Critical Thinking, Evidence-Based Practice and Clinical Decision-Making

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Critical Thinking, Evidence-Based Practice and
Clinical Decision-Making
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Critical Thinking
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Critical Thinking

• Involves the
• Discipline
• Willingness
• Ability
• Active awareness (metacognition)
• To
• Assess evidence and claims
• Seek a breadth of information (confirming and
  contradicting)
• Make objective, well supported judgments to guide
  belief and action

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Critical Thinking Is the Ability To

• 1. Interpret numerical relationships in graphs.
• 2. Identify inappropriate conclusions and
  understand the limitations of correlational data.
• 3. Identify evidence that might support or not
  support an hypothesis.

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• 4. Identify new information that is needed to
  draw conclusions.
• 5. Separate relevant from irrelevant information
  when solving a problem.
• 6. Learn and understand information in an
  unfamiliar domain.
• 7. Use elementary mathematics skills in the
  context of solving a larger real world problem.

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• 8. Draw inferences between separate pieces of
  information and formulate conclusions.
• 9. Recognize how new information might change the
  solution to a problem.
• 10. Communicate effectively.

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Skilled Critical Thinking Requires

• Clarity
• Accuracy
• Precision
• Relevance
• Depth
• Breadth
• Logic

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• Clarity clear, transparent, translucent,
  unambiguous
• Accuracy correctness
• Precision exactness, meticulousness
• Relevance significance, bearing
• Depth penetration, profundity
• Breadth width, extensiveness, extent
• Logic reason, judgment, sense

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Critical Reading

• Applying context
• Reading with a purpose
• Being sensitive to language and word play

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Critical Reading Practice

• Read the article distributed by the instructor.
  Critically analyze the article. Look at
• Clarity
• Accuracy
• Precision
• Relevance
• Depth
• Breadth
• Logic

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Critical Writing

• Paraphrase the issue without taking sides.
• Give pros and cons of both sides.
• Summarize or conclude. May or may not take a side
  in conclusion.

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Critical Writing Practice

• Present your perspective on the issue below,
  using relevant reasons and/or examples to support
  your views.
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• The Balanced Budget Act proposed to limit
  payment for PT and Speech Therapy services
  combined to 1500 a year. It is more important to
  eliminate this cap than to keep it and thereby
  help to control overall spending on health care.

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Critical Listening

• Identify factual errors.
• Identify inappropriate conclusions or
  generalizations that may be unsubstantiated.
• Separate relevant from irrelevant information.
• Identify additional information that is needed.
• Evaluate breadth of information.
• Develop a question to address problems with
  clarity, accuracy, precision, relevance, depth,
  breadth, logic.

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Critical Listening Practice

• View the video and discuss how well reasoned you
  find the arguments
• http//www.upledger.com/media/default.htm

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Evidence-Based Practice
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Evidence-Based Practice

• EBP is the
• Conscientious
• Explicit
• Judicious
• Use of
• Current best evidence
• To
• Make decisions about the care of individual
  patients

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The Practice of EBP

• Integrates
• Individual clinical expertise with
• Best available external clinical evidence from
  systematic research

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Individual Clinical Expertise

• Proficiency and judgment acquired through
  clinical experience and clinical practice.
• Results in
• More effective and efficient diagnosis
• More thoughtful identification and compassionate
  use of
• Patients predicaments, rights and preferences

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Current Best Evidence

• Clinically relevant research that includes
• Basic science of physical therapy
• Accuracy and precision of diagnostic tests
• Power of prognostic markers
• Efficacy and safety of therapeutic,
  rehabilitative and preventive regimens

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Current Best Evidence Alone is Not Enough

• Available evidence may be inappropriate or
  inapplicable to the individual patient
• Clinical Expertise Alone is Not Enough
• Without evidence, practice can rapidly become out
  of date, to the detriment of the patient

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Framing a Question
In patients with Will Compared to. Result in?
In patients with osteoarthri-tic pain Will exercise and joint mobilization Compared to exercise alone Result in less pain as measured on the VAS?
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Hooked on Evidence

• APTA website for members to identify the evidence
• In development
• http//www.hookedonevidence.org/

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Link to Portal
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Clinical Decision-Making
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Clinical Decision-Making

• Problem solving and critical thinking in a
  clinical setting using EBP

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Clinical Decision Making Tasks in Physical Therapy

• Communicating or discussing diagnosis or clinical
  impressions with other practitioners
• Determining the prognosis
• Collaborating with patients, family
• Setting goals
• Defining outcomes
• Delivering, managing, monitoring and adjusting
  the plan of care
• Differential diagnosis (Diagnostic Reasoning)

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The Disablement Model
Social Aspects
Medical Aspects
Domain of Physical Therapists
From Guide to Physical Therapist Practice, 2nd
ed. Phys Ther. 2001819-744.
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Example The Disablement Model
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Diagnostic Reasoning

• Diagnosis a label for a particular combination
  or set of symptoms, findings, and hunches.
• Diagnostic reasoning

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Decision-Making Trees
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Reflective Thinking

• Used to resolve ethical problems
• No correct answer
• Complex situations

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Scientific Inquiry

• Research
• Organized and systematic study of a problem or
  phenomenon for the purpose of generating
• New knowledge
• New or different ways of understanding (new
  theories)

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Creative Thinking

• May or may not pertain to a problem
• Focuses on generating new
• Ideas
• Concepts
• Inventions
• Applications of prior knowledge