2. Using PTNow for Evidence-Based Practice: Clinical Practice Guidelines

3. Objectives
After viewing these slides, the clinician and educator APTA member will be able to:
Navigate PTNow to access both primary and secondary peer-reviewed resources for patient care
Search for CPGs, CPG+ to apply in clinical practice

4. Permissions
If you find parts of this presentation useful in communications with others, please:
Maintain the formatting of each slide, including the APTA copyright statement
Acknowledge APTA as the source of the data
Do not change slide content without being granted written permission
Using selected slides in any order is allowed without further permission

5. APTA Vision and Strategic Plan
Use of PTNow for evidence-based practice is consistent with APTA’s vision and strategic plan for the physical therapy profession.

6. evidence-based practice
Components of
evidence-based practice
“Physical therapist practice incorporates all components of evidence-based practice (EBP) (Figure 1-4), integrating best available research evidence, clinical expertise, and an individual's values and circumstances to make decisions regarding services for patients and clients, regarding practice management, and regarding health policy.” (Guide to Physical Therapist Practice, 3.0) Sackett DL, Rosenberg WM, Muir Gray JA, et al. Evidence-based medicine: what it is and what it isn't. BMJ.1996;312: Available at: 
PTNow assists the clinician with enhancing their clinical expertise in order to provide quality patient care. Members can also utilize APTA’s Learning Center for professional development opportunities to further enhance their skills and expertise.

7. Knowledge Synthesis
Individual
Studies
Primary literature consumption is not feasible on large scale to impact clinical behaviors
Synthesis documents are excellent resources
Clinical practice guidelines (CPGs) are a quality synthesis document.
CPGs
Systematic Reviews
An internist must read 34 primary literature articles daily to stay current in the field (Straus S, Tetroe J, Graham I. Defining knowledge translation. CMAJ. 2009;181(3/4): )
Following an extensive literature review, Schreiber and Stern outlined the frequent challenges and barriers for use of EBP by physical therapists in the United States. These obstacles include: 1) difficulty applying results of randomized controlled trials to unique clinical practice environments, 2) insufficient literature searching and research literacy skills, and 3) logistical hindrances, such as time, productivity standards, and access to electronic resources in the clinical environment. (Schreiber J, Stern P. Review of the literature on evidence-based practice in physical therapy. Int J Allied Health Professions. 2005:3. Available at

8. Mission of PTNow Translates physical therapy knowledge into action
Supports evidence-informed care to help clinicians improve their clinical decision making.
Promotes using best available evidence to achieve optimal patient outcomes
HISTORY:

9. An APTA Members-Only Evidence-Based Resource.

10. http://www.ptnow.org How to Access? [APTA member login required]
PTNow has responsive design, which allows adaptation and resizing of information of information on screen, regardless of type, size, or position of electronic device.
Trouble-shooting Networking FAQs:
If you have difficulty accessing PTNow or literature databases at your institution or clinic, please check with your IT department for potential firewall or security issues.
If having difficulty accessing APTA membership resources, please contact
If having difficulty accessing PTNow resources once logged in, please contact

11. A combo of custom content & external resources provide members the best available evidence in patient care
Each tab along the top blue banner holds a wealth of resources—CLICK & EXPLORE
Access to publications for literature searching. As of 2/2018:
> Almost 500 Cochrane Reviews
> Almost 300 CPGs
> 242 test & measure summaries
> 38 custom clinical summaries

12. Clinical Practice Guidelines
“Statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options”.
March 2011, the National Academy of Medicine (formerly the Institute of Medicine) published Clinical Practice Guidelines We Can Trust
Rather than dictating a one-size-fits-all approach to patient care, clinical practice guidelines offer an evaluation of the quality of the relevant scientific literature and an assessment of the likely benefits and harms of a particular treatment.

13. How Do CPGs Help Show Value of PT Management of Health Conditions?
Standardize communication in practice
Discuss movement system-related diagnostic categories
Identify “best” outcome measures
Identify tests and measures integral to establishing a plan of care
Describes best evidence-based intervention strategies
CPGs reduce unwarranted variation in patient care
CPGs are critical for enabling PTs and PTAs to have the current state of the evidence related to a health condition.
CPGs are key to decreasing unwarranted variations in practice, decreasing the knowledge translation gap, and optimizing movement.

14. APTA and Components: Better Together to Enhance EBP
APTA has worked with many Sections and Academies to provide CPGs:
8 CPGs developed by APTA and sections; 17 APTA-funded CPGs in development; CPG+ analysis of section-developed CPGs
Did you know that the Orthopaedic Section has translated its CPGs into Chinese?

