what is the role of PT as a critical inquirer? how can Physical therapist use new evidence for research and treatment

1. Physical Therapist as Critical Inquirer
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SYED ZAIN UL ABIDIN
DPT,MSPT*(IPMR,KMU)

2. • What's meant by critical inquiry?
• History of critical inquiry
• Foundation for physical therapy
• Evidence based practice
• Steps in evidence based practice
• Some idea about the data sources
• Diagrammatic flow chart showing how EBP is
implemented??
Objectives of this presentation
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3. • Scientific methods to read and interpret professional
literature;
• Participate in, plan, and conduct research; evaluate
outcomes data;
• Assess new concepts and technologies.(on experimental
basis)
What’s meant by critical Inquiry??
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4. • Since day 1, physical therapy has recognized
the importance of critical inquiry.
• In 1921 AWPA stated the importance of
scientific investigation.
• 3rd Edition of Therapeutic Exercise and
Massage,(1932) was introduced, because of
clinical research in pathology.
THE HISTORY OF CRITICAL INQUIRY
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5. • In 1975 Helen Hislop lamented that physical therapy
is still infant.
• According to him a gap exist between Physical
therapy and clinical research.
• In 1993 Gary Soderberg addressed that
there is dire need for implementation of
science in physical therapy.
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6. • In a review of articles in the professional
journal Physical Therapy, Robertson noted a
lack of evidence and coherence among the
articles in three topic areas—knee, back, and
electrical stimulation
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7. According to Robertson the issues are….
• Lack of agreement on what physical therapy is
and what PTs do
• Lack of understanding of why physical therapy
is necessary
• Lack of agreement on terms and concepts
• Lack of clinical literature in the discipline
• Lack of development of relevant theory
Issues in unique body of knowledge!!!
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8. • In 2003, using the Hedges Project Criteria, it
was concluded that 56% of the 179 articles
reviewed were original research and the rest
were general discussion.
• only 11% of the articles met the Hedges
criteria for high-quality evidence suitable for
direct application to patient care.
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9. • Just as with other health care professionals, PTs
cannot expect patients and third party payers to
accept on blind faith that PTs do good things and
people get better.
• As Wolf asks,
“Do our patients improve because of the physical
interventions we provide, thus affecting their
state of well-being, or do our caring and
interaction favorably affect patient behaviors,
which subsequently motivates them to improve
physically?”
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10. • Over the past 30 years, the American Physical
Therapy Association (APTA) has taken major
steps to advance the science of the profession,
including formation of the Foundation for
Physical Therapy, publication of a clinical
research agenda, to develop a database for
evidence in physical therapy.
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PEDRO

11. • The Foundation for Physical Therapy was established in
1979 to support the research needs of the physical
therapy profession in three areas:
● Scientific research, to create a solid platform for future
clinical research
● Clinical research, to assess the efficacy of physical
therapy interventions and to help define best practice
● Health services research, to assess the effectiveness of
physical therapy practice in the emerging health care
delivery models
THE FOUNDATION FOR PHYSICAL
THERAPY:
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12. • The following are some of the foundation’s
activities, designed to advance these
objectives:
● Assisting clinicians, researchers, and
academicians in doctoral programs
● Expanding funding for new researchers
● Supporting clinically relevant research
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13. • is the integration of the best research evidence
with clinical expertise and patient values.
• Best research evidence as clinically relevant
research from the basic sciences that leads to
accurate and precise diagnosis and prognostic
markers, as well as therapeutic
• Clinical expertise is clinical skills and past
experiences
• Patient values are preferences and concerns
Evidence based practice
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15. • The popularity of EBP has emerged from
clinicians’ realization of the following:
● They need new information on a daily basis.
● They lack the time to find new information.
● Traditional information resources often are out of
date, wrong etc
● A disparity exists between clinical judgment,
which increases with experience, and “current,
relevant” information, which decreases with
experience.
POPULARITY OF EBP:
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16. • Step 1: Formulating a well-built question
• Step 2: Identifying articles and other evidence-based
resources that answer the question
• Step 3: Critically appraising the evidence to assess its
validity
• Step 4: Applying the evidence
• Step 5: Re-evaluating the application of evidence and areas
for improvement
STEPS IN APPLYING EVIDENCE-BASED
MEDICINE
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19. • Remains a matter of controversy
• Certain physical therapy faculties assume a great
deal of responsibility for new knowledge through the
academic triad—teaching, scholarship, and service
• Individual research agendas are more often driven by
personal interest and available funding than by the
needs of the profession
WHOSE RESPONSIBILITY IS RESEARCH?

