EVIDENCE BASED

PRACTICE
DPT, Lecture 1
FARHEEN HASNAIN UROOJ KHAN
Advanced MSPT, BS PT MSAPT (DUHS),BSPT (LNH), ADPT (ZMU)
MGH Institute of Health Professions
Fulbright US Scholar Lecturer/Physiotherapist
Assistant Professor/Cardiac Sindh Institute of Physical Medicine and
Rehabilitation coordinator Rehabilitation
Sindh Institute of Physical Medicine
and Rehabilitation

24.5.2021
INTRODUCTION TO THE
MODULE

 3 credit hours: 2 hours theory, 2 hour practical class per week

 Tutors: FARHEEN HASNAIN & UROOJ KHAN

 Assessment criteria:

 Theory Exam: BCQS

 Practical Exam: searching best evidence +viva

 Internal Evaluation: mid term, class tests, in-class discussions and

presentation in groups.
 TEXT AND REFERENCE
BOOKS:
 Practical evidence based physiotherapy by Rob Herbert, Gro
Jamtdvent, Judy Mead and Kare Birger Hagen
 Lecture objectives
 Define EBP

 Purpose of EBP

 What is ‘best evidence’

 Discuss how to ask relevant clinical question and its

importance
EVIDENCE BASED PRACTICE
 What is EBP?
 The application of clinical decision making for
patient management based on research evidence,
clinical expertise, patient values and preferences
and clinical circumstances
- Dave Sackett
 Patient To be able
to walk!
Concerns

EBM

Best research Clinical

evidence Expertise
Purpose of Evidence based
practice
 To integrate best research evidence with our clinical
expertise and our patient’s unique values and
circumstances

 The concept of EBP makes sure that the patient is

provided quality care because our choices are backed
by sound scientific data

However

There is no pure scientific method that can replace the

influence of experience, intuition and creativity in
clinical judgment
Purpose Cont….

 ‘Evidence based practice’ helps in clinical decision

making by integrating the ‘art’ of clinical practice
and the ‘science’ that supports clinical practice

 Therefore, it is the applied evidence to a clinical

scenario or in the context of a patient to support the
process of clinical decision making. We can also call
it EVIDENCE-BASED DECISION MAKING
EBP may not be possible
when:
 Scientific evidence is incomplete

 Scientific evidence is unavailable

 There is no access to latest literature

 The clinician does not realize the importance of

cognition and metacognition and practices on the
basis of intuition and antedotes
Why do we need ‘best
evidence’
 Sackett and colleagues mention that EBP is the
conscientious, explicit and judicious use of current
best evidence in making decisions about the care of
the individual patients.

 Studies that meet validity standards should be used

to determine how the results of the research apply to
the given clinical situation
How someone should start
searching ?
How someone should start
searching ?

Make a good and

relevant clinical question
 Component of a good
clinical question - PICO
 The process of EBP starts by asking a relevant
clinical question. Therefore a good and
comprehensive question (relating to the patient issues
and management) is a basis to finding the relevant
answer

 P Patient/ problem

 I intervention

 C comparison

 O outcome
 PICO
 P – the target population? Characteristics of the
patient or the problem being considered

 I – intervention being considered. Prognostic factor

or a diagnostic test

 C – what comparison or control condition is being

considered. (Not relevant for a question of prognosis
or examining one diagnostic test or intervention

 O – outcomes of interest. What measurements will

be relevant to understanding the effectiveness of an
intervention and importance of a prognostic factor or
a diagnostic test accuracy
Questions may be related to:

 Patient’s diagnosis, prognosis or intervention

 Clinical guidelines and their validity

 Etiology of patient problem

 Safety and cost effectiveness of care

 CASE EXAMPLE
 MJ is a 75 yr old woman who suffered a R CVA 2
months back. She is being seen by an occupational,
physical and speech therapist in an inpatient setting.
She walks with a cane – mod assistance and exhibits
poor balance. One of your colleagues suggest that
you consider training the patient on a treadmill with
partial body weight support, but you have not tried
this approach before.
 In an elderly patient 2 months post stroke -
Patient
 Is partial weight-bearing supported treadmill
training - Intervention
 More effective than traditional gait training
with full weight bearing – Comparison
 For improving walking speed, endurance
and balance? - Outcome
Thank you……….