Clinicians Guide to Evidence Based Practice Andre Ishmael, SPT University of Central Florida Doctor of Physical Therapy Class of 2014

Evidence Based Practice  What it’s not:  Sifting through all studies containing desired words  Only randomized controlled  Overly time-consuming

Evidence Based Practice  According to the APTA:  Evidence-based practice is access to, and application and integration of evidence to guide clinical decision making to provide best practice for the patient/client.

Evidence Based Practice  According to the APTA:  Evidence-based practice includes the integration of best available research, clinical expertise, and patient/client values and circumstances related to patient/client management, practice management, and health care policy decision making.  Aims of evidence-based practice include enhancing patient/client management and reducing unwarranted variation in the provision of physical therapy services.

Types of Evidence Critical to The Clinician and Patients  Diagnosis  Prognosis  Intervention/Treatment

The 5 Steps for Accessing Evidence 1. Formulate a Practice Question 2. Search for Evidence 3. Appraising the Evidence 4. Apply the Results 5. Evaluate the Outcomes

The 5 Steps for Accessing Evidence 1. Formulate a Practice Question 2. Search for Evidence 3. Appraising the Evidence 4. Apply the Results 5. Evaluate the Outcomes

The 5 Steps for Accessing Evidence 1. Formulate a Practice Question  PICO  P – Patient/Problem – Patient situation, population, or problem of interest  I – Intervention – Diagnostic test, Prognostic factor, or Treatment  C – Comparison  O – Outcome

The 5 Steps for Accessing Evidence 1. Formulate a Practice Question  PICO  P – Patient/Problem – Patient situation, population, or problem of interest  I – Intervention – Diagnostic test, Prognostic factor, or Treatment  C – Comparison  O – Outcome  PICO Example  P – 40 year old female with Patellofemoral Pain Syndrome  I – Therapeutic Taping in addition to Therapeutic Exercise  C – Therapeutic Exercise  O – Decreased Pain  “In a 40 year old female with Patellofemoral Pain Syndrome, will therapeutic taping be more effective than therapeutic exercise lone in decreasing pain.”

The 5 Steps for Accessing Evidence 1. Formulate a Practice Question 2. Search for Evidence 3. Appraising the Evidence 4. Apply the Results 5. Evaluate the Outcomes

The 5 Steps for Accessing Evidence 2. Search for Evidence  Push or Pull Method

The 5 Steps for Accessing Evidence 2. Search for Evidence  Online Search Resources:   Scholar.google.com   

The 5 Steps for Accessing Evidence 2. Search for Evidence (PubMed)

The 5 Steps for Accessing Evidence 2. Search for Evidence

The 5 Steps for Accessing Evidence 2. Search for Evidence

The 5 Steps for Accessing Evidence 2. Search for Evidence

The 5 Steps for Accessing Evidence 2. Search for Evidence

The 5 Steps for Accessing Evidence 2. Search for Evidence (Google Scholar)

The 5 Steps for Accessing Evidence 2. Search for Evidence

The 5 Steps for Accessing Evidence 2. Search for Evidence

The 5 Steps for Accessing Evidence 1. Formulate a Practice Question 2. Search for Evidence 3. Appraising the Evidence 4. Apply the Results 5. Evaluate the Outcomes

The 5 Steps for Accessing Evidence 3. Appraising the Evidence  QUADAS  Quality Assessment of DIAGNOSTIC Studies (0 = No; 1 = Unclear; 2 = Yes)

The 5 Steps for Accessing Evidence 3. Appraising the Evidence  Quality Assessment for Prognostic Cohort Studies  Quality Assessment of PROGNOSTIC Studies

The 5 Steps for Accessing Evidence 3. Appraising the Evidence  PEDro Scale  Quality Assessment of Randomized controlled for INTERVENTIONAL Studies

The 5 Steps for Accessing Evidence 3. Appraising the Evidence  PRISMA  Preferred Reported Items for SYSTEMATIC REVIEWS and META-ANALYSES

The 5 Steps for Accessing Evidence 3. Appraising the Evidence  PRISMA cont.  Preferred Reported Items for SYSTEMATIC REVIEWS and META-ANALYSES

The 5 Steps for Accessing Evidence 3. Appraising the Evidence  PRISMA cont.  Preferred Reported Items for SYSTEMATIC REVIEWS and META-ANALYSES

The 5 Steps for Accessing Evidence 1. Formulate a Practice Question 2. Search for Evidence 3. Appraising the Evidence 4. Apply the Results 5. Evaluate the Outcomes

The 5 Steps for Accessing Evidence 4. Apply the Results  Clinician should take in to account research, clinical expertise, and patient values when applying the results  Questions to ask:  Is the patient so different from those in the study that its results cannot apply?  Is the treatment feasible in our setting?  What are the patients potential benefits and harms form therapy.  According to the article on therapeutic taping on Patellofemoral Pain Syndrome patients with therapeutic taping and with therapeutic exercise had less pain and performed better functionally compared to just therapeutic exercise.  Results can be applied to your patients with Patellofemoral Pain Syndrome treatment plan.  Keep in mind that results will not always be the same for all patients even those similar to population of the study.

The 5 Steps for Accessing Evidence 1. Formulate a Practice Question 2. Search for Evidence 3. Appraising the Evidence 4. Apply the Results 5. Evaluate the Outcomes

The 5 Steps for Accessing Evidence 5. Evaluate the Outcomes  Evaluation of outcomes should be a constant process.  Are your patients getting better?  What types of patients are getting better?  What types of patients are not getting better?  Outcomes for similar patients may not necessarily be the same.

Case  19 year old female college soccer player with history or reoccurring R ankle sprains.  Evidence shows less reoccurrence of ankle sprains with strengthening of hip musculature.  Pt. has preconceived notion that electrical stimulation will strengthen ankle musculature without therapeutic exercise and no need to strengthen hip musculature.  What do you do?

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