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Introduction to the Basics           November 9, 2012
1.   Define EBM/EBP2.   History of EBM in AT3.   The Process4.   EBP Web-based Resources
    Using evidence to                                                         The specific way you     support your clin...
EBM       Current       Evidence Clinical     PatientExpertise     Values
    Keeping up to date                                                       Conducting “research”     Using knowledge ...
   EBM originally coined in 1992   Began gaining momentum in AT in early    2000s   Now a mandated component of AT Educ...
   Overall    ◦ Lack of outcome effectiveness studies    ◦ Available evidence is inconclusive or contradicting   Persona...
1.   Asking appropriate clinical questions2.   Acquiring medical evidence3.   Critically appraising available evidence4.  ...
P: Patient or ProblemI: InterventionC: ComparisonO: Outcome
Follow this link for a PICO tutorial….                         PICO Tutorial   This worksheet can be used to help you deve...
   Understanding types of information   Understanding types of research   Understanding Levels of Evidence   Key datab...
   Expert Opinion   Case Report   Case Series   Cohort Study    ◦ Prospective vs. Retrospective   Case Control Study...
   For a very clear explanation of each type of    research and how to recognize it, complete    this tutorial:          ...
   To further explain the difference between    filtered and unfiltered information and where    to find it….. (take a lo...
   Now that you’re familiar with:    ◦ Research design (MA, RCT, cohort study, etc.)    ◦ Prospective v. retrospective re...
CEBM have since updated thisinformation slightly as of 2009and is working to do so again.
National Athletic Trainers’ Association Position Statement: Preventing Sudden Death in Sports ◦ Review the article and not...
Physiotherapy Evidence DatabasePEDro is the Physiotherapy Evidence Database. PEDro is  a free database of over 22,000 rand...
   This database is important for you not only    because it may provide a critically appraised    article resource BUT,...
   Databases                            Other Databases    ◦ PubMed (publicly available)    ◦ Google Scholar Beta (publi...
   Establishing a solid clinical question (PICO)    should help make your literature search more    effective.           ...
   Complete this case scenario tutorial to assess    your understanding of the EBP process                  Practice Case...
   Patient Oriented Evidence that Matters (POEM)    ◦ An example    ◦ POEM Research Summaries   Clinical Prediction Rule...
   Information provided by NATA    ◦ http://www.nata.org/EvidenceBasedEdu   Centre for Evidence Based Medicine    ◦ http...
EBP Quick Course for ATs
EBP Quick Course for ATs
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EBP Quick Course for ATs

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  • Acknowledge that there may be varying levels of familiarity with this process, but working under the premise that most are unfamiliar.
  • EBM = TheoryEBP = Practical ApplicationProvide real-life example… perhaps use a practice brief from Boston University
  • Current Evidence = Best EvidenceClinical Expertise = Clinical JudgmentClin. Exp. is typical area of focus for most AtsQuestion: Are you doing what you’ve always done? What does the current research say about the effectiveness of what you do?Question: What consideration do you make for your patient values/goals? Do you even know your patient goals before you begin evaluation and/or treatment plan?
  • EBP is…. A way to improve care Promote critical thinking Specific support for AT profession/practices 3rd party reimbursement Validity, (+) perception of profession
  • AT Ed. Competencies…. One domain of 8 in 5th edition (available on Blackboard)BOC CEUs…. With next cycle expected to demonstrate completion of certain number EB-CEUs
  • Ask ACIs first and compare to this listConsider discussion potential strategies for working around these personal/organizational barriers
  • Overtime, through various modes we will begin to address the rest of the steps including: completing a literature search appraising the evidence understanding what the statistics mean applying your findings to clinical practice/patients evaluating process to improve overall process
  • Page 551 SORT article
  • Transcript of "EBP Quick Course for ATs"

    1. 1. Introduction to the Basics November 9, 2012
    2. 2. 1. Define EBM/EBP2. History of EBM in AT3. The Process4. EBP Web-based Resources
    3. 3.  Using evidence to  The specific way you support your clinical make decisions practice regarding the “integration of the best evaluation, diagnosis, research evidence with and treatment of your clinical expertise and patient patient values to make  Total integration of clinical decisions” EBM into clinical practiceEvidence-Based Medicine Evidence-Based Practice(EBM) (EBP)Jutte, LS & Walker, SE (2009). Incorporating and Teaching Evidence-Based Practice, from The Athletic Trainers Pocket Guide to Clinical Teaching(ed. by Weidner TG), p. 43 - 59; Slack, Inc.Steves, R & Hootman, JM (2004). Evidence-Based Medicine: What is it and How Does it Apply to Athletic Training. JAT, 39(1): 83-87.
    4. 4. EBM Current Evidence Clinical PatientExpertise Values
    5. 5.  Keeping up to date  Conducting “research”  Using knowledge  Using a “cookbook”  About the patient  About the clinician  Stagnation  Advancement EBP is…. EBP is NOT….Starkey, C (Feb. 26, 2011). Evidence: It Can Be For Us or Up Against Us; Athletic Training Educators Conference, Washington, DC.Steves, R & Hootman, JM (2004). Evidence-Based Medicine: What is it and How Does it Apply to Athletic Training. JAT, 39(1): 83-87.
