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
EBP Quick Course for ATs
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 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.
EBM Current Evidence Clinical PatientExpertise Values
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.
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
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.
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
P: Patient or ProblemI: InterventionC: ComparisonO: Outcome
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?
Understanding types of information Understanding types of research Understanding Levels of Evidence Key databases
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*
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?
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
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)
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 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?
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.
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
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
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
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*
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
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