Professional Ethics

Dr. Beriwan Abdulqadir Ali

11th May 2020
10th L

Types of evidence
• A hierarchy of evidence is often described or used in the literature.

• However, such a hierarchy fails to recognise that different research

methods are needed to answer different types of questions.
• Physiotherapists need to contribute to an ongoing debate to develop a
hierarchy that reflects more appropriately a patient-centred approach
to practice.
what does evidence-based practice mean for
physiotherapists?
• 'In order to deliver effective care, information relating to treatment
options is identified, based on the best available evidence.
• A range of sources of information the physiotherapist may need to
draw on; including research evidence, patient organisations and
clinical guidelines is listed.
A hierarchy of evidence.

1. Evidence obtained from a systemic review or meta-analysis of randomised

controlled trails.
2. Evidence obtained from at least one randomised controlled trial.
3. Evidence obtained from at least one well-designed controlled study
without randomisation.
4. Evidence obtained from at least one other type of well-designed
experimental study.
5. Evidence obtained from well-designed non-experimental descriptive.
studies such as comparative studies, correlation studies and case studies.
6. Evidence obtained from expert committee reports or opinions and/or
clinical experience of respected authorities.
What practical steps need to be taken to
identify and use research evidence?

• Think about the clinical question you are trying to answer in your
information search?
- Identify the population (e.g. people with multiple sclerosis with
symptoms of urinary incontinence), the intervention you are looking
for (e.g. neuromuscular electrical stimulation) and the outcome (e.g. a
reduction in symptoms) and use this information to formulate a search
strategy.
• Work in partnership with an information scientist to get the best results
from a literature search (their information skills and knowledge
combined with your clinical skills and knowledge).
• Look first for evidence that has already been synthesized - systematic
reviews, nationally developed clinical guidelines or standards.
• This saves a lot of effort looking for individual studies. If it is a high
quality synthesis, it will also provide a more reliable estimate of
effectiveness.
• Know your databases well enough to know which will have the most
relevant information for any particular topic.
• Check the titles and abstracts for relevance.
• Critically appraise any relevant papers you have found to assure yourself of
their quality, and of the reliability of their conclusions (a list of appraisal
instruments can be found at the end of this chapter).
• When you find the 'best available evidence', think about it in relation to
your patient and your past experience - is it appropriate for that patient, will
you be able to quantify for the patient the degree of likely benefits and harms
(if any)?
• Discuss the evidence with the patient and agree together the preferred
intervention(s).
• Implement the preferred intervention(s).
• Evaluate the effect of the intervention(s) and act accordingly.