    6. 6.  EBM originally coined in 1992 Began gaining momentum in AT in early 2000s Now a mandated component of AT Education and AT clinical practice ◦ 5th edition of AT Education Competencies ◦ Updates in BOC CEU requirements for current professionals
    7. 7.  Overall ◦ Lack of outcome effectiveness studies ◦ Available evidence is inconclusive or contradicting Personal ◦ Current health policies ◦ Complexity of practice ◦ Incomplete access to information ◦ Difficulty interpreting data ◦ Organizational barriers ◦ Ineffective CE sessions Maher CG, Sherrington C, Elkins M, Herbert RD, & Moseley AM (July 2004). Challenges for Evidence-Based Physical Therapy: Assessing and Interpreting High-Quality Evidence on Therapy. Physical Therapy, 84(7): p. 645 - 654.
    8. 8. 1. Asking appropriate clinical questions2. Acquiring medical evidence3. Critically appraising available evidence4. Applying evidence in context of clinical expertise and patient values5. Evaluating (assessing) effectiveness of intervention
    9. 9. P: Patient or ProblemI: InterventionC: ComparisonO: Outcome
    10. 10. Follow this link for a PICO tutorial…. PICO Tutorial This worksheet can be used to help you develop future PICO/Clinical Questions (or use version I have attached as an additional file): PICO WorksheetFollowing the completion of this activity, what questions do you have about creating PICO questions?
    11. 11.  Understanding types of information Understanding types of research Understanding Levels of Evidence Key databases
    12. 12.  Expert Opinion Case Report Case Series Cohort Study ◦ Prospective vs. Retrospective Case Control Study Systematic Reviews (SR) ◦ Compare to narrative review: HERE Meta Analysis (MA) Randomized Control Trial (RCT) *Click on each study for an example*
    13. 13.  For a very clear explanation of each type of research and how to recognize it, complete this tutorial: Research Design What questions do you still have now that you have completed this tutorial?
    14. 14.  To further explain the difference between filtered and unfiltered information and where to find it….. (take a look!) Types of Information Tutorial Understanding information and the search process Flow chart
    15. 15.  Now that you’re familiar with: ◦ Research design (MA, RCT, cohort study, etc.) ◦ Prospective v. retrospective research ◦ Filtered v. unfiltered information The next question is why are they depicted in a triangle? Levels of Evidence (Grade of Recommendation)
    16. 16. CEBM have since updated thisinformation slightly as of 2009and is working to do so again.
    17. 17. National Athletic Trainers’ Association Position Statement: Preventing Sudden Death in Sports ◦ Review the article and note that following each recommendation made there is a grade. ◦ This grade can be interpreted by looking at the SORT Level of Recommendation scale on the previous slide. ◦ What is the difference between an A, B, C recommendation?
    18. 18. Physiotherapy Evidence DatabasePEDro is the Physiotherapy Evidence Database. PEDro is a free database of over 22,000 randomised trials, systematic reviews and clinical practice guidelines in physiotherapy. For each trial, review or guideline, PEDro provides the citation details, the abstract and a link to the full text, where possible. All trials on PEDro are independently assessed for quality. These quality ratings are used to quickly guide users to trials that are more likely to be valid and to contain sufficient information to guide clinical practice. PEDro is produced by the Centre for Evidence-Based Physiotherapy at The George Institute for Global Health.
    19. 19.  This database is important for you not only because it may provide a critically appraised article resource BUT, Because it also offers a way to critically appraise research articles specific to physiotherapy PEDro Rating System
    20. 20.  Databases  Other Databases ◦ PubMed (publicly available) ◦ Google Scholar Beta (publicly (FREE) available) ◦ Cochrane Library (aspects ◦ TRIP Search publicly available) ◦ EMBASE ◦ Sage Journals Online ◦ ScienceDirect (part of ◦ SUMSearch SciVerse… Scopus) ◦ EBSCOHost ◦ PEDro  CINAHL  Also offers a link to a  ERIC variety of other  HealthSource: Nursing/Academic Edition databases, click HERE  MedLine  SPORTDiscus Those items highlighted in BLUE are available through the Hofstra Libraries
    21. 21.  Establishing a solid clinical question (PICO) should help make your literature search more effective. Literature Search TutorialThis will give you effective tools on how to use PubMed Cochrane Google Scholar
    22. 22.  Complete this case scenario tutorial to assess your understanding of the EBP process Practice Case Study PICO & Literature Search Worksheet Example #1 *I have adapted a version as well, as a fillable pdf form it’s attached as a separate document*
    23. 23.  Patient Oriented Evidence that Matters (POEM) ◦ An example ◦ POEM Research Summaries Clinical Prediction Rules (CPR) ◦ Tutorial ◦ How they’re developed ◦ Example Critically Appraised Topics (CAT) Critically Appraised Papers (CAP) General Resource ◦ National Guideline Clearinghouse  Sample Guideline ◦ Clinical Evidence
    24. 24.  Information provided by NATA ◦ http://www.nata.org/EvidenceBasedEdu Centre for Evidence Based Medicine ◦ http://www.cebm.net/index.aspx?o=1001 Webinar on Literature Searches ◦ http://mediasite.ics.uwex.edu/mediasite5/Viewer/?peid =916b24591eb14050b0e66b769fb9d6e81d NATA CEU Online Course (3 CEUs) ◦ http://cf.nata.org/quizcenter/courses/evidence/index.h tml
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