Post by von on May 4, 2005 13:35:25 GMT 7
Evidence-Based Practice and Physical Therapy
During his address to congress on behalf of people with disabilities, Michael J. Fox said that if you ask a person what their favorite therapy is, they will tell you it is the one that works. Using interventions that work is what evidence-based practice (EBP) is all about. It is not a particularly new concept, as David Sackett originally proposed it for medicine in the early 1990s. Since that time, over 1,000 articles on this topic have been published in medical journals. To quote Sackett, "Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values" (Sackett et al., 2000). Importantly, this definition states that clinical decision-making should be based on three components: research, clinical expertise, and patient values. Thus, it is not solely driven by research studies, but also values clinical expertise and the wishes of the patient and family when determining optimal interventions. Furthermore, this definition acknowledges that not all research evidence is equal, and that some research studies should be given greater consideration than others when evaluating therapeutic regimens.
EBP is a five-step process.(Sackett et al., 2000).
Step 1 is to convert the need for information into a clinically relevant, answerable question.
What exactly is it that you want to know? One method for formulating the question is referred to as PICO.
P refers to the patient or population of interest
I to the intervention,
C to the comparison intervention (if one exists), and
O to the outcome.
An example of how to use the PICO method to refine a question regarding the role of exercise for certain clinical problems is shown below.
Putting this all together results in a more refined question. "For clients with post-polio syndrome, is strength training better than relaxation exercises for increasing levels of daily physical activity?"
Step 2. is to efficiently find the best evidence. This step is often easier said than done, but all things considered, the Internet has greatly increased the ease with which many clinicians can access and rapidly sort current information.
Step 3. is to critically appraise the evidence. Surprisingly, there are only three critical questions that you need to ask to appraise most clinical studies. Is the study valid? Are the findings clinically important? Do the findings apply to my client? However, answering each of these three questions requires a systematic analysis. Indeed, a series of factors needs to be considered when appraising the validity, such as was the study retrospective or prospective? Was it randomized? Did it use human or animal subjects? Depending upon the answers to these and other questions, the validity of the evidence, or in other words, how close it is to the truth, is ranked. To appraise the clinical importance of the evidence one needs to consider the magnitude of the effect of the intervention, as well as the probability of the effect generalizing to whole patient populations. To appraise the applicability of the findings, you must compare your client to the subjects used in the study, consider the feasibility and risks and benefits of the intervention, and also determine if it is in line with the client’s preferences
Step 4. involves applying critically appraised evidence to clinical practice. Of all the steps, this is the one that may be the most difficult. Numerous challenges face health care providers interested in changing their clinical practice based on EBP. These challenges include, but are not limited to, a lack of control over their workload, competing priorities, limited access to the Internet and/or journals, lack of training in information technology and critical appraisal of literature, and a lack of institutional support for EBP. To overcome these obstacles, it helps to remember the ancient proverb, "A journey of a thousand miles begins with one step." Start small. Form a lunchtime journal club to critically appraise relevant clinical studies. Be a "clinician-scientist" by using valid and reliable tests and measures to acquire baseline measurements and evaluate outcomes of your clients. Search for a topic of interest on PubMed or another database. Be part of the APTA Hooked on Evidence Initiative. These are just a few of many possible ways to begin to integrate EBP into clinical practice.
Step 5. is to evaluate the effects of EBP on clinical outcomes. Whether incorporating EBP into physical therapy practice will increase the likelihood that Michael J. Fox and all of our other clients receive interventions that are effective is unknown. The essence of EBP is an argument for critical appraisal of therapeutic interventions. Wisely, the people who developed EBP extended this requirement not only to clinical interventions, but also to EBP itself. Future studies are needed to determine if there is a correlation between the integration of EBP into clinical practice and improvements in outcomes.
In conclusion, EBP is a five-step process that aims to improve health care outcomes by balancing findings from research with clinical experience and patient/family preferences. Extensive information on EBP is available both in print and online. Additional information on how to incorporate EBP into physical therapy practice was presented at the Fall 2002 PTWA Conference. We have the technology for EBP. We have the intelligence to critically appraise evidence. The time is right to incorporate EBP into physical therapy practice.
