Evidence-based practice (EBP) in physiotherapy uses clinical experience, patient values, and the best available evidence to inform decision-making. It promotes critical evaluation of research to ensure that interventions are effective and suited to individual patient requirements. It also improves treatment outcomes, promotes patient-centered care, and increases the profession's credibility.

1. EVIDENCE-BASED
PRACTICE(EBP)
Dr Neha Dubey
PhD(PT)
Faculty; Deptt of Physiotherapy
UPUMS, SAIFAI

2. Evidence-based Practice(EBP)
1. An approach to healthcare that combines the
best available scientific data, clinical
expertise, and patient values and preferences
to inform decision-making and enhance
patient outcomes.
2. It entails making thoughtful, transparent, and
reasonable decisions about individual
patients' care based on the most recent best
evidence.
Dr Neha Dubey(PT)

3. Importance of Evidence-Based Practice
in Physiotherapy
1. Improving Patient Outcomes: It ensures that healthcare
decisions are based on the most current and relevant
evidence, leading to better patient outcomes and quality of
care.
2. Optimizing Resource Utilization: By utilizing evidence-
based guidelines and practices, healthcare resources can be
allocated more efficiently, reducing unnecessary costs and
improving healthcare system sustainability.
3. Enhancing Patient Safety: It helps to minimize the risks
associated with healthcare interventions by ensuring that
treatments and procedures are grounded in evidence of
effectiveness and safety.

4. 4. Promoting Accountability and Transparency: It promotes
accountability and transparency among healthcare providers in
healthcare delivery to justify their clinical decisions based on
the best available evidence.
5. Advancing Healthcare Knowledge: Through the systematic
evaluation and synthesis of research evidence, it contributes to
the advancement of knowledge, driving innovation and
continuous improvement in clinical practice.
6. Empowering Patients: it emphasizes patient-centered care,
involving patients in decision-making processes and considering
their values and preferences. This empowers patients to take an
active role in their healthcare journey.
7. Fostering Professional Development: Practicing EBP requires
healthcare professionals to continuously engage in critical
appraisal of evidence, enhancing their knowledge and skills and
promoting lifelong learning and professional development.

5. Types of Evidences
In research, evidence is critical for supporting claims, hypotheses, or
conclusions. The types of evidence are listed below:
1. Primary Sources: These are original sources of data or information that
researchers collect firsthand. Examples include experiments, surveys,
interviews, observations, and case studies. Primary sources provide direct
evidence and are often considered the most reliable type of evidence.
2. Secondary Sources: Secondary sources involve analyzing and
interpreting primary sources or existing data. Examples include literature
reviews, meta-analyses, and systematic reviews. While secondary sources
don't provide original data, they offer valuable insights by synthesizing
and analyzing existing evidence.
3. Quantitative Data: Quantitative evidence consists of numerical data that
can be measured and analyzed statistically. This includes variables such
as counts, measurements, and frequencies. Quantitative data are often
collected through surveys, experiments, and standardized assessments.

6. 4. Qualitative Data: It consists of non-numerical data that describe
qualities, characteristics, or meanings. This includes observations,
interviews, focus groups, and open-ended survey responses. Qualitative
data provide rich, detailed insights into people's experiences,
perspectives, and behaviors.
5. Statistical Evidence: It involves analyzing quantitative data to identify
patterns, relationships, or trends. This includes descriptive statistics (e.g.,
mean, median, standard deviation) and inferential statistics (e.g., t-tests,
regression analysis) to make inferences about populations based on
sample data.
6. Experimental Evidence: It involves conducting controlled experiments
to test hypotheses and evaluate causal relationships. Researchers
manipulate independent variables to observe their effects on dependent
variables while controlling for confounding factors. Experimental designs
provide strong evidence for causality.
7. Correlational Evidence: It involves examining relationships between
variables without manipulating them. Correlational studies measure the
degree to which variables are related or co-vary. While correlational
evidence cannot establish causation, it can identify associations and guide
further research.

7. 8. Longitudinal Evidence: It involves studying subjects over an
extended period to track changes or developments over time.
Longitudinal studies provide insights into trends, trajectories, and
developmental processes. They are valuable for understanding how
variables change or interact over time.
9. Case Study Evidence: It involves in-depth analysis of individual
cases or small groups. Case studies provide detailed, context-
specific information and can be particularly useful for exploring
rare phenomena, complex situations, or unique contexts.
10. Historical Evidence: It involves analyzing past events,
documents, artifacts, or records to understand historical
phenomena or trends. Historical research relies on primary and
secondary sources to reconstruct and interpret past events and their
significance.

8. Forms of Evidences
Some common forms of evidence used in research are:
1. Empirical Evidence: This is evidence based on direct observation
or experimentation. It involves collecting data through systematic
observation, measurement, or experimentation.
2. Documentary Evidence: It consists of written records, documents
that provide information or support a claim. This includes official
documents, reports, manuscripts, and historical records.
Documentary evidence is valuable for verifying facts,
documenting events, and providing historical context.
3. Testimonial Evidence: It includes statements or accounts
provided by witnesses, experts, or individuals with relevant
knowledge or experience. For e.g.: interviews, survey responses,
testimonies, or quotes from participants.

