Question: Have you heard the term EBP mentioned at one of your recent CE courses? Skimmed over it in the PT Journal? Saw it on the American Physical Therapy Association website? Do you think it could be beneficial but aren’t quite sure where to begin?
Well your not alone, a majority of APTA members feel that having evidence could help in decision making when treating patients but many still are not using it because its too time consuming or because it’s too daunting of a task.
Well today, I’m going to try and break down EBP for you and make it applicable for you, as the working clinician, not the seasoned scientist.
EBP is one of the keystones to the DPT curriculum and we are getting it thrown at us from every angle. Our very first semester in our first year has a research class and introduces us to the subject. In all of our core classes, like ortho, therex, kinesiology, we not only have our textbooks to read and learn from, but we also get several research articles from our teachers so that we are up to date with the current “literature” as they call it.
What is it? Evidence-based practice is just practice based on proof.
It’s not just based off research, it based on the integration of your clinical expertise, what the patient themselves value, and the best available research evidence.
For example, you have a pt who is recovering from a TKA and you know quad strengthening will be one of your main goals. Well, you have numerous exercises to improve quad strength, but you only have time to do just a few exercises. EBP can help you narrow down the top 3 exercises lets say, to maximizes quad over other muscles, proven by EMG
To understand why we’re using EBP, let’s review this history timeline briefly-
Back in the 1990s, as I'm sure you remember, health care costs sky rocketed and caused cost control measures to be implemented. third-party payers needed justification for PT services.
So, in 1995 the Guide to Physical Therapist Practice was published to provide a comprehensive & detailed list of physical therapy services…but there was no research to substantiate these services…. That’s when the concept of evidence-based practice was developed. “EBP is practice based on proof”
In the year 2000, the APTA house of delegates adopted the APTA Vision statement for physical therapy 2020, otherwise known as vision 2020. vision 2020 was a beacon for the profession and provided a distinct direction for current and future action.
I bet your thinking you don’t have time for looking at research, but the whole purpose of EBP is to improve efficiency in clinical decision making to select and apply interventions that will maximize positive pt outcomes.
How can you begin to use EBP? Well, I’ve composed a binder full of relevant research articles that I’ve gotten throughout my curriculum that you can use. It has articles ranging from recent surgical procedures and rehab protocols to the efficacy of modalities and other therapeutic interventions. It’s got tabs that are divided by anatomical area for you to reference at your leisure.
If this is something that your really interested in, and want to learn how to select the most appropriate articles, including how to use search engines, determine the article’s validity, quality, etc I’ve added 3 articles under the tab “EBP” to guide you if you so choose.
(pass out research article #1) Now that you have the articles, here’s how to read a research article-
First we need to understand the different sections of an article, b/c not all of it is important for you as a clinician to read- usually they’re about 10-15 pages long and you don’t need to read them all, and you don’t have to read them front to back.
So, the elements of a research article include-
The title, self explanatory but sometimes the authors try to make the article sound more interesting or try to reel you in so be weary that the article may not be exactly what it says
Next is the Abstract- this is they key element for you. An abstract is a brief summary (100-300 wds long) that sumarizes the puporse, methods, results, and discussion. Always read this first.
Then you have the introduction: this sets the stage for the problem the reserachers were trying to address and why they felt it was necessary to research. This is usually a good background of information on the condition or pt population.
Then you have the method- this is the technical part to the paper that you can skim over. this is necessary so that the research could be replicated exactly and is a way to show it’s validity.
The results section presents the results of the study without commenting on the meaning. This section has all the statistical analyses and can get very complex…
Discussion- this is where the authors interpret their results
Evidence-Based Practice Presentation Sep2013
Clinical applications for working clinician
Viera VA Physical Therapy In-Service: Tina Postrel, SPT
September 3rd, 2013
Evidence-Based Practice (EBP)
O Part 1: what is it? Why?
O Part 2: how?
O Part 3: let’s practice!
Part 1: What?
O Bottom line: Practice based on proof!
O Integration of-
O Clinical expertise
O Patient values
O Best available research evidence
References (1, 2, 3)
Part 1: Why?
health care costs
Vision 2020 created:
“Guided by integrity, life-long
learning, and a commitment to
comprehensive and accessible
health programs for all people,
PTs and PTAs will render
throughout the continuum of care
and improve quality of life for
Part 1: Why?
O Improve efficiency!
O Improved patient
References (2, 3)
Part 2: How?
O Introducing… your new
O For more on choosing a
research article using a
database: flip to the
“EBP” tab for “how-to”
articles or go to APTA’s
References (2, 3, 5)
Part 2: How?
O Elements of research article:
O how to read a research article reference (1)
O 1. Carter R, Lubinsky J, Domholdt E. Rehabilitation Research: Principles and Applications. St. Louis, MO:
Elsevier Saunders; 2011.
O 2. Cleland J, Noteboom J, Whitman J, Allison S. A Primer on Selected Aspects of Evidence-Based Practice
Relating to Questions of Treatment, Part 1: Asking Questions, Finding Evidence, and Determining
Validity. Journal Of Orthopaedic & Sports Physical Therapy. August 2008;38(8):476-484.
O 3. Noteboom J, Allison S, Cleland J, Whitman J. A primer on selected aspects of evidence-based practice
relating to questions of treatment, Part 2: Interpreting results, application to clinical practice, and self-
evaluation. Journal Of Orthopaedic & Sports Physical Therapy. n.d.;38(8):485-501.
O 4. Pagliarulo M. Introduction to Phyiscal Therapy. St. Louis, MO: Elsevier Mosby; 2012.
O 5. APTA Evidence-based Practice Resources. American Physical Therapy Association. [www.apta.org]
O 6. BADE M, KOHRT W, STEVENS-LAPSLEY J. Outcomes Before and After Total Knee Arthroplasty
Compared to Healthy Adults. Journal Of Orthopaedic & Sports Physical Therapy. September
O 7. Murtaugh B, Ihm J. Eccentric Training for the Treatment of Tendinopathies. Current Sports Medicine
Reports (Lippincott Williams & Wilkins). May 2013;12(3):175-182.