Excerpts of an article taken from PTWA (PT Association of Washington) Website. For more on the article, Click here
During his address to congress on behalf of people with disabilities, Michael J. Fox said that if you ask a person what their favorite therapy is, they will tell you it is the one that works. Using interventions that work is what evidence-based practice (EBP) is all about. It is not a particularly new concept, as David Sackett originally proposed it for medicine in the early 1990s. Since that time, over 1,000 articles on this topic have been published in medical journals. To quote Sackett, "Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values" (Sackett et al., 2000). Importantly, this definition states that clinical decision-making should be based on three components: research, clinical expertise, and patient values. Thus, it is not solely driven by research studies, but also values clinical expertise and the wishes of the patient and family when determining optimal interventions. Furthermore, this definition acknowledges that not all research evidence is equal, and that some research studies should be given greater consideration than others when evaluating therapeutic regimens.
EBP is a five-step process.(Sackett et al., 2000).
Step 1 is to convert the need for information into a clinically relevant, answerable question.
What exactly is it that you want to know? One method for formulating the question is referred to as PICO.
P refers to the patient or population of interest
I to the intervention,
C to the comparison intervention (if one exists), and
O to the outcome.
An example of how to use the PICO method to refine a question regarding the role of exercise for certain clinical problems is shown below.
- P What individual or patient populations do I have in mind?
People with post-polio syndrome. - I What type of exercises am I considering?
Strength training. - C How does my intervention compare to the effects of another intervention? What is that other intervention?
Relaxation exercises. - O What are the goals of the exercise intervention?
Increased daily activity level.
Putting this all together results in a more refined question. "For clients with post-polio syndrome, is strength training better than relaxation exercises for increasing levels of daily physical activity?"
Step 2. is to efficiently find the best evidence. This step is often easier said than done, but all things considered, the Internet has greatly increased the ease with which many clinicians can access and rapidly sort current information.
Step 3. is to critically appraise the evidence. Surprisingly, there are only three critical questions that you need to ask to appraise most clinical studies. Is the study valid? Are the findings clinically important? Do the findings apply to my client? However, answering each of these three questions requires a systematic analysis. Indeed, a series of factors needs to be considered when appraising the validity, such as was the study retrospective or prospective? Was it randomized? Did it use human or animal subjects? Depending upon the answers to these and other questions, the validity of the evidence, or in other words, how close it is to the truth, is ranked. To appraise the clinical importance of the evidence one needs to consider the magnitude of the effect of the intervention, as well as the probability of the effect generalizing to whole patient populations. To appraise the applicability of the findings, you must compare your client to the subjects used in the study, consider the feasibility and risks and benefits of the intervention, and also determine if it is in line with the client’s preferences
Step 4. involves applying critically appraised evidence to clinical practice. Of all the steps, this is the one that may be the most difficult. Numerous challenges face health care providers interested in changing their clinical practice based on EBP. These challenges include, but are not limited to, a lack of control over their workload, competing priorities, limited access to the Internet and/or journals, lack of training in information technology and critical appraisal of literature, and a lack of institutional support for EBP. To overcome these obstacles, it helps to remember the ancient proverb, "A journey of a thousand miles begins with one step." Start small. Form a lunchtime journal club to critically appraise relevant clinical studies. Be a "clinician-scientist" by using valid and reliable tests and measures to acquire baseline measurements and evaluate outcomes of your clients. Search for a topic of interest on PubMed or another database. Be part of the APTA Hooked on Evidence Initiative. These are just a few of many possible ways to begin to integrate EBP into clinical practice.
Step 5. is to evaluate the effects of EBP on clinical outcomes. Whether incorporating EBP into physical therapy practice will increase the likelihood that Michael J. Fox and all of our other clients receive interventions that are effective is unknown. The essence of EBP is an argument for critical appraisal of therapeutic interventions. Wisely, the people who developed EBP extended this requirement not only to clinical interventions, but also to EBP itself. Future studies are needed to determine if there is a correlation between the integration of EBP into clinical practice and improvements in outcomes.
In conclusion, EBP is a five-step process that aims to improve health care outcomes by balancing findings from research with clinical experience and patient/family preferences. Extensive information on EBP is available both in print and online. Additional information on how to incorporate EBP into physical therapy practice was presented at the Fall 2002 PTWA Conference. We have the technology for EBP. We have the intelligence to critically appraise evidence. The time is right to incorporate EBP into physical therapy practice.
Excerpts of an article taken from PTWA (PT Association of Washington) Website. For more on the article, Click here
??..... we are still tied to this rehab doctors.... let's face it.... we cannot impose our bright PT mind judgment on the treatment of the patient because of some rehab doctors who are insecure of their position that maybe one day, they will no longer have a patient to treat because of the PT's....