9. 4. Visual Evidence: It involves using images, photographs,
diagrams, charts, graphs, or maps to support research findings or
illustrate key points. Visual evidence can enhance understanding,
communicate complex information, and provide visual
representations of data or phenomena.
5. Audiovisual Evidence: This can include recordings of interviews,
experiments, observations, or simulations. Audiovisual evidence
provides additional sensory information and can enhance
engagement and communication.
6. Meta-Analytical Evidence: Meta-analysis involves synthesizing
the results of multiple studies on a particular topic to provide a
more comprehensive understanding of the evidence. Meta-
analytical evidence combines data from diverse sources to generate
more robust conclusions than individual studies alone.

10. Evidence-based decision-making
and management practice
It involves using the best available evidence to inform and guide
decision-making processes within an organization. It works by:
1. Utilizing Research Evidence: Decision-makers gather and
evaluate relevant research evidence from a variety of sources,
including peer-reviewed studies, reports, and expert opinions. This
evidence provides a foundation for informed decision-making.
2. Applying Professional Expertise: It bring their knowledge,
experience, and skills to the decision-making process. They use
their understanding of organizational goals, resources, and
constraints to assess the feasibility and implications of various
options.

11. 3. Considering Participant Input: Effective decision-making
involves considering the perspectives and preferences of all
relevant participants, including employees, customers,
shareholders, and community members. Their input helps ensure
decisions are aligned with broader organizational values and goals.
4. Balancing Risks and Benefits: Decision-makers weigh the
potential risks and benefits associated with different courses of
action. They consider factors such as cost-effectiveness, potential
impact on stakeholders, and long-term sustainability to make
decisions that maximize benefits while minimizing risks.
5. Implementing Continuous Evaluation: Evidence-based
management involves implementing systems for monitoring and
evaluating the outcomes of decisions. This allows organizations to
assess their effectiveness and adjust strategies as needed to achieve
desired results.

12. Key Elements of EBP in
Physiotherapy
1. Research Literature Review: Physiotherapists must conduct
thorough reviews of existing research literature to identify the
most current and relevant evidence related to their clinical
question or problem.
2. Clinical Expertise: Integrating clinical expertise involves
utilizing the skills, knowledge, and experience of the
physiotherapist to effectively apply evidence to individual
patient cases, considering unique patient characteristics and
circumstances.
3. Patient Values and Preferences: Patient-centered care is
essential in evidence-based practice. Physiotherapists must
consider patient values, preferences, and goals when making
clinical decisions, ensuring that treatment plans align with what
matters most to the patient.

13. 4. Critical Appraisal Skills: Physiotherapists need to possess
the ability to critically appraise research evidence,
evaluating its validity, relevance, and applicability to
clinical practice. This skill ensures that only high-quality
evidence informs decision-making.
5. Continuous Evaluation and Improvement: Evidence-
based practice in physiotherapy is a dynamic process.
Physiotherapists must continually evaluate the
effectiveness of interventions through outcome measures
and patient feedback, adapting treatment plans as needed to
optimize patient outcomes.

14. Importance of Hierarchy of Evidence
It is a framework used in research and evidence-based practice to rank
the strength and validity of different types of evidence. This
hierarchical approach is important for several reasons:
1. Guiding Decision-Making: The hierarchy of evidence provides a
structured framework for researchers, practitioners, and decision-
makers to evaluate the quality and reliability of evidence when
making decisions. By following a systematic hierarchy,
stakeholders can prioritize the use of the highest quality evidence
available.
2. Promoting Evidence-Based Practice: The hierarchy of evidence
helps clinicians identify and prioritize high-quality evidence to
inform clinical decisions, leading to better patient outcomes and
more effective healthcare delivery.

15. 3. Optimizing Resource Allocation: The hierarchy of evidence
allows organizations to allocate resources efficiently by focusing
on evidence that is methodologically rigorous and likely to have
the greatest impact on decision-making.
4. Minimizing Bias and Error: IT helps minimize the risk of
drawing erroneous conclusions or making decisions based on
flawed evidence. This promotes transparency, accountability,
and integrity in research and decision-making processes.
5. Facilitating Critical Appraisal: Critical appraisal is the process
of systematically evaluating the strengths and limitations of
research evidence. The hierarchy of evidence serves as a guide
for critically appraising studies, helping researchers and
practitioners assess the validity, reliability, and relevance of
different types of evidence.

16. 6. Supporting Research Synthesis: In fields such as systematic
reviews and meta-analyses, researchers synthesize evidence from
multiple studies to generate comprehensive conclusions. The
hierarchy of evidence aids in synthesizing and interpreting research
findings by providing a framework for assessing the quality and
reliability of included studies.
7. Advancing Knowledge: By promoting the use of high-quality
evidence and rigorous research methods, the hierarchy of evidence
contributes to the advancement of knowledge and the development
of evidence-based guidelines, policies, and interventions. This
fosters innovation, improves research quality, and enhances the
credibility of scientific research.

17. Embrace the
evidence, empower
your practice.