Evidence Based Practice: Unit I Introduction: Clinical Decision Making

1. Evidence Based Practice: Unit I Introduction:Clinical Decision Making Mount St. Mary’s College Doctor of Physical Therapy Program Faculty Online Instruction

2. . • 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

3. . • 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

4. Client/Patient Problem EBP begins and ends here! • A patient problem that cannot be answered with existing knowledge. • A challenge to one’s own existing knowledge– does literature support our best judgment??

5. Client/Patient ProblemEBP begins and ends here! • Recognize • Reflect

6. Identify Learning or Developmental Need • Diagnosis • Prognosis • Therapy (Intervention)

7. Identify Learning or Developmental Need • Diagnosis • Prognosis • Therapy (Intervention)

8. Identify Learning or Developmental Need • Diagnosis • Prognosis • Therapy (Intervention)

9. 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

10. Background Questions • Pathology • Novel patient conditions

11. 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/

12. PICOmaker http://www.library.ualberta.ca/pdazone/pico/

13. 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, 2006;86:136-140.

14. Domain IISearch for Evidence • Scholarly Literature Databases • Evidence-Based Medicine Databases: • PubMed’s Clinical Queries & Cochrane Library are useful tools.

15. Domain IIICritically Appraise Evidence • Use evidence hierarchy to guide selection and appraisal: • Meta-analyses, systematic reviews first. • Randomized Controlled Trials

16. Systematic Reviews and Meta-Analyses Randomized Controlled Trials Cohort Studies Case Control Studies Opinions, Letters Animal Research In vitro Research

17. Systematic Reviews and Meta-Analyses Randomized Controlled Trials Cohort Studies Case Control Studies Opinions, Letters Animal Research In vitro Research

18. Systematic Reviews and Meta-Analyses Randomized Controlled Trials Cohort Studies Case Control Studies Opinions, Letters Animal Research In vitro Research

19. Systematic Reviews and Meta-Analyses Randomized Controlled Trials Cohort Studies Case Control Studies Opinions, Letters Animal Research In vitro Research

20. Systematic Reviews and Meta-Analyses Randomized Controlled Trials Cohort Studies Case Control Studies Opinions, Letters Animal Research In vitro Research

21. Systematic Reviews and Meta-Analyses Randomized Controlled Trials Cohort Studies Case Control Studies Opinions, Letters Animal Research In vitro Research

22. Systematic Reviews and Meta-Analyses Randomized Controlled Trials Cohort Studies Case Control Studies Opinions, Letters Animal Research In vitro Research

23. Systematic Reviews and Meta-Analyses Randomized Controlled Trials Cohort Studies Case Control Studies Opinions, Letters Animal Research In vitro Research

24. Domain IIICritically Appraise Evidence • Is the evidence valid? • Are the results important?

25. Evidence rating scales • Single Article: • PEDro Scale (for RCTs) • Reviews

26. CAT Development • Critically Appraised Topics • http://www.cebm.net/catmaker.asp

27. Domain IVApply Findings Interpret evidence in the context of the specific issues related to the client/patient problem.

28. 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

29. 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

30. Summary • EBP Defined • Sackett’s Model • Applied to the “Guide”