This document discusses evidence-based practice (EBP) in physiotherapy. It provides several definitions of EBP which emphasize integrating the best research evidence with clinical expertise and patient values. The document notes that clinical practices become outdated if new evidence is not incorporated. It highlights the importance of EBP in improving patient care and outcomes. Examples of research on manual therapy for neck pain, shortwave diathermy for low back pain, and a survey of Malaysian physiotherapists' treatment preferences for low back pain are provided to illustrate EBP. The introduction to research section outlines the importance of clinical research and different types including experimental and non-experimental research.

1. NORZULAIKA BINTI ALIAS
PENGAJAR JURUPULIH
PERUBATAN ANGGOTA
EVIDENCE BASED PRACTICE

2. Evidence Based Practice(EBP)
The practice of health care in which the
practitioner systematically finds, appraises,
and uses the most current and valid research
findings as the basis for clinical decisions.
(Mosby’s Medical Dictionary, 8th edition.©2009,Elsevier)

3. Evidence Based Practice(EBP)
“the conscientious, explicit and judicious use
of current best evidence in making decisions
about the care of the individual patient. It
means integrating individual clinical expertise
with the best available external clinical
evidence from systematic research.”
(Sackett D, 1996)

4. Evidence Based Practice(EBP)
“evidence-based medicine(EBM) is integration
of best research evidence with clinical
expertise and patient value”
(Sackett et al. 2000)

5. Research
Patient’s
Value
Clinical
Expertise

6. Evidence Based Practice(EBP)
“The practice of evidence-based medicine
means integrating individual clinical expertise
with the best available external clinical
evidence from systematic research”
(Sackett et al. 1996)

7. Sackett et al, 1996
As Sackett and his colleagues point out, clinical
practices become out of date if new evidence is not
drawn upon.
However, the clinician must be aware of what
evidence is appropriate to integrate into their
practice
This can prove to be a difficult and time-consuming
task but it is an essential skill in implementing
evidence based practice.

8. Evidence Based Practice(EBP)
• Evidence based practice is one useful
approach to improving the impact of practice
in medicine, psychology, social work, nursing
and allied fields.
• EBP and practice evaluation work together
very well, but they have different purposes
and use very different methods.

9. Evidence Based Practice(EBP)
• Clinical guidelines should be freely accessible
with international collaboration and
endorsement
• Information to support EBP should be made
available in different languages and format.
• Duplicated in effort should be avoided
• EBP must be part of long learning and all PTs
should recognize the important of developing
necessary skill for EBP.

10. Why Evidence Based Practice(EBP)?
• It is one step toward making sure each client
gets the best service possible
• Some argue it helps keep your knowledge up
to date, supplements clinical judgment, can
save time and most important can improve
care and even save lives.
• Some say, it’s unethical to use treatments that
aren’t known to work.

11. How is EBP Implemented in Practice?
• Profiling research that informs professionals
and clients about what works is where
evidence based practice starts.
• These summaries tell us what we know about
treatment and program efficacy based on
experimental work-as well as what we don’t
know or aren’t really sure about.

12. How is EBP Implemented in Practice?
• Having access to information on what works
allows professionals, in conjunction with
clients, to select treatments that are most
likely to be helpful before intervention is
begun.

13. Examples
Evidence Based Practice(EBP)

14. MANUAL THERAPY IN TREATMENT OF NECK PAIN
Rheumatic Diseases Clinics of North America-
Volume 22,Issue 3(August 1996)
• Manual therapies have been demonstrated to be effective for
mechanical neck pain in the short term when used in
combination with other treatments.
• The risk of increased symptoms resulting from manual
therapy is low(in the range of 1%-2%),with the most common
symptom aggravation being vertigo or dizziness.
• The risk of serious complication or death from neck
manipulation is extremely low(in the range of 0.0001%)

15. Evaluation of The Effects Of Shortwave Diathermy in
Patients With Chronic Low Back Pain
Bangladesh Med Res Counc Bull-01-APR-2009;35(1):18-
20
 A prospective experimental study on 97 patients of chronic low back
pain was conducted to find out the effects of shortwave diathermy.
 They were divided randomly into two groups and treated with
nonsteroidal anti-inflammatory drugs, exercises, activities of daily
living instructions and with or without shortwave diathermy
 After six weeks of treatment, improvements were observed in both
the group. But significant difference in improvement was found in
shortwave diathermy group than in placebo group. The present
study suggests that shortwave diathermy is effective for the
treatment of patients with chronic low back pain.

16. A survey of Malaysia Physiotherapist On Current
Practice And Reasons For Preference Of Treatment
Techniques On Non-specific Low Back Pain
• The result indicated that Manual Therapy and
Electrotherapy were most preferred, indicating a lack
of EBPT which could have been contributed by PTs
attending skill based course that lacked evidence
findings on the techniques recommended.
• This study also identified the lack of formal higher
education training to implement EBPT.
(Divinder Kaur, 2002)

17. INTRODUCTION TO RESEARCH

18. • The concept of research in physiotherapy has evolved with the
development of techniques of practice and changes in the
health care system.
• Clinical research is a structured process of investigating facts and
theories and exploring connections.
• It proceeds in a systematic way:
- to examine clinical conditions and outcomes.
-to establish relationships among clinical
phenomena.
-to generate evidence for decision making
-to provide the impetus for improving methods of practice.

19. • Clinical research must be empirical and critical
-results must be observable, documented and examined for
validity.
• The objective process is dynamic and creative activity:
-performed in many different settings
-using a variety of quantitative and qualitative measurement
tools.
-focus on the application of clinical theory and interventions.

20. Types of research related to scope
of physiotherapy
• Experimental research
-it refers to investigations in which the researcher
manipulates and controls one or more variables and
observe the resultant variation in other variables
-to compare conditions or intervention groups, to
suggest cause-and-effect relationships.
• Nonexperimental research
-it refers to descriptive or exploratory investigations in
nature and do not exhibit direct control over the studied
variables
-it is often referred as observational reseach:to reflect
the idea that phenomena are observed rather than
manipulated.