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Evidence Based Practice and Finding the Information You Need

Evidence Based Practice and Finding the Information You Need



EBP presentation geared towards Physical Therapy students enrolled in PT 610 at the University of South Alabama

EBP presentation geared towards Physical Therapy students enrolled in PT 610 at the University of South Alabama



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    Evidence Based Practice and Finding the Information You Need Evidence Based Practice and Finding the Information You Need Presentation Transcript

    • Clista Clanton, MSLS, AHIP August 27, 2009
    • Evidence-Based Practice
      • Evidence-Based Practice (EBP) requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources.
      Dawes, M., Summerskill, W., Glaszion, P., Cartabellotta, A., Martin, J., Hopayian, K. et al. (2005) Sicily statement on evidence-based practice. BMC Medical Education , 5. Retrieved 7/22/09 from http://www.biomedcentral.com/1472-6920/5/1
    • Evidence-Based Medicine
      • "Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”
      Sackett, D.L. et al. (1996) Evidence based medicine: what it is and what it isn't. BMJ 312 (7023), 13 January, 71-72.
    • Adapted from: Sackett D.L., Rosenberg M.C., Gray J.A., Haynes R.B., Richardson W.S. (1996). Evidence based medicine: what it is and what it isn't. BMJ, 312, 71-72.
    • Developing the Clinical Question
      • Step 1: Formulate the clinical issue into a searchable, answerable question.
      • Step 2: Distinguish what type of question you may have.
      Background Foreground Experience with Condition
    • Background Questions
      • Background questions ask for general information about a condition or thing.
        • A question root (who, what, when, etc) combined with a verb.
        • A disorder, test, treatment, or some other form of healthcare.
          • What causes arthritis?
          • What is the recommended length of exercise for pregnant women?
      Background questions are typically answered by textbooks.
    • Foreground Questions
      • Foreground questions ask for specific knowledge about a specific patient with a specific condition.
        • Are specific stabilization exercises any more effective than general strengthening exercises for low back pain?
        • Are strengthening exercises contraindicated in people suffering from post polio syndrome?
      Foreground questions are typically answered by databases that access the research literature
    • Developing the question
      • Foreground questions usually have four components.
      P = P atient population I = I ntervention C = C omparison O = O utcome
    • PICO: Components of an answerable, searchable question Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare : A guide to best practice . Philadelphia, PA: Lippincott Williams & Wilkins. Patient population/disease The patient population or disease of interest - age - gender - ethnicity - with certain disorder (e.g., hepatitis) Intervention The intervention or range of interventions of interest - Exposure to disease - Prognostic factor A - Risk behavior (e.g., smoking) Comparison What you want to compare the intervention against - No disease - Placebo or no intervention/therapy - Prognostic factor B - Absence of risk factor (e.g., non-smoking) Outcome Outcome of interest - Risk of disease - Accuracy of diagnosis - Rate of occurrence of adverse outcome (e.g., death)
    • In patients with chronic pain , does the use of progressive muscle relaxation lead to a lessening of pain ? In patients with post polio syndrome , are strengthening exercises contraindicated ? Is the 6-minute walk test useful in assessing the functional capacity of COPD patients ? In patients with low back pain , are specific stabilization exercises or general strengthening exercises more effective? In patient with [Patient/ Problem] does [Intervention] or [Comparison, if any] affect [Outcome]
    • Types of Questions
      • Diagnosis: How to select a diagnostic test or how to interpret the results of a particular test.
      • Prognosis: What is the patient's likely course of disease, or how to screen for or reduce risk.
      • Therapy: Which treatment is the most effective, or what is an effective treatment for a particular condition.
      • Harm or Etiology: Are there harmful effects of a particular treatment, or how these harmful effects can be avoided.
      • Prevention: How can the patient's risk factors be adjusted to help reduce the risk of disease?
      • Cost: Looks at cost effectiveness, cost/benefit analysis.
      • Qualitative: Helps to understand clinical phenomena with emphasis on understanding the experiences and values of patients.
    • Health Sciences Literature
      • Primary – original research
        • Experimental (an intervention is made or variables are manipulated)
          • Randomized Control Trials
          • Controlled trials
        • Observational (no intervention or variables are manipulated)
          • Cohort studies
          • Case-control studies
          • Case reports
      • Secondary – reviews of original research
        • Meta-analysis
        • Meta-synthesis
        • Systematic reviews
        • Practice guidelines
        • Reviews
        • Decision analysis
        • Consensus reports
        • Editorial, commentary
      Not used in EBP
    • Type of Question Suggested Best Type of Study Therapy RCT > cohort > case control > case series Diagnosis Prospective, blind comparison to gold standard Etiology / Harm RCT > cohort > case control > case series Prognosis Cohort study > case control > case series Prevention RCT > cohort study > case control > case series Clinical Exam Prospective, blind comparison to gold standard Cost Economic analysis Questions of therapy, etiology and prevention which can best be answered by RCT can also be answered by a meta-analysis or systematic review.
    • Hierarchy of Evidence Case Series/Case Reports Case Control Studies Cohort Studies Randomized Controlled Trial Systematic Review Meta-analysis/ Meta-synthesis Animal Research/Expert Opinion Start at the top and work your way down.
    • Systems Computerized decision support Summaries Dynamed, ACP PIER, Clinical Evidence, EBP guidelines Synopses TRIP, ACP Journal Club Syntheses Cochrane Systematic Reviews, DARE, PEDro Studies PubMed, Scopus, CINAHL Haynes RB. Of studies, summaries, synopses, and systems: the “5S" evolution of services for finding current best evidence. ACP Journal Club . 2001;134: A11–13. Adapted from Haynes (2001)
    • Sources of Information
      • Dynamed
      • Cochrane Library
      • TRIP
      • PEDro
      • National Guideline Clearinghouse
      • PubMed
      • Scopus
      • CINAHL
      • Google Scholar