21. • In 1996, 93.4% of PTs surveyed reported no
work-related research activity.
• In 2001 PTs reported spending an average of
1% of their time each week on research or
critical inquiry.
ROLES OF THE STAFF PHYSICAL
THERAPIST IN CRITICAL INQUIRY

22. • The following sections explore five remaining
aspects of critical inquiry that do
not overlap with the PTs’ other roles
• (1) Application and Critique of Research
• (2) Publisher of case reports
• (3) Collaborator in clinical research studies
• (4) An assessor of new concepts and technology
• (5) Research subject
Continue….

23. • Application and Critique of Research:
PTs’ education gives them the skills to practice
evidence-based physical therapy.
Critique of the literature also is done in journal
clubs, which are small groups of practitioners
who meet regularly to explore research on a
selected topic.

24. • Publication of Case Reports:
1. Think. What is the focus of your case?
2. Search the literature.
3. Write:
a. introduction (rationale)
b. case description
c. outcomes
d. Reflect on what happened (discussion)
4. Submit the case report for publication in a
peer-reviewed publication.

25. • Collaboration in Clinical Research:
According to Fitzgerald and Delitto,
research must be done on patients in clinical
settings if the physical therapy profession is to:
1. Document the effectiveness of interventions
accurately
2. Validate patient classification systems
3. Identify prognostic indicators of functional
limitations & disability.

26. • Factors which are crucial for clinicians conducting
clinical research
Research
related
injuries
Maintenance
of support
Availability of
target
population
Patient
management
issues
Resources
Ethical
consideration
FACTORS

27. • Assessment of New Concepts and Technology:
The PT should determine whether:
1.The theories underlying the intervention or
instrument are supported by valid anatomical and
physiological evidence
2. The intervention or instrument is designed for a
specific type of patient population
3. Potential side effects are presented

28. 4. Studies from peer-reviewed journals that support
the intervention’s or instrument’s efficacy are
provided
5. The supportive peer-reviewed studies include well-
designed, randomized, controlled clinical trials or
well-designed single-subject experimental studies
6. The proponents of the intervention or instrument
are open and willing in discussing its limitations

29. • Serving as a Research Subject:
SERVING AS A
RESEARCH SUBJECT
Interest
Completion of
study
Participation
Research
design
Value of
study

30. • APTA Code of Ethics and Guide for Professional
Conduct
Principle 5 of the code places a duty on the PT to
“maintain and promote high standards for physical
therapy practice, education, and research.”
Section (6.5A) states that a PT “participating in
research shall abide by ethical standards governing
protection of human subjects and dissemination of
results.”
ETHICAL AND LEGAL ISSUES IN
CRITICAL INQUIRY

31. Section (6.5B) states that PTs to “support
research activities that contribute knowledge
for improved patient care,”
Section (6.5C) directs PTs to report unethical
acts “in the conduct or presentation of
research.”

32. • Other sections of the Guide for Professional
Conduct (GPC) and the Code of Ethics (COE)
specifically address the issues of truthfulness,
autonomy and consent, and compliance with
laws and regulations.
• Using and providing accurate, relevant
information are also responsibilities of the
researcher.

33. • Protection of Human Subjects (Nuremberg Code)
PROTECTION OF
HUMAN SUBJECTS
Rights of
subjects
Prohibition of
studies
Avoidance of
injury
Disclosure of
risks to
subjects
Voluntary
participation
Balancing of
risks

34. Institutional Review Boards(IRB)
Over the past half century, federal regulations to
ensure protection of human subjects have
developed continually, culminating in the
Common Rule of 1991.
IRBs are the mechanism by which institutions
determine whether the benefit to society from a
research study warrant the risk to individual
subjects in the study.
An important feature of this process is the use of
IRBs to review research before it is implemented.

35. • Subjects vs. Patients
A patient should reasonably expect that health
care providers will attempt
 to place the individual’s interests first
 respect confidentiality
 be truthful
 disclose relevant information
 respect individual and cultural differences
 collaborate with the patient in achieving goals

36. • Responsibilities of Clinical Researchers
Besides protecting human subjects, PTs who
participate in clinical research have a
responsibility
to report results honestly and accurately
to report both positive and negative results
to comment constructively on research
literature.

37. • Ethics and Evidence-Based Practice
Investigation of the effectiveness of physical
therapy interventions is undeniably necessary
and potentially stands to benefit patients,
clients, and society.
For this reason, most PTs have embraced the
concept of evidence-based practice.

38. • Critical Inquiry Role in the Ethics Literature
Although it has not been explored as extensively
as the PT’s role in patient/client management,
the critical inquiry role has been the subject of a
handful of peer-reviewed articles; from 1970 to
2000, 9.9% of peer-reviewed publications dealt
with critical inquiry.
Informed consent and protection of human
subjects also were frequent topics.

39. THANK YOU