Mick Hughes - Translating evidence to clinicians, as a clinician

Hello, everyone. Welcome to the Monash Musculoskeletal Research Unit podcast. My name is Luke Perritson. I'm a physiotherapist, educator, and researcher in the Department of Physiotherapy at Monash University. So in this episode of the podcast, I'm going to have a chat with Mick Hughes about his experiences with translating research to clinicians as a clinician. So Mick's well-known in Melbourne, as well as nationally and internationally as a physiotherapist and an exercise physiologist with a special interest in ACL rehabilitation, and he's also very busy with evidence translation. He runs a very successful blog, YouTube channel, Facebook page, Twitter account, all aimed at educating clinicians in how to use valid and reliable outcome measures and evidence-based treatment techniques and translating research findings. So he's also the co-author of the Melbourne ACL Rehabilitation Guide 2.0 with Randall Cooper, and he works clinically at the Melbourne Sports Medicine Centre in Melbourne. So on top of all that, Mick runs Learn.Physio, an education resource for physiotherapists. So he's a busy man. Mick Hughes, welcome to the podcast. Luke, what a wind-up. No, thank you. Thank you for that. I'm great to be here and really honoured to be asked to come on to the show and then hopefully share some valuable experiences that I've got that may help younger clinicians navigate the research world and the knowledge translation world that's out there. So no, thanks for having me on board. Fantastic. Yeah. Thanks for coming on board. So I've touched on, highlighted a package of some of the many things that you do, but let's go back a step. Tell us a bit about yourself and your background and your interests and current work and projects. Yeah. I'll probably start back where it all began. I originally trained as an exercise scientist. It wasn't even, you couldn't even call yourself an exercise physiologist back in the day yet. So I graduated from Australian Catholic Uni in 2002 with an exercise science degree. And I felt going up through high school and even through physiotherapy, sorry, exercise science school, I felt like I really wanted to pursue a career into physiotherapy. Having a couple of injuries when I was playing sport as a young one, I'd sort of seen enough of physiotherapy and enough of exercise and rehabilitation to think, yeah, that's the kind of career I'd love to pursue. And so I was just never really good at high school. I was always having too much fun playing basketball, working, going to parties and probably not being diligent enough with my studies to go straight from high school into physio. So I sort of took the long way around through exercise science. But I feel like that three years in exercise science school was really valuable in my career as a physiotherapist as well with that strong emphasis on exercise and rehabilitation and a very active approach and the lessons I learned there and the skills that I learned there was really, really, really valuable as a physiotherapist. So, yeah, so after I graduated from exercise science, I went into physiotherapist school up at James Cook Uni and yeah, that's kind of like where I became, yeah, got to my goal of being a physiotherapist and yeah, that's where it all began. I was lucky enough to work in sporting circles with Rugby League up there and met my wife in Townsville and then we moved to Newcastle and got involved in soccer and had a few years there, had a child and then we moved to Melbourne. So we've been slowly working our way down the eastern seaboard and we've been down here for five or six years now and we've now had another child and we've now got two. And Melbourne really is where we'll call home and but here in Melbourne, I guess, is where I sort of found my sort of feet with sport and really being passionate about sharing sports physiotherapy research and trying to break down those barriers that we see between research being produced and translating into clinical practice. And yeah, I guess, hopefully I've covered a little bit of that background succinctly enough. Oh yeah. So you've found your feet, but you found your voice as well. So you've had your blog and your website, you've had blogs up there since 2016, is that right? Yeah, that's right. That's kind of what was the turning point in 2016. Really I got forced, I guess I felt like I got forced and put in a way by moving to Melbourne and not knowing anyone down here and being really out of my comfort zone in terms of my clinical practice. So previously I'd been an employee, so I had the luxury of just being able to get paid and earn a living with the comfort of being in an employee status. Here in Melbourne, I was effectively a subcontractor where I was really effectively my own business within the sphere of someone else's business. So whenever I was quiet, I wasn't earning money. And so I felt like, okay, no one knows me here in Melbourne and I'm only saying dodgy necks and backs. I'm not really enjoying my work. And I was studying my master's in sports physio at the time and I thought, well, here's a really good opportunity to, in my downtime, write some blogs, extend on my access that I've got at the moment. I had a library of sports physio journals I could get from my master's program. And so whenever I had some downtime, I'd jump on the library database and I'd look through some areas of interest and I'd read and I'd write. So I'd make use of my time because if I wasn't seeing people, I needed to get better at doing the things that I wanted to do. And the way that I was writing was in a way that I wrote about the areas that I had a strong interest in and then I shared it. So I didn't love saying necks, I didn't love saying backs and shoulders, I love saying knees and I love saying hips and ankles. So I sort of diverged my interest into those areas and researched them a little bit deeper, deeply and deeper and also wider. And once I started rolling out a few blogs and putting up there on social media, that's where it really sort of started to change. And I saw a really positive shift then to actually seeing patients walking the door saying, oh, hey, I saw my doctor who read your blog last week and he thinks that you know a thing or two about knees, so I want you to go see Mick. And so when I started to see a little bit of that, I was like, oh, okay, here's something. So I just continued with it and it certainly evolved. So it