Finding Evidence to Support Physical

Therapy Clinical Practice: DPT

Objectives
After completing this lecture, you should be able to:

 Identify the sources of evidence for primary questions

 Develop a good search strategy and conduct an
efficient PubMed search using MeSH database
 Find the highest levels of evidence using PubMed
Clinical Queries and Evidence-Based filters
 Find evidence using Cochrane, PEDro, CINAHL, TRIP
 Find evidence-based practice guideline (National
Guideline Clearinghouse)

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Evidence-Based Medicine
 The process of systematically finding, appraising, and
using contemporaneous research findings as the basis
for clinical decision.
 Formulate a clinical question

 Literature search

 Evaluate the evidence

 Implement findings in clinical practice

Rosenberg, William and Anna Donald. Evidence based

medicine: an approach to clinical problem-solving. BMJ
1995; 310:1122-1126.

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Hierarchy of Evidence
(Evidence Pyramid)
Source: Med Research Library Brooklyn

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Key Databases for Evidence-Based
Physical Therapy Practice
 PubMed@UCSF
 CoChrane Library
 PEDro
 TRIP (Turing Research into Practice)
 CINAHL
 Hooked on Evidence (APTA)

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Developing Search Strategies
 Formulate a well-built clinical question (PICO).
 Break your question into multiple concepts.
 Locate the appropriate MeSH (indexed term) for
each concept.
 Run the search using AND, OR, NOT
 Apply limit options (date, language, age,
publication type, gender), major headings and
subheadings
 Modify your search strategies and rerun your
search.

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Boolean Operators (upper case)
 AND
Combine different concepts to narrow
your search.
aged AND women  aged women
 OR
Broaden your search to include similar
concepts.
HIV OR AIDS  AIDS patients
 NOT
Exclude a concept from your search.
AIDS NOT hearing aids  AIDS patients

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Searching PubMed: MeSH Terms

 Using the MeSH Database to locate MeSH

terms; using MeSH terms to increase the
precision of your search results

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When to use Keyword search?
 New studies not yet indexed
e.g. PubMed – in process
PubMed – as supplied by publisher

Do a keyword search and limit search results

for the past few months.

search sample: (ACL OR anterior crucial

ligament) reconstruction

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PubMed: Clinical Queries
 Finding the highest levels of evidence:
systematic reviews and meta-analyses faster
and easier
 Providing further analysis of randomized
controlled trials

 Graft choice in ACL reconstruction

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Setting up Evidence-Based Filters
Using my NCBI
 Filters help sort search results faster
 Set up EB filters for systematic reviews,
meta-analyses, RCTs, practice guidelines

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Set Up EB Filters Using My NCBI
 Register My NCBI.

 Setting up filters for systematic reviews, RCT, meta-analysis,

practice guideline and outcomes assessment

 Select ‘Filters’ in the far left menu, and then select

PubMed.
 Select ‘Browse’ to choose specific filters or select ‘Search’
to enter a specific filter.
 For example: Select “Search” to look up ‘systematic
reviews’. Select Systematic reviews under the matching
filters list and then check the ‘Add’ box to automatically
add
systematic reviews as one of your filters.
 Go back to ‘Search’ and repeat this with ‘meta-analysis”,
“randomized controlled trial”, “practice guideline” and
“outcomes
assessment.”

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MyNCBI (Save Search, Updates)
 Save search strategies and set up email updates
 Set up user preferences – highlight search
 words in your retrieval.
 Setting up “User Preferences” for color highlighting:
Click “User Preferences” in the far left menu and
choose a color for highlighting.

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Cochrane
 Cochrane Database of Systematic Reviews
 Database of Abstracts of Reviews of Effects
(DARE)
 Cochrane Central Register of Controlled Trials

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PEDro
 Physiotherapy evidence-based database,
produced by the Centre for Evidence-Based
Phsiotherapy in Australia
 Covers RCTs, systematic reviews, clinical
practice guidelines in physiotherapy
 Trials rated for quality

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TRIP
 Searches over 75 sites of high quality
medical information
 Provides you direct, hyperlinked access to
the evidence-based material on the web as
well as articles from premier online journals
such as BMJ, JAMA, NEJM and the Lancet

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CINAHL
 55% of overlap with MEDLINE
 Indexes journal articles, books, book
chapters, dissertations, AV materials,
conference proceedings
 Controlled vocabulary/thesaurus:
Nursing headings

Special Interest: Evidence-Based Practice

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Evidence-Based Practice
Guidelines
 National Guidelines Clearinghouse
http://www.guideline.gov/

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Literature Search Online Tutorials
 PubMed Quick Tours

 CINAHL, Basic Searching, Advanced

Searching

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Exercises
 Formulate a clinical question.
 Effectiveness of strength training for
stroke patients
 Graft choice in ACL reconstruction
 Effectiveness of education in school
children with low back pain
 Heat or cold for low back pain

 Literature Search
PubMed, NGC, Cochrane, PEDro, TRIP,
CINAHL

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Managing Citations
Endnote vs. RefWorks

RefWorks
 a FREE web-Based citation management
tool
 Check the class schedule
http://www.library.ucsf.edu/edtech/class/
and reserve a space for the RefWorks
class.

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