Evidence based practice

PT – KMTC (Introduction to Physiotherapy)

What is Evidence-Based Practice (EBP)?
• EBP is “the conscientious, explicit and judicious use of current best
evidence in making decisions about the care of the individual patient.
• It means integrating individual clinical expertise with the best
available external clinical evidence from systematic research.” (Sackett
D, 1996).
Cont.…..
• EBP is the integration of clinical expertise, patient values, and the best
research evidence into the decision making process for patient care.
• Clinical expertise refers to the clinician’s cumulated experience,
education and clinical skills. The patient brings to the encounter his or
her own personal preferences and unique concerns, expectations, and
values.
• The best research evidence is usually found in clinically relevant
research that has been conducted using sound methodology. (Sackett
D, 2002)
Cont.…….
• The full integration of these three components into clinical decisions
enhances the opportunity for optimal clinical outcomes and quality of
life.
• The practice of EBP is usually triggered by patient encounters which
generate questions about the effects of therapy, the utility of
diagnostic tests, the prognosis of diseases, and/or the etiology of
disorders.
• Evidence-Based Practice requires new skills of the clinician, including
efficient literature searching, and the application of formal rules of
evidence in evaluating the clinical literature.
Cont.…..
• The practice of EBP is usually triggered by patient encounters which
generate questions about the effects of therapy, the utility of
diagnostic tests, the prognosis of diseases, and/or the etiology of
disorders.
• Evidence-Based Practice requires new skills of the clinician, including
efficient literature searching, and the application of formal rules of
evidence in evaluating the clinical literature.
 The Steps in the EBP Process:
ASSESS the patient 1. Start with the patient -- a clinical problem or question arises from
the care of the patient

ASK the question 2. Construct a well-built clinical question derived from the case

ACQUIRE the evidence 3. Select the appropriate resource(s) and conduct a search

APPRAISE the evidence 4. Appraise that evidence for its validity (closeness to the truth) and
applicability (usefulness in clinical practice)

APPLY: talk with the 5. Return to the patient -- integrate that evidence with clinical
patient expertise, patient preferences and apply it to practice

Self – evaluation 6. Evaluate your performance with the patient

Review EBP and critical appraisal
The evidence‐based practice (EBP) process.

 Decision or question arising from a patient’s care.

 Formulate a focused question.
 Search for the best evidence.
 Appraise the evidence.
 Apply the evidence.
 EBP in practice
• Depending upon specialty, between 50 and 80 per cent of all
'medical activity' is evidence based.
Why does evidence from research fail to get into
practice?
• 75% cannot understand the statistics
• 70% cannot critically appraise a research paper
What critical appraisal is NOT
• Negative dismissal of any piece of research
• Assessment of results alone
• Based entirely on statistical analysis
• Only to be undertaken by researchers/ statisticians
How do I appraise?
• Mostly common sense.
• You don’t have to be a statistical expert!
• Checklists help you focus on the most important aspects of
the article.
• Different checklists for different types of research.
• Will help you decide if research is valid and relevant.
 Formulation of steps in literature review
• Step One: Identification of the condition
• Step Two: classify clinical challenge
• Step Three: Formulating an answerable clinical questions
• Step four: Identification of Key terms
• Step five: Search process
Step five: Search process
1.Choose the 3. Search process stages:
research engine e.g.
internet explorer, • Go to website
Mozilla or Chrome.
• Then library and e-learning
2. Identify database
e.g. • Catalogue
• PEDro
• E-journal and
• Google scholar
• Cochrane • Select e-journal or e-books
• Hinari
• Cambridge library
 Search history
Search strategy
Databases
PHYSIOPEDIA (n= 66)
In patient with wrist MEDLINE (n= 46)
sprain, is friction PEDRO (n= 0)
massage or PRICED GOOGLE SCHOLAR (n= 686)
principle approach the COCHRANE (n=0)
most effective
treatment?

Excluded after
Total Hits abstract scan
(n= 798) (n= 795)

Included after title and Excluded after full

abstract scan text screen
(n= 3) (n = 2)

Included after full text screen

(n=1) Quality assessment
Note
• Always apply evidence based practice in clinical scenarios
Clinical reasoning
• Refers to the cognitive process that healthcare professionals use to
arrive at a diagnosis or treatment plan for a patient.
• It involves the synthesis of data from various sources, including the
patient's history, physical examination findings, and laboratory test
results, along with consideration of the patient’s unique
circumstances, such as their age, gender, sociocultural background,
and other relevant factors
Clinical reasoning typically involves the
following steps:

• 1. Gathering information: Collecting information about the patient's

medical, social and personal history, including the reason for their
visit.
• 2. Hypothesizing: Formulating tentative explanations for the patient's
symptoms or problem based on the gathered information.
• 3. Prioritizing: Identifying the most likely diagnosis or problem and
prioritizing any tests or further investigations to confirm the
hypothesis.
• 4. Test options: Formulating a treatment plan or recommending
further testing based on the most likely diagnosis.
• 5. Evaluating: Continuously monitoring patients for any changes in
symptoms and re-evaluating the diagnosis or treatment plan if
necessary.
Thank you