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  1. #1
    Junior Member
    تاريخ التسجيل
    May 2014
    المشاركات
    1

    EVIDENCE BASED PRACTICE of PHYSIOTHERAPY

    EVIDENCE BASED PRACTICE of physiotherapy

    What is Evidence Based Practice?
    n A process whereby research evidence, clinical knowledge and reasoning are used to make decisions about interventions that are effective for a specific client(s)
    n A review of the evidence in relation to a clinical practice question
    n EBP is only a part of the decision making process
    n EBP considers client’s preferences, beliefs and views
    n Aims to improve the quality of care and life for the client

    Research vs. EBP:
    EBP is not about conducting research it is about USING RESEARCH
    n Research= systematic process of gathering and synthesising empirical data to generate knowledge about a given topic
    n EBP= the conscientious, explicit and judicious use of best current evidence in making decisions about care for clients

    Why is EBP important?
    n Clinical decisions can be clearly explained and justified to clients and their families
    n Demonstrate interventions are clinically and cost effective to colleagues, managers and administration
    n Maintaining and improving therapists knowledge base and the evidence base of OT for the future
    How to use EBP?
    Five Steps:
    n Identify and formulate a clear review question
    n Search the literature for relevant clinical articles and evidence
    n Critically appraise the evidence
    n Implement the evidence within practice
    n Evaluate the impact of the evidence
    Step 1: Formulate a review question:
    Questions can be in relation to:
    n The cause of a condition
    n Diagnosis and assessments
    n Prevention of conditions
    n Prognosis of conditions
    n Treatment outcomes
    n Client concerns
    n Economic evaluation



    Clinical vs. Review Questions:
    Clinical Question:
    n A general question relating to a clinical practice situation
    Review Question:
    n Comes from a clinical question
    n It is clear and specific to guide the search
    n A useful question consists of a problem, intervention and outcome and often takes the form of:
    “What is the evidence for the effectiveness of X (intervention) for Y (outcome) in a client with Z (problem or diagnosis)”

    How to Write a Review Question?
    Use PICO format:
    P= The population or problem you are interested in (client group, problem)
    I= The intervention that you are interested in
    C= The comparison or alternative intervention (if relevant)
    O= The outcome or reason for using the intervention

    Example of PICO Question:
    What evidence is there for the validity and relevance of the Barthel Index vs. the COPM as an assessment of occupational performance for older adults who have a physical disability.

    Step 2: Searching the literature to find the evidence:
    n Need to use an organised and systematic approach
    n Develop search strategies before you start, including:
    n Databases you will use
    n Key terms to search under
    n Set limits of your search
    Databases to Use:
    Need to consider:
    n Is your focus medical or broader?
    n Is your focus OT specific?
    n Do you want literature from a particular country or area? (eg. Australia or Asia)
    n Is there a specific research method you want to focus on? (eg. systematic review)









    Key Terms and Search Limits:
    n Pull out the key terms from your review question
    n Generally the problem, intervention and outcome
    n Consider alternative or related terms (eg. Occupation and activity)
    n Set limits for your search, including
    n Language of the article
    n Research design
    n Date of publication

    Step 3: Critically Analysing the Evidence:
    n Assess the value and trustworthiness of the evidence
    n No research is without its flaws, need to ask:
    “Do the flaws make me question the conclusion?”
    n 3 broad areas to analyse:
    n The rigor of the research
    n Significance of the results
    n Impact upon your OT practice

    Levels of Evidence:
    Consider the type of research conducted: (hierarchical list)
    n Systematic reviews, meta analysis
    n Randomised controlled trials (RCTs)
    n Non-randomised controlled trials
    n Case controlled trials
    n Cohort studies
    n Descriptive studies
    n Qualitative studies
    n Expert opinion
    Questions for Critiquing Evidence:
    Some general questions to ask include:
    n What is the question?
    n What is the purpose of the research?
    n Did the research design allow the question to be answered?
    n What were the results?
    n Were the researchers interpretations valid?
    n Are the results relevant and useable in practice?
    Useful critical appraisal checklist and guidelines are available at:
    www-fhs.mcmaster.ca/rehab/ebp











    Step 4: Implementing the evidence:
    Examples of strategies to implement evidence into practice include:
    n Apply the results to one or a group of clients
    n Reconsider treatment plans/goals
    n Develop handouts on topics (with other professionals)

    Considerations when implementing evidence:
    n Who is the right therapist to be implementing the evidence?
    n What does the evidence say the “right” thing to do is?
    n What is the right way to implement the intervention?
    n What is the right place for the implementation?
    n What is the right time to implement?

    Step 5: Evaluating the impact of the evidence:
    When evaluating the impact, consider:
    n The client’s outcomes
    n Cost effectiveness
    n Client satisfaction
    n Therapist satisfaction

    Barriers to EBP:
    Some barriers to EBP that have been discussed in literature include:
    n Access and availability to information
    n Limited time
    n Lack of EBP skills
    n Confidence in the value of the evidence
    n Support from management
    n Conflict with client centered philosophy of OT
    HOWEVER, BARRIERS CAN ALWAYS BE OVERCOME

    Becoming an Evidence Based Practitioner:
    Strategies include:
    n Regularly ask clinical reflective questions
    n Take time to track down the best evidence to support your therapy
    n Use the evidence in your therapy
    n Evaluate the impact of this evidence on your therapy


    Mai Waleed -5651 PT3

  2. #2
    Administrator
    تاريخ التسجيل
    Oct 2011
    الدولة
    Cairo - Egypt
    المشاركات
    15,229
    Important subject for all PT

 

 

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