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Doctor of Physical Therapy (DPT) Resources

Evidence Based Practice (EBP)

In physical therapy, EBP emphasizes the conscientious, explicit, and judicious use of the current best evidence to make decisions about patient care. It involves integrating individual clinical expertise with the best available external clinical evidence from systematic research. This combination ensures that patients receive the most effective treatments based on the latest scientific findings, practitioner experience, and patient preferences.

For physical therapists, EBP means staying updated with the latest research in the field, critically appraising the evidence, and applying it to clinical practice. It also involves engaging patients in their care by considering their values and preferences, which can significantly impact the outcomes of physical therapy interventions.

                 

Steps for Acquiring Evidence 

  1. Identify a clinical problem and create a well-defined research question (using the PICO framework).
  2. Translate the PICO framework into a search strategy.
  3. Brainstorm and gather synonyms.
  4. Construct the search strategy.
  5. Choose the most relevant databases.
  6. Tailor the search strategy to each database.
  7. Assess results and appraise studies.
  8. Save searches and export results to a reference manager (e.g., Zotero or Research Matrix)

PICO Framework

First you need to define a problem and formulate a clinical question. In the research process, this is the research question or statement. In the clinical setting, ‘asking a question’ may become part of a research study, a quality improvement project, or lead to evidence-based practice.

A commonly used format for creating a clinical question is known as PICO or PICO(T), which refers to: Patient/Problem, Intervention, Comparison, Outcome and occasionally Timeframe/Type of Study.

 

 

Clinical Question

Most common type of clinical questions: Therapy, Diagnosis, Harm, Prognosis

Therapy  determining the effect of interventions on patient-important outcomes
Diagnosis establishing the power of a test to differentiate between those with and without a target condition or disease
Etiology/Harm
ascertaining the effects of potentially harmful agents on patient-important outcomes
Prognosis
estimating a patient's future course

 

Examples of Clinical Questions Using PICO Framework

You have a patient who has difficulty exercising due to COPD and you wonder if pursed lip breathing techniques may improve their endurance.

P = patients with COPD

I = pursed lip breathing

C = regular breathing

O = improved exercise endurance

Clinical Question: In patients with COPD, does using pursed lip breathing, as compared to regular breathing, improve exercise endurance?

 

You are working with a recent stroke patient who is having balance issues and you are considering using virtual reality in their therapy.

P = recent stroke, balance issues

I = virtual reality

C = no virtual reality

O = improved balance

Clinical Question: In recent stroke patients, how does using virtual reality affect or improve balance?

Searching with PICO Framework

  •  Develop keywords for each of the applicable PICO elements of your topic.
  •  Start your search by combining 2 or 3 PICO elements with Boolean operators (AND, OR, NOT)
  •  Look for subject headings that represent your keyword and PICO  elements.
  •  Apply limiters depending on your topic, and consider what is the best type of study for your question.

Construct PICO Search Strategies 

Search strings are constructed searches that combine concepts with Boolean operators (AND, OR, NOT). You can start building a search string by using keywords from your list of PICO terms and synonyms or related terms of them and then move to established subject terms that databases use to tag item records. 

 

Select Databases

The following databases are ideal for finding evidence-based literature:

Assess Results & Appraise Studies

Depending on your research question, you need to address what type of study would provide the best evidence. When searching for articles, databases often have filters allowing you to acquire specific types of studies.

Types of Studies

Systematic Review: It is an intensive review of the literature on a given topic. It uses explicit and rigorous methods to identify the studies included in the review. It also critically appraises and synthesizes all the studies included in the review. - secondary research 

Meta-Analysis: Similarly to a systematic they overview extensively the literature on a topic, but they combine the results of all the studies identified in a quantitative way. They synthesizing summaries and make a conclusion that may be used to evaluate therapeutic effectiveness. - secondary research

Randomized Controlled Trial: It is a clinical trial that involves at least one test treatment and one control treatment. There was concurrent enrollment and follows up of the test- and control-treated groups, and in which the treatments were administered by a random process.- primary research

Cohort Study: A study in which subsets of a defined population are identified and studies over a period of time to see the effects of something. - primary research 

Cross-sectional Study: A study that describes the relationship between diseases and other factors at one point in time in a defined population. They are often used for comparing diagnostic test. 

Retrospective Cohort: A study that follows the same direction of inquiry as a cohort study, but this study design uses information that has been already collected in the past and kept in files or data sets.  

Case Control Study: A study that starts with the identification of persons with a specific condition then compared with a control group who do not have the condition. The relationship of an attribute to the disease is examined by comparing often relying on medical records of and patient recall  for data collection. Documenting  the frequency or levels of the attribute in each group. These type of studies are often less reliable because showing a statistical significance is harder. - primary research

Case Series / Reports: Articles written about one patient or a series of patients with the same issue. Great for rare diseases, disorders, and drug/treatment reactions. Not the best source of evidence because it focuses on a small group of people, but sometimes it's the only source.

Qualitive VS Quantitative

Qualitative Research:

Uses words to describe human behaviors. It answers a wide variety of questions related to human responses to actual or potential health problems. The purpose of qualitative research is to describe, explore and explain the health-related phenomena being studied.

Quantitative Research:

Uses numbers to obtain precise measurements that can later be statistically analyzed.  Many quantitative studies test hypotheses.  It follows a systematic, subjective approach to examine the relationship between variables with the primary goal being to analyze and represent that relationship mathematically through statistical analysis.  This is the type of research approach most commonly used in scientific research problems.

Appraise Levels of Evidence

When reading articles and determining which studies to use, have in mind the type of study by reading and critically evaluating their methodology and compare it to levels of evidence.