Role of The Physical Therapist in Critical Inquiry Critical Inquiry (PTH 511) Session 1 by Michael Parker, PT, Ph.D, FACSM

The Physical Therapist as a Critical Inquirer What are the competencies required? What are Roles of the Physical Therapist as a Critical Inquirer?

Competencies Required to Assume the Role of a Critical Inquirer1 Apply the principles of scientific methods to: Read and Interpret Professional literature Justify and Plan Research Projects Conduct Research Projects Evaluate Outcomes Data (not exclusively research) Assess New ideas and techologies 1 Swisher LL , Page CG. Professionalism in Physical Therapy: History, Practice, & Development. . p. 109.

Evaluation of Outcomes Data Not Exclusively a Research Role Outcomes Research: Outcomes data can be used to develop clinical guidelines and pathways of patient management –for specific institutions Affecting institution-specific clinical decisions is where outcomes assessment (critical inquiry) “overlaps” with the administrative consultative role of the physical therapist (Swisher & Page, p. 117)

Outcomes Research: Measures1 the End Result of Health Care Rx Measures or Indicators Used: Morbidity Mortality Length of Stay (LOS), discharge disposition Health Status Level of Disability 1Swisher LL., Page CG. Professionalism in Physical Therapy: History, Practice, & Development. . p. 114.

Outcomes Research: Effectiveness Vs. Efficacy Studies1 Effectiveness Study: How does a clinical practice effect everyday patient care? Example: Effect of Hip & Knee Education on LOS & discharge disposition following TJR. Efficacy Study: Address if clinical practice can work in ideal situations, e.g., RCT in specialty centers 1Page CG, Swisher LL. Professionalism in Physical Therapy: History, Practice, & Development. . Box 6-7, p. 114-5.

What are the Exclusive Roles1 of the Physical Therapist as a Critical Inquirer? A user of research A publisher of case reports A collaborator in clinical research projects An Assessor of new ideas and technology A research participant (subject) 1 Swisher LL., Page CG. Professionalism in Physical Therapy: History, Practice, & Development. . p. 117.

The Physical Therapist Uses the Research in 2 Ways: Evidence – Based Practice Approach: Using secondary information already screened for validity & relevance by “Experts”. Traditional Method: Individuals independently critique articles and apply information to a clinical question.

The Physical Therapist Uses the Research in 2 Ways: Evidence – Based Practice Approach Evidence – Based Practice Approach – A.K.A. The information mastery1 approach; Search Secondary Sources developed by special data bases; Cochrane, POEMS, Best Evidence, Hooked-on-Evidence, etc Evaluate the secondary source and determine if results apply to clinical question 1Page CG, Swisher LL. Professionalism in Physical Therapy: History, Practice, & Development. . Figure 6-1, p. 115.

The Physical Therapist Uses the Research in 2 Ways: Traditional Method1 Traditional Method (Evidenced-based medicine – Search primary source research data bases: Medline, Academic Premier, CINAHL Nursing Index Evaluate the research report in terms of its design, sample, variables and determine if the results can be applied to the clinical question 1 Swisher LL, Page CG,. Professionalism in Physical Therapy: History, Practice, & Development. . Figure 6-1, p. 115.

PTs can Use Research in 2 Ways: 2. 1. (Swisher & Page, P. 115)

How to Evaluate a Research Article: Traditional Method Authors (Background, degrees) and Journal (peer reviewed) Year Published (Recent or Dated) Purpose or Goal of the Study Variables, Subject information Type of Data, Measurement Equipment

Also, answer the questions in Box 6-9, page 118, to perform a Traditional Critique of a Research Report. (Swisher & Page, P. 119)

Cases are about either: What are the Exclusive Roles1 of the Physical Therapist as a Critical Inquirer? Publisher of Case Reports Cases are about either: PT management of a patient with a unique diagnosis or condition PT management of a patient with a common diagnosis using a unique or new intervention or treatment approach 1Page CG, Swisher LL. Professionalism in Physical Therapy: History, Practice, & Development. . p. 117.

What are the Exclusive Roles1 of the Physical Therapist as a Critical Inquirer? Publisher of Case Reports Steps to Writing a Case Report Focus or Purpose of the Case Literature Search. What new information does the case add to the body of knowledge? Write Describe reason for doing this case Case Description: patient, intervention Case outcomes Discuss or reflect on what happened 1Page CG, Swisher LL. Professionalism in Physical Therapy: History, Practice, & Development. .p. 118.

What are the Exclusive Roles1 of the Physical Therapist as a Critical Inquirer? Collaborators of Clinical Research Clinically meaningful research must be done with a team of others: Other Clinicians Faculty members Medical doctors and Nurses 1Page CG, Swisher LL. Professionalism in Physical Therapy: History, Practice, & Development. .p. 120.

Important Factors & Barriers to Complete Clinical Research in Collaboration: Facility or institutional resources Patient management issues Availability of Target patient population Support of other health professionals including local IRBs Research-related injuries or illness Ethical Considerations, i.e. placebo, controls, sham treatments Note, fewer than 1% of clinicians publish research (p. 120, Swisher & Page) due to barriers to clinical research

What are the Exclusive Roles1 of the Physical Therapist as a Critical Inquirer? Assessor of New Treatments and Technology. PTs only should affirm treatments, equipment, & continuing education courses that have a sound scientific basis 1Page CG, Swisher LL. Professionalism in Physical Therapy: History, Practice, & Development. .p. 120.

How to Determine Scientific Merit of Ideas and/or Technology1 Underlying theories have anatomical & physiological evidence Rx or instrument refers to a specific type of patient population, not a cure all. Side effects are presented Studies from peer reviewed journals (well designed, Randomized, etc.) support Rx or instruments effectiveness Supporters of Rx and/or instruments are open to and agree to discuss its limitations 1Page CG, Swisher LL. Professionalism in Physical Therapy: History, Practice, & Development. .p. 121.

What are the Exclusive Roles1 of the Physical Therapist as a Critical Inquirer? Serving as a Research PARTICIPANT (Subject). Decision to be a Participant consider: Value of Study to Physical Therapy Integrity of Research Design Time Commitment to Participate Personal Ability to be objective