Evidence Based Practice: Unit I Introduction: Clinical Decision Making

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Evidence Based Practice Unit I
IntroductionClinical Decision Making
Mount St. Marys College Doctor of Physical
Therapy Program Faculty Online Instruction
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• Domain V
• Evaluate Use of evidence
• Assess EBP skills and use of evidence.
• Share and store critical appraisals
• Monitor literature for new evidence

Identify Learning or Developmental Need
.

• Domain I
• Ask Focused Questions
• Identify category of evidence (Diagnosis,
  Prognosis, Intervention)
• Formulate four-part clinical question

Client/Patient Problem EBP begins and ends here!
Domain IV Apply Findings Interpret evidence in
the context of the specific issues related to
the client/patient problem.

• Domain II
• Search for Evidence
• Use evidence hierarchy to guide search
• Search for meta-analyses, systematic reviews
  first.
• Search primary literature

• Domain III
• Critically Appraise Evidence
• What is the level of evidence?
• Is the evidence valid?
• Are the results important?

Modified by Slavin, 2005
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.

• Domain V
• Evaluate Use of evidence
• Assess EBP skills and use of evidence.
• Share and store critical appraisals
• Monitor literature for new evidence

Identify Learning or Developmental Need
.

• Domain I
• Ask Focused Questions
• Identify category of evidence (Diagnosis,
  Prognosis, Intervention)
• Formulate four-part clinical question

Client/Patient Problem EBP begins and ends here!
Domain IV Apply Findings Interpret evidence in
the context of the specific issues related to
the client/patient problem.

• Domain II
• Search for Evidence
• Use evidence hierarchy to guide search
• Search for meta-analyses, systematic reviews
  first.
• Search primary literature

• Domain III
• Critically Appraise Evidence
• What is the level of evidence?
• Is the evidence valid?
• Are the results important?

Modified by Slavin, 2005
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Client/Patient Problem
EBP begins and ends here!

• A patient problem that cannot be answered with
  existing knowledge.
• A challenge to ones own existing knowledge does
  literature support our best judgment??

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Client/Patient ProblemEBP begins and ends here!

• Recognize
• Reflect

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Identify Learning or Developmental Need

• Diagnosis
• Prognosis
• Therapy (Intervention)

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Identify Learning or Developmental Need

• Diagnosis
• Prognosis
• Therapy (Intervention)

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Identify Learning or Developmental Need

• Diagnosis
• Prognosis
• Therapy (Intervention)

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Domain IAsk Focused Questions

• Background/Foreground Questions.
• Formulate four-part clinical question
• P atient, population, problem
• I ntervention, prognostic factor, or exposure
• C omparison or alternative intervention
• O utcome to measure or achieve

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Background Questions

• Pathology
• Novel patient conditions

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Foreground Questions

• Answerable Question
• P atient, population, problem
• I ntervention, prognostic factor, or exposure
• C omparison or alternative intervention
• O utcome to measure or achieve
• PICOmaker
• http//www.library.ualberta.ca/pdazone/pico/

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PICOmaker
http//www.library.ualberta.ca/pdazone/pico/
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Evidence in Practice

• Hoppenrath T, Ciccone CD. Is there evidence that
  phonephoresis is more effective than ultrasound
  in treating pain associated with lateral
  epicondylitis? Phys Ther, 200686136-140.

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Domain IISearch for Evidence

• Scholarly Literature Databases
• Evidence-Based Medicine Databases
• PubMeds Clinical Queries Cochrane Library are
  useful tools.

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Domain IIICritically Appraise Evidence

• Use evidence hierarchy to guide selection and
  appraisal
• Meta-analyses, systematic reviews first.
• Randomized Controlled Trials

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Systematic Reviews and Meta-Analyses
Randomized Controlled Trials
Cohort Studies
Case Control Studies
Opinions, Letters
Animal Research
In vitro Research
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Systematic Reviews and Meta-Analyses
Randomized Controlled Trials
Cohort Studies
Case Control Studies
Opinions, Letters
Animal Research
In vitro Research
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Systematic Reviews and Meta-Analyses
Randomized Controlled Trials
Cohort Studies
Case Control Studies
Opinions, Letters
Animal Research
In vitro Research
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Systematic Reviews and Meta-Analyses
Randomized Controlled Trials
Cohort Studies
Case Control Studies
Opinions, Letters
Animal Research
In vitro Research
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Systematic Reviews and Meta-Analyses
Randomized Controlled Trials
Cohort Studies
Case Control Studies
Opinions, Letters
Animal Research
In vitro Research
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Systematic Reviews and Meta-Analyses
Randomized Controlled Trials
Cohort Studies
Case Control Studies
Opinions, Letters
Animal Research
In vitro Research
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Systematic Reviews and Meta-Analyses
Randomized Controlled Trials
Cohort Studies
Case Control Studies
Opinions, Letters
Animal Research
In vitro Research
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Systematic Reviews and Meta-Analyses
Randomized Controlled Trials
Cohort Studies
Case Control Studies
Opinions, Letters
Animal Research
In vitro Research
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Domain IIICritically Appraise Evidence

• Is the evidence valid?
• Are the results important?

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Evidence rating scales

• Single Article
• PEDro Scale (for RCTs)
• Reviews

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CAT Development

• Critically Appraised Topics
• http//www.cebm.net/catmaker.asp

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Domain IVApply Findings

• Interpret evidence in the context
• of the specific issues related to the
• client/patient problem.

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Domain VEvaluate Use of evidence

• Assess your own EBP skills and use of evidence.
• Share and store critical appraisals (CATs)
• Monitor literature for new evidence

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Useful Websites

• www.cebm.net/toolbox.asp
• www.cebm.utoronto.ca
• www.ptjournal.org/info/eipList_backup.cfm
• www.otcats.com/topics/index.html
• www.guideline.gov
• www.pedro.fhs.usyd.edu.au/index.html
• www.hookedonevidence.com
• (requires APTA membership)
• www.informedhealthonline.org

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Summary

• EBP Defined
• Sacketts Model
• Applied to the Guide