15. CPG Development
APTA sections represent the clinical expertise of the profession.
APTA facilitates sections’ development of CPGs through a program that provides support and funding, including an annual CPG workshop.
For more information about APTA’s role in developing CPGs, please see the CPG webpage:

16. PTNow: Your Portal to Physical Therapy-Related CPGs!
295 CPGs by societies around the world
Full-text access linked in 95% of CPGs
Includes related resources (e.g. executive summaries, algorithms, change reports)
About CPGs on PTNow:

17. Accessing CPGs on PTNow
Use the search field below the “Filter Results” banner to search inside only that area of PTNow.
Your results will be restricted to the documents loaded in area of the site you are searching.

18. Once you submit your Search criteria, you get a list of applicable CPGs.
You then choose which CPG that you would like to view.
To view the full CPG (95% of CPGs are open access), click the “Access the Clinical Practice Guideline” button.
This will lead you to the full CPG article in the hosting journal.

20. CPG+: APTA’s CPG Translation Tool
Brief appraisals of full CPGs performed by 3–4 physical therapist and methodologist authors.
Includes:
Quality ratings (using the AGREE II tool)
Highlights of the CPG
“Check Your Practice” tips for clinicians.
They are also linked to the open access full CPG for easy reference.
Access from the CPG+ box on PTNow homepage
In order to facilitate quicker implementation of knowledge into practice, APTA created the CPG+. Though these brief summaries are clinically-useful—THEY DO NOT TAKE THE PLACE of reading and implementing the full CPG.
Accessed via widget on PTNow homepage or on CPG+ page.

21. CPGs: AGREE II Appraisal
Rating between 0 and 7 (highest)
AGREE II scores by domain
AGREE II rater comments
The Appraisal of Guidelines Research & Evaluation (AGREE) II is an international tool to assess the quality and reporting of practice guidelines. Please visit the AGREE Trust website to learn more about this tool and to download the instrument.

22. CPG+ http://www.ptnow.org/cpgplus
Find all of the available CPG+ at the web address on the slide.
They can also be accessed from the widget on the bottom right of the PTNow home page.

24.
Includes links to additional resources on the Academy of Neurology Physical Therapy web page.

25. Many CPGs recommend standardized outcome measures for clinical use
Many CPGs recommend standardized outcome measures for clinical use. Did you know that PTNow has >200 Test & Measure Summaries to assist you?

26. Companion Tutorials
Please see the following additional PTNow slide deck tutorials
Faculty/student slides & handouts
Clinician slides & handouts

27. Questions? articlesearch@apta.org for searching assistance
for clinically-related questions

28. References
Guide to Physical Therapist Practice 3.0. Alexandria, VA: American Physical Therapy Association;
Sackett DL, Rosenberg WM, Muir Gray JA, et al. Evidence-based medicine: what it is and what it isn't. BMJ. 1996;312:71–72.
Straus S, Tetroe J, Graham I. Defining knowledge translation. CMAJ. 2009;181(3/4):161–168.
Schreiber J, Stern P. Review of the literature on evidence-based practice in physical therapy. Int J Allied Health Professions. 2005:3. Available at
Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, eds. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press;

29. References
Levac D, Glegg SMN, Camden C, et al. Best practice recommendations for the development, implementation, and evaluation of online knowledge translation resources in rehabilitation. Phys Ther. 2015;95:648–662.
Deutsch J, Romney W, Reynolds J, Manal TJ. Validity and usability of a professional association’s web-based knowledge translation portal: American Physical Therapy Association’s PTNow.org. BMC Med Inform Decis Mak. 2015;15:79.
Fell DW, Burnham JF. Access is key: teaching students and physical therapists to access evidence, expert opinion, and patient values for evidence-based practice. J Phys Ther Educ ;18(3):12–23.
Green LW. Making research relevant: if it is an evidence-based practice, where's the practice-based evidence? Fam Pract. 2008;25(Suppl 1):i20–24.
Jones CA, Roop SC, Pohar SL, et al. Translating knowledge in rehabilitation: systematic review. Phys Ther. 2015;95:663–677.

30. References
Mickan S, Tilson JK, Atherton H, et al. Evidence of effectiveness of health care professionals using handheld computers: a scoping review of systematic reviews. J Med Internet Res. 2013;15(10):e Accessed February 8, 2018.
Muñoz ML, Hoffman LM, Brimo D. Be smarter than your phone: a framework for using apps in clinical practice. Contemporary Issues in Communication Science and Disorders ;40:138–150.
Ohtake PJ, Smith J, Lee A. Clinical practice guidelines: implementation in acute care physical therapist practice. J Acute Care Phys Ther. 2014;5(2):59–69.
Rycroft-Malone J. Implementing evidence-based practice in the reality of clinical practice. Worldviews Evid Based Nurs. 2012;9:1.
Hakim EW, Reicherter EA. Bench to bedside: cultivating student champions and clinician super-users of evidence-based practice. J Perioper Crit Intensive Care Nurs. 2016;2:104.