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What is Evidence-Based Practice (EBP)?
- integration of best research evidence with our clinical expertise and patient's unique values and circumstances
- when elements are integrated, clinicians and patients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life
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What are the sources of evidence?
- 1. patient's unique values and circumstances
- 2. best research evidence
- 3. clinical expertise
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Define "patient's unique values and circumstances" as a source of evidence:
- values, preferences, expectations
- clinical state and circumstances
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Define "best research evidence" as a source of evidence:
results of scientific research
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Define "clinical expertise" as a source of evidence:
- personal knowledge, expertise, and expectations
- established experts
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KEY POINT: The best research evidence, our clinical expertise, and our patient's unique values and circumstances should INFORM our practice.
- As therapists, we make the decisions about patient care (It's our license)
- These decisions should be well-informed/intelligent ones
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What type of question is "What is subacromial impingement syndrome?"
background question
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Name the 5 Steps for EBP:
- 1. Ask a focused clinical question
- 2. Search for the best research evidence
- 3. Appraise the quality of the research evidence
- 4. Integrate the research evidence with information about the patient and clinical expertise
- 5. Reflect on the process to improve the future
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In step 1 for EBP, what type of clinical questions should be asked?
background and foreground questions
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What makes a clinical question well-built?
- the question should be directly relevant to the problem at hand
- the question should be pharsed to facilitate searching for a precise answer
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What are the 3 parts of making a well-built clinical question for step 1 of EBP?
- 1. the patient or problem being addressed
- 2. The exposure/intervention being considered and/or the comparision intervention or exposure
- 3. clinical outcomes of interest
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What is the PECO (PICO) approach?
- an approach to formatting your clinical question
- P: patient/problem
- E: exposure (I: intervention)
- C: comparison group
- O: outcome
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Name the levels of the USC "Evidence Pyramid" from top to bottom (better to less good):
- Level 1a: systematic reviews
- Level 1b: randomized clinical trials
- Level 2b: cohort studies
- Level 3b: case-control studies
- Level 4: case series and case studies
- Level 5: narrative review, expert opinion, textbooks
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KEY POINT: We must critically appraise the integrity of each source of evidence:
- clinical expertise
- best research evidence
- patient's unique values and circumstances
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KEY POINT: Truth
- There is no perfect article
- Every article can teach us something
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What are some things to consider when you reach step 5 (reflect on process to improve the future)?
- patient outcomes
- reimbursement
- image
- respect
- confidence
- influence
- program development
- conflict resolution
- personal/patient/staff motivation
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Important Reminders...
- Information on its own doesn't change practice.
- We must learn more about how we move from evidence to change, but we know that change is not always easy
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