really helps you to establish yourself? It did, it did, it absolutely did. And I think for anyone out there that, you know, if you're coming out through physio school and you're sort of not knowing what to do and you're down time, I strongly encourage any new grads who often aren't seeing a lot of patients early to use that time wisely to upskill and read. Even though I had the luxury of open access library database through the university, I understand that not all clinicians still have that access. So they need to find some free articles here, there and everywhere. But there's a lot of great papers out there that are free. You just got to try them. One of the blogs on your website is, I think it's 22 papers that shaped my career related to the ACL or words that affect. So that's a blog that's a summary of all the free ones and all the ones that are behind a paywall. And it can be as simple as that. I think there's some really nice advice in there for, particularly for new graduates, but for anyone as a clinician who you know that you have to be accessing and looking at research. But times have changed from when research was hidden behind a paywall and you had to be in university. There's a lot of resources and having someone like you translate those and put them in plain and simple terms for everyone is really useful. Yeah, that was the original goal. I remember writing a blog in the downtime in Melbourne. I also had a luxury of a lot of travel time. So I was catching trams to and from work and every tram ride was about 45 minutes to an hour. So there was an hour there that I felt I could be effectively using my time better rather than just scrolling through my Facebook feed or my Instagram feed of my own personal stuff. I thought, well, there's an hour that I could be used reading, reading research papers or writing a post. And that's how I sort of took that. And one of the times I was reading some research, I came across a paper that, and it's often cited now, whenever you're looking about knowledge translation on the paper saying there was a 17 year delay between research being published and actually being adopted universally. And I read that paper and I thought, well, that's a pretty big time lag. And if what I'm reading here in an ACL paper, for example, is going to take 17 years now for it to be implemented regularly, then I felt like I had a voice there to try and change that and speed that process up. So that's kind of my approach. It was that way to begin with was to try and speed up this knowledge translation and make it easier for clinicians to make sense of the research in a more practical way as well. Sometimes the research can be quite jargony and it can be actually quite complicated. And to try and, I guess, summarize it in a meaningful way has been a goal of mine as well. So hopefully that's sort of coming across. And Christian Barton also too, and Adam Colvin all ran a brilliant blog too, talking about that as well. So I sort of really took inspiration from those two papers and blogs and try to sort of do a little bit of my own as well. Just really important resource for a lot of people and something that you've done. Mostly, I guess, in your spare time, as you're saying, in filling the gaps that are available that we all have. It's really busy, especially as a new grad, you're really busy all the time. So what tell us about Learn Physio, Learn.Physio? How did that start and what's your role there? Yeah, we actually really just stumbled across it. I guess taking a step back from that originally was probably about two or three years ago, I had some ACL presentations and I basically put them online to a website called Learn.Physio. And they're a product of, because I've got a really intense public, I've got an intense fear of public speaking, believe it or not, it's getting better. And so a while ago, I got asked to do a presentation to a group of 200 physios at La Trobe University on ACL. And I thought, oh gosh, I'm going to bomb out hard here. So to practice, I did a presentation to a couple of 20 physios locally in our clinic. And I did a presentation. And so I did that presentation and it was pretty well received. And then I did a second one and a third one, all on the same presentation. I thought, look, there's probably some value in here and taking that presentation and putting it online. And I looked around on some websites and there wasn't really anything out there. And I came across this website called Learn.Physio, which was a marketplace for people to share their presentations and make some money off it. So I put that presentation up online and I started, I charged about 40 bucks a pop for it to be watched and downloaded. And it took off. It was pretty popular and people worldwide were watching it. And it was up there for a while and I put another couple and I was sort of earning some little passive incomes along the way. It came down to a point where Randall and I, Randall Cooper and I, we'd sort of evolved a little bit from the Melbourne ACL Rehab Guide and we wanted to turn that into a bit more of a real-life presentation where we'd walk you through the steps of the Melbourne ACL Rehab Guide in a really good way. And we sort of made this two-hour masterclass where we sort of sat down and discussed the Melbourne ACL Rehab Guide and how we would do it practically. And we're like, okay, where are we going to put it now? And I said, well, Learn.Visio is there. It's a really good resource. I've got some stuff up on there and we could go and see how it went. And so we got in contact with the web owner and he said, look, I don't have much interest in that website anymore. It's too busy with other projects. Would you guys like to have it? And we were like, for free? And he said, yeah, just take it off my hands. You guys will do a much better job with it. Take down all the other stuff that's on there if you want to. But the domain Learn.Visio is yours if you want it. And we're like, why not? Let's go with it and see where it evolves to from there. And kudos to them for doing that and that gift to you because you've really done something with it. Yeah, fantastic. Yeah. So we took that brand and we took the website and we then turned it into this resource. And basically, as it stands, Learn.Visio is an online educational resource where we provide these two to two and a half hour master class videos. And initially, it was just two ACL videos and ACL reconstruction and non-operative ones. But in the last