript for submission. MCM and EKR conceptualised the review. MCM, WG, GLM and EKR wrote the manuscript.
Funding MCM is supported by an Australian Government Research Training Program Fee Offset Scholarship through the NHMRC of Australia. EKR is supported by an Early Career Fellowship from the NHMRC of Australia. GLM is supported by a Leadership Investigator Grant from the NHMRC of Australia ID 1178444.
Competing interests GLM has received support from ConnectHealth UK, Seqirus, Kaiser Permanente, Workers’ Compensation Boards in Australia, Europe and North America, AIA Australia, the International Olympic Committee, Port Adelaide Football Club and Arsenal Football Club. Professional and scientific bodies have reimbursed him for travel costs related to presentation of research on pain at scientific conferences/symposia. He has received speaker fees for lectures on pain and rehabilitation. He receives book royalties from NOIgroup publications, Dancing Giraffe Press and OPTP. MCM has received speaker fees for lectures on tendinopathy. EKR has received speaker fees for lectures on tendinopathy and has designed an app for anterior knee pain rehabilitation.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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