Evidence-based practice is defined as the “integration of the best research evidence with clinical expertise and patient values.”¹ The demand for and interest in applying evidence to rehabilitation practice has substantially grown in the past decade, in part, by the increase in publication of systematic reviews (over 700 relevant to the practice of physical therapy alone), other articles related to evidence in practice, and transition towards quality value-based reporting and payment models.
The concept of evidence-based medicine, or, more broadly, EBP, marks a shift among health care professionals from a traditional emphasis on actions based on the opinions of authorities to guide our clinical practice to an emphasis on data-based, clinically relevant studies and research. Not only are therapists expected to continue using their learned skills in taking a patient history, conducting a comprehensive examination, determining a diagnosis, and determining appropriate options for intervention, they are also expected to include evidence in their practice. Guyatt and colleagues² identify six key abilities clinicians must possess in order to effectively apply EBP:
- Identify gaps in knowledge
- Formulate clinically relevant questions
- Conduct an efficient literature search
- Apply rules of evidence, including a hierarchy of evidence, to determine the validity of studies
- Apply the literature findings appropriately to the patient problem
- Understand how the patient’s values affect the balance between potential advantages and disadvantages of the available management options, and appropriately involve the patient in the decision
So where do we begin? The first step is to determine your access to research. Many healthcare facilities limit internet access for security reasons, so your research may have to be conducted at home.
The second step is learning about the resources available, for example:
- The American Journal of Occupational Therapy
- Provides a free “Most Read” section
- APTA’s Hooked on Evidence
- Search article extractions or clinical scenarios for evidence related to PT interventions
- ASHA’s research page
- Comprehensive page with information on EBP, research databases, and other topics
- Rehabilitation Measures Database
- Search Outcome Measuring Tools; provides reliability and validity of measures
- Google Scholar
Third step is to avoid feelings of therapist inadequacy if you have to tell your patient “I’m not certain about…however I have excellent resources to help guide my decision making.” You don’t have to have all the answers on the very first visit. There is a wealth of evidence-based research at our fingertips…we just have to be willing to access the information and further educate ourselves along the way.
- Sackett DL, Strauss SE, Richardson WS, et al.Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed. Edinburgh, Scotland: Churchill Livingstone;
- Guyatt GH, Haynes RB, Jaeschke RZ, et al. Users’ guide to the medical literature, XXV: evidence-based medicine—principles for applying the users’ guides to patient care. JAMA.2000; 284:1290–1296.