1. Practicum: Athletic Training PICO Evidence-Based Medicine Frederic Murray Assistant Professor MLIS, University of British Columbia BA, Political Science, University of Iowa Instructional Services Librarian Al Harris Library frederic.murray@swosu.edu

2. Abstract Criteria You will formulate a clinical question (PICO) that relates lower extremity evaluation. You will then do a literature review over that question to find a professional peer-review journal article that provides sound reason and answers to your clinical question.

3. Today’s Class Learn about EBM and how to formulate a good clinical question using PICO

4. Evidence Based Medicine Evidence-based medicine (EBM) is using and carrying out practices based on the best available knowledge. Clinical Expertise EBMBest Research Patient Preferences

5. Why Evidence Based Medicine? Exponential Growth in Medical Literature Impossible for Medical Practitioners to keep up http://tinyurl.com/d9dvuz5

6. Why Evidence Based Medicine? There are 7827 articles relevant to family practice published every month That’s 260 articles a day (every day) to keep up….

7. Why Evidence Based Medicine? There are a lot of Evidence Based Review Sources that Synthesize and critically appraise healthcare literature They can be found in Your Library

9. RCT- Gold Standard Randomized controlled trials are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome –Random allocation to intervention groups –Patients and trialists should remain unaware of which treatment was given until the study is completed-although such double blind studies are not always feasible or appropriate –All intervention groups are treated identically except for the experimental treatment

11. The fundamental skill necessary to conduct evidence-based medicine is learning to design a Well-Built Clinical Question.

12. Step 1: Well Built Question With clinical cases, there is often a barrage of details to digest. To effectively search EBM resources, you need to decide what details are important.

13. PICO: Detailed P: Patient, population, predicament, or problem. Information involves demographics such as age, sex and race. Other important information could include social situations, resources and patient values, and the clinical setting. I: Intervention, exposure, test, or other agent. What type of intervention is being considered? Is this a medication of some type or a form of diagnostic imaging such as radiograph or ultrasound imaging? Or is the intervention at this point a given special test the sports therapist is using to determine the pathology? C: Comparison, intervention, exposure, test, etc., if relevant. The treatment itself can only be compared with something else other than itself. The comparison may be with another medication, another form of imaging such as magnetic resonance imaging, to a current standardized treatment or to no treatment at all. O: Outcomes of clinical importance, including time when relevant. What would be the desired effect you would like to see? What effects are not wanted? Are there any side effects involved with this form of testing or treatment? Manske, R. C., & Lehecka, B. J. (2012). EVIDENCE – BASED MEDICINE/PRACTICE IN SPORTS PHYSICAL THERAPY. International Journal of Sports Physical Therapy, 7(5), 461–473.

14. Step 1: Well Built Question what about the Population? what about the Intervention? what about the Comparison? what about the Outcome? P The population/patient’s disorder or disease I The intervention or finding under review C A comparison intervention (if applicable) O The outcome PICO

15. Pico: Example Question Among female high school athletes, does a coach-led structured neuromuscular warm-up program reduce lower extremity injuries compared to standard non- structured warm-ups?

16. PICO Example Among female high school athletes, does a coach-led structured neuromuscular warm-up program reduce lower extremity injuries compared to standard non-structured warm- ups? Population? Intervention? Comparison? Outcome?

17. PICO Example Populationfemale high school athletes Interventionstructured neuromuscular warm-up program Comparisonstandard non- structured warm-ups Outcomereduce lower extremity injuries

18. Among female high school athletes, does a coach-led structured neuromuscular warm- up program reduce lower extremity injuries compared to standard non-structured warm-ups? PopulationIntervention Comparison Outcome

19. PICO: A State of Mind A systematic way to identify important concepts in a case Formulate a question for searching Often you will often not have a comparison intervention

20. Framing Good Questions Describe the subject –How would I describe a group of patients similar to this one?” Define which intervention –taping versus ice Define the type of outcome –changes in a physical sign –outcome of a diagnostic test –response to therapy

21. PICO: Case 1# A 29 year old man presented with history of injury to his right knee whilst playing sports resulting in a complete ACL tear. He underwent successful ACL reconstruction with a four strand hamstring tendon autograft. The graft was fixed on the femur using two bioabsorbable cross- pins and on the tibia with an Intrafix screw and sheath. The patient presented 13 months following the ACL reconstruction with symptoms of knee pain, locking and catching. He did not recall any specific injury to the knee which initiated these symptoms.

22. PICO: Case 2# A 19-yr-old Division I college football player complained of acute onset of severe epigastric and right upper quadrant abdominal pain shortly after completing a 50-m sprint. The aching pain radiated to his upper back and was associated with progressive vomiting without blood, bile, or "coffee grind" emesis. He had been eating well before practice and hydrating without any pain or bloating. He denied any fevers, chills, diarrhea, headaches, food intolerance, or recent travel. He also denied the use of alcohol, tobacco products, drugs, or supplements.

23. V. Class Exercise Worksheet –Develop PICO Questions for the case studies –Search library databases to answer your question (1 source) –List Citation (APA)

24. Thanks!

25. Questions? Contact me: Frederic Murray 774-7113 frederic.murray@swosu.edu