Introduction to evidence based

practice (EBP)

Sisay.D (MSc PT)

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objectives
At the end of this lesson student able to know ….
 About EBP and EBPT.

 Explain the concept of evidence-based practice.

 Select, access, interpret and summarise evidence

appropriate to an aspect of physiotherapy.

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What is EBP?

 Evidence based practice (EBP) is 'the integration of best

research evidence with clinical expertise and patient values'

which when applied by practitioners will ultimately lead to

improved patient outcome.

o A careful, unambiguous, and well thought-out use of current

best evidence in making decisions about the care of

individual patients.
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CONT..
 It is the process of systematically finding, appraising and using
up to date research findings as the basis for clinical decision
making.

o The purpose of using EBM tools and EBM methods is to save

lives, as the continual expansion of new medical knowledge
makes it impossible for clinicians to keep up with it all.

o It is the clinician’s responsibility to be able to find the right

information when the patient’s course depends on it.

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Cont.…
o Advocates the use of up-to-date “best” scientific
evidence from healthcare research as the basis of making
decisions.
o It offers:

o Objective way to determine high quality and

safety standards.
o The process of transferring clinical findings into
practice.
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components of EBP.
 there are three fundamental components of evidence based
practice.

 best evidence: which is usually found in clinically relevant

research that has been conducted using sound methodology.

 clinical expertise: refers to the clinician's cumulated

education, experience and clinical skills.

 patient values: which are the unique preferences, concerns

and expectations each patient brings to a clinical encounter.

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Cont.….

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Evidence Based Physiotherapy
 Evidence-based physiotherapy practice (EBPP) is "open and
thoughtful clinical decision making" about the physical therapy
management of a patient/ client.

 it integrates the "best available evidence with clinical

judgments" and the patient/ client's preferences and values.

 further considers the larger social context in which physical

therapy services are provided, to optimize patient/client
outcomes and quality of life.

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What is EBPT?

 Evidence-based physical therapy (EBPT) has

been defined as "physiotherapy informed by

relevant high quality clinical research"

(Herbert, Jamtvedt, Mead & Hagen).

 "The practice of evidence-based physiotherapy

should be informed by the integration of

relevant high quality clinical research, patients'

preferences and physiotherapists practice &

knowledge“.

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Why Practice EBPT?

 The practice of EBPT really comes from making the "cost

effectiveness of physiotherapeutic intervention in comparison

with other ... treatment, or no treatment at all" make clinical

sense.

(Koes, 1997)

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Cont.…
 Another reason for the existence of EBPT, is because
 it is "the best strategy clinicians can use to cope with the
potential chaos and uncertainty of modern clinical practice.

 to meet the ethical imperative of providing the best

possible care for our patients"

(Sherrington, Moseley & Herbert, 2001, p. 125)

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Goals of EBPT
Following evidence based practice procedures helps to:

 make sure that all decisions made for patient care take into
account "the best available evidence."

 better plan and evaluate service delivery.

 better analyze research studies and direct those findings to

better care.

 provide better patient information.

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Cont.….
 take better measurement and do interpretation of
outcomes to provide the best care possible.
 better understand the reasons for lack of compliance by
patients in relation to their PT care.
 accurately judge the relationship between patients and
physical therapists and its effect on health-related
outcomes.
 develop theories based on evidence in practice.

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The 5 Step EBP Process
1. ASK: Formulate an answerable clinical
question Ask

2. ACCESS: Track down the best Evidence

3. APPRAISE: Appraise the evidence for its Evaluate Access

validity and usefulness.

4. APPLY: Integrate the results with your

clinical expertise and your patient Apply Appraise

values/local conditions.

5. Evaluate: Evaluate the effectiveness of the

process.
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1. Formulate an answerable question

 First ASSESS the patient:

 A clinical problem or question arises from the care of the

patient.

 Clinical questions are usually triggered by patient

encounters which generate questions about the diagnosis,

therapy, prognosis or aetiology.

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Cont.…

 The question must be specific and concrete in order to

be searchable in databases.

 Vague questions lead to vague answers; specific

questions are needed to gain specific answers to guide
decisions.

 It can save time.

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CONT….

 The better formed the question, the more quickly may

related literature (or the lack of it) be revealed.

 If we do not pose clear questions, we are less likely to

discover helpful research findings and change what we do;

we may harm clients or offer clients ineffective methods.

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Questions may pertain to….

 The anatomic, physiologic, or pathophysiologic nature of the

problem or issue.

 The medical and surgical management options.

 The usefulness of diagnostic tests and clinical measures to

identify, classify, and/or quantify the problem.

 Which factors will predict the patient or client’s future health

status.

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Cont.…
 The benefits and risks of potential interventions.

 The nature of the outcomes themselves and how to

measure them.

 The perspectives and experiences of others with

similar problems or issues.

 Any of these questions may give rise to a search for

evidence to help and inform the answer.

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 Types of clinical questions

Background questions
 Background questions reflect a desire to understand the nature of

an individual’s problem or need.

 These questions focus on the natural evolution of a condition and

its medical or surgical management rather than on the physical

therapy component.

 These are the most common types of questions that patients or

clients and their families will ask.

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Example
 “What are the side effects of steroid treatment for
asthma?”

 “How long will it take for a total knee arthroplasty

incision to heal?”

 “What are the signs and symptoms of an exacerbation

of multiple sclerosis?”

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Foreground questions
 Foreground questions are the heart of EBP practice.

 These questions help clinicians, and their patients or clients

make decisions about the specific physiotherapist
management of their problem or concern.

 Foreground questions contain four key elements originally

referred to with the acronym “PICO” (population,
intervention, comparison, outcome).

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Foreground Questions
 “PICO” (population, intervention, comparison, outcome).

P = Patient, population or problem

(Who are the patients or populations? What is the condition?)
I = Intervention (What do you want to do with this patient
(e.g., treat, diagnose)?
C = Comparison intervention
(What is the alternative to the intervention (e.g., placebo, an
intervention, nothing?)
 not all questions will include a comparison.
 O = Outcome
(What are the relevant outcomes (e.g., Disability, pain, function,
quality of life)?

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questions on Intervention
 Is proprioceptive neuromuscular facilitation (PNF) (I) an

effective treatment technique for restoring core trunk stability

(O) in a 70 year-old adult with right hemiparesis due to stroke

(P)?

 Is PNF (I) more effective than the neurodevelopmental

technique (NDT) (C) for restoring core trunk stability (O) in a

7-year-old adult with right hemiparesis due to stroke (P)?

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CONT….
 In children with spastic hemiplegic cerebral palsy (P),
what is the effect of NDT(I) to improve upper limb motor
function (O) compared with constraint induced movement
therapy (CIMT) (C) within a 1 year period (T)?

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CLASS ACTIVITY
 FIND OUT PICO/ Form a Question?
 Isobel is a 72 year old woman who recently had a fall in
her home. Her injuries were mild but she is anxious
about it happening again. She has asked for advice on how
she can reduce the likelihood of further falls. You think
that a strengthening exercise program may help.
 Question: In the elderly, does a strengthening exercise
reduce the risk of falls?

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