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

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

3. 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.

4. 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)

5. 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.

6. 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

7. 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.

8. 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.

9. 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.

10. 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.

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

12. 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

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

14. 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.

15. 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.

16. 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.

17. 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

18. 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.

19. 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.

20. 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