Evidence-informed Health (Physiotherapy) Care WHY AND WHAT IS IT K Hariohm MPT Professor in PT MSAJ College of PT ICEBNR
objective1. What is evidence informed practice2. What is the need for EIP3. Learning the rudiments of of evidence informed practice
IS MEDICINE A SCIENCE What is science What is faith“Knowledge covering general Faith is belief with strongtruths of the operation of conviction; firm belief ingeneral laws, esp. as obtained something for which thereand tested through scientific may be no tangible proof;method [and] concerned with complete trust in or devotionthe physical world." to. Faith is the opposite of doubt.
What is the first step in a scientific method WHAT CONSTITUTES A SCIENTIFIC METHOD
MEDICINE IS SCIENCE•Science starts with a problem or aquestion•Evidence based practice – no question orno problem
REALLY DID THE APPLE FALL ON NEWTONFormulate a questionNo science without problem or questionEBP cannot happen if you don’t have a problemAsk the right question Apple falls on Newton
What are the question in physio-therapeutic scienceQuestion should be related to our patient care.1. Which treatment to follow for a particular patient or condition2. Which is method of treatment is better3. Which test to perform to help in diagnosis4. Can it lead to worsening of the patient (harm).5. Will my patient achieve a goal can he/she achieve
OTHERWISE THE QUESTION HAS NO VALUEQuestions related to our patient care
WHEN AM I GOING TO FINISH LEARNING ALL THESE AND STARTPRACTICINGProfessional question
THE PRECIPITATE! IF YOURE NOT PART OF THE SOLUTION, YOURE PART OF Next step -Find solution• Who do we usually ask- • Expert • Teacher • Social media- peers• Refer what? • Books • Journal (really)• Infer from • Physiological and other rationale • discuss and infer (peer discussion)
Can I take ideas and treatment on the face DOES IT MEAN I NEED NOT LISTEN TO MY PROFESSOR value of the expert
Dont go “according to Mr. ” to every treatment method and statement
WHAT IF MY PEERS ARE ALL DUMB OR SUPER SMARTDiscussion with peers Remember they can or may also come to the conclusion it is an elephant.
We go and read•What are we reading•When was it published•Was it referred properly•Is there confirmation bias
Remember medicine is science•It has to be proved•Is there a physiological validity for what is said•Experimented•Repeatability•Ideal homogeneity in the answer ?!
What is evidence based practiceEvidence based medicine istheconscientious, explicit, andjudicious use of current bestevidence in makingdecisions about the care ofindividual patients. Thepractice of evidence basedmedicine means integratingindividual clinical expertisewith the best availableexternal clinical evidencefrom systematic research.(From BMJ 1996;312:71-72)
Why evidence informed practiceWell its how science is doneMakes the practice better- better outcomesfor your patient
So how do I practice EBP or intelligently1. Formulate a proper question2. Search for answer3. Critically look at the answer for “truth”4. Put it into practice using you experience and expertise5. Re-evaluate