EVIDENCE BASED PHYSIOTHERAPY

3. WHAT DO I NEED TO KNOW??

4. CONTENT
• Overview
• Relevent clincal questions
• Refinning of questions
• Effects of interventions
• Experiences
• prognosis
• Diagnosis

5. Overview:

6. A well known saying is that ‘the beginning of all wisdom lies not in the
answer, but in the question’.
 The first step in evidence-based practice is to formulate a specific question.
 The question you have concerning your practice should be formulated so it is
possible to find a scientific answer to the question.
 Posing specific questions relevant to a patient’s problem provides a focus to
thinking, and it helps in the formulation of search strategies and in the process
of critical appraisal of evidence

7. Relevent clinical
questioning:

8. The most important clinical questions are those concerning:

10. SCENARIO
Mr. Y is 43 years old. He presents with low back pain of relatively acute
onset (about 2 weeks) with pain radiating down his left leg. He has no
apparent neurological deficits. The problem has arisen during a period of
heavy lifting at work and has become progressively worse over subsequent
days. Mr. Y’s general practitioner prescribed analgesics, anti-inflammatory
drugs and bed rest for 5 days, but this brought little improvement. He was
then referred to you for treatment to relieve his pain and restore physical
functioning.

11. Refining of question

12.  Before we begin the hunt for evidence that relates to our clinical
questions, we need to spend some time making the questions specific.
 Structuring and refining the question makes it easier to find an answer.
 One way to do this is to break the problem into parts

13. Effects of interventions

14. DEFINITION
“An intervention is a combination of program elements or strategies designed to
produce behaviour changes or improve health status among individuals or an entire
population. Interventions may include educational programs, new or stronger policies,
improvements in the environment, or a health promotion campaign.”

15. We usually break questions about the effects of intervention into
four part.
The words that is used majorly for it is “PICO”
P I C O

16. EXAMPLE
Patient
Intervention
Comparison Intervention Outcome
Adult with acute low
back pain
Bed rest Advice to stay active Pain and disability

17. Experiences:

18. It involves:
1) Questions
2) Specifying problem
3) Phenomenon of interest
4) Patient attitude
5) Patients concerns

19. EXAMPLE
Patient Phenomena
Adult with acute low back pain Principal concerns

20. Prognosis:

21. WHAT IS PROGNOSIS?
“A doctor’s judgement of the likely or expected development of disease or of the
chances of getting better”
Comparison between two groups…
Mutual interest of pt. and therapist..

22. FACTORS MAINLY INVOLVE IN PROGNOSIS
 KNOWLEGE
 SEVERITY OF THE DISEASE
 HEALTH STATE
 PRESCRIBED TREATMENT
 CASE DEPENDANT FACTORS

23. EXAMPLE
Patient Indicator Outcome and time frame
Adult with acute low back pain No previous spells of low back
pain
Probability of being pain-free
within 6 weeks

24. Diagnosis:

25. WHY DO WE NEED DIAGNOSIS?
Identification Examination Evaluation

26. ACCURACY OF DIAGNOSTIC TESTS
 Misclassification of diagnostic test….REASON?
 It is useful to know the probability of misclassification?
 A perfect index test?
 Research ?

27. EXAMPLE:

30. THANK YOU!
YEAR-END SUMMARY PLAN BUSINESS REPORT PPT IN THE NEW YEAR