six months, we've certainly grown that and filmed some new courses. And we're going to be putting up another 10 to 20 courses by the time the year's out as well. So we just saw a market there to provide physiotherapists not only here in Australia, but all around the world, access to some of the best presenters in the world as well. And we're lucky here in Melbourne to have some of the smartest minds in the world here at our doorstep. And why not make the use of them and showcase their talent all across the world and share information that would ordinarily be hard to get to? Jo Kemp, for example, and her expertise in FAI, like for a clinician in America or the UK or somewhere in Europe to get to one of her courses would cost an arm and a leg. And here we are providing access to her expertise at a fraction of the cost. And Ryan Timmons is coming on board soon with a hamstring one and a few other presenters. So that's kind of like where we're at with Learn.physio. We're trying to provide the best people in the business and share their wealth of information. And you're really breaking down that key barrier that we talk about that to evidence translation and making it more efficient. And reducing that 17 years down to something more reasonable. Hopefully, yeah, break it down from 17 to less than five. That would be nice, I think. So what are some of the challenges for clinicians that clinicians face in implementing research? And how do you try to address those challenges? How are you helping? Yeah, I think as a clinician, it is hard to stay constant. Because I mean, you look at the ACL literature, just one example of how challenging it can be. Every month, there'd be at least, I don't know the exact count, but there'd be at least hundreds of ACL papers produced every month. Maybe, probably even more, to be honest. To be really on top of the ACL literature, just on top of a busy clinical caseload. And obviously, just to have time away from the clinic and just your own downtime. You don't want to be consumed by physio 24-7. You need to have family time and social time and family time as well. So to stay even close to being relevantly up-to-date is really, really hard. And that's just the ACL, for example. If you've got an interest in shoulders, necks and backs, the research out there would be just as frequently published. So that's certainly one of the biggest challenges I see as my own clinician is even staying constant with that's pretty hard and up-to-date is quite hard. So I guess my little bit that I'm trying to provide are these little snippets of information that I try to take without cherry-picking as much as I can. I understand I probably do cherry-pick a little bit of the information, but I'm trying to make things practical in a way. So for example, like we're talking about one of the key papers that I really love driving home is Adam Colmanaw's work in the single-leg sit-to-stand, for example. Delving through some of his research and Kay Crosley's research and finding these little meaningful cut-offs to make the clinician's work a little bit easier. I love his paper on 22 single-leg sit-to-stands that's associated with better quality of life than those who can do more than 22 than those who can't do 22, one to three years after an ACL reconstruction. Finding bits of information like that that can be meaningful to both the clinician and to the patient I find is an important part of my research journey trying to share information because sometimes it can be quite hard going through a paper and saying, okay, look, this research is telling us this, but what can we do with that? How relevant is this to the person in front of me? And trying to make sense of some of the numbers I think is the challenge. And that's where hopefully I've started to bring home. And I know I shared one the other day was single-leg hop test, for example. ACL patients should be really striving for that. Males, 90% of their height or 80% of their height for females. And just those little targets, I think, and those little snippets of gold, I think they're the big ones I've been trying to get out of the literature and share to a wider audience that can be valuable. Hopefully, anyway, hopefully there's been some nice knowledge translation there. Value is the key word. It's very valuable. And you're very active on Twitter and Facebook as well. You've got a Facebook page and your blogs. So people can find, where can people find you and follow you online? What are your handles? Yeah, so Mick, Instagram is probably the more popular one, but MickHughes.physio is Instagram and Facebook. Twitter is a little bit different. It's Mick W Hughes. And then YouTube would be MickHughes.physio as well. And yeah, what do people find on your YouTube channel? It's really good. Like I said, I was actually going to sit down this afternoon or over this weekend. It's actually organized a little bit better, but you'll find over on my YouTube channel about 120 different types of videos of exercises that I think would provide value in different forms of rehabilitation following ACL injury. Most commonly, there's a few ankle sprain videos. There's a few hamstring videos, but probably 90% of what's featured on my YouTube channel is ACL based, ranging from, okay, here's what you could do in the early stages of rehab soon after you follow, soon after you've injured your ACL all the way through to, hey, these are the hot tests I think you should be performing to clear a person before they return to sport. And there's going to be a wide scope of what's in between as well, including different choices of mid-stage rehab, late stage rehab, lots of jumping, lots of landing exercise options in there too. But yeah, literally over a hundred different videos there that people can go through and watch to get inspiration for their patients. Excellent. Look, Mick, we'll wrap it up there. Thanks very much for your time. And listeners, we'll put a link to the papers that Mick was mentioning there and all his social media handles and everything else. So you can find him in the show description, in the notes where you're listening to this, wherever you get your podcasts from. And we have part two of a conversation coming up soon. We're going to be recording and this is going to be diving into ACL rehabilitation. So for everyone interested in that topic, listen on to the next episode. But for now, Mick, thanks very much for coming on board. Hello, it's a pleasure. Can't wait for the next chat.