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.
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.
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 |
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Prognosis |
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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?
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.
The following databases are ideal for finding evidence-based literature:
The Cochrane Library is a collection of six databases that contain different types of high-quality, independent evidence to inform healthcare decision-making, and a seventh database that provides information about Cochrane groups. Includes full-text Cochrane systematic reviews.
CINAHL Complete is the world's most comprehensive nursing & allied health research database, providing full text for more than 1,350 journals indexed in CINAHL. Of those, 953 are not found with full text in any version of Academic Search, Health Source or Nursing & Allied Health Collection. This authoritative file contains full text for many of the most used journals in the CINAHL index, with no embargo. With full-text coverage dating back to 1937, CINAHL Complete is the definitive research tool for all areas of nursing and allied health literature.
MEDLINE provides authoritative medical information on medicine, nursing, dentistry, veterinary medicine, the health care system, pre-clinical sciences, and much more. Created by the National Library of Medicine, MEDLINE uses MeSH (Medical Subject Headings) indexing with tree, tree hierarchy, subheadings and explosion capabilities to search citations from over 5,400 current biomedical journals.
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.
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.
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.
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.
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.