Finding Evidence to Support Physical Therapy Clinical Practice: DPT

1. Finding Evidence to Support Physical Therapy Clinical Practice: DPT Min-Lin E. Fang, MLIS Education and Information Consultant for Nursing and Social and Behavioral Sciences 415-476-3397 Fang@library.ucsf.edu

2. Objectives After completing this lecture, you should be able to: • Identify the sources of evidence for primary questions • Develop a good search strategy and conduct an efficient PubMed search using MeSH database • Find the highest levels of evidence using PubMed Clinical Queries and Evidence-Based filters • Find evidence using Cochrane, PEDro, CINAHL, TRIP • Find evidence-based practice guideline (National Guideline Clearinghouse)

3. Evidence-Based Medicine • The process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decision. • Formulate a clinical question • Literature search • Evaluate the evidence • Implement findings in clinical practice Rosenberg, William and Anna Donald. Evidence based medicine: an approach to clinical problem-solving. BMJ 1995; 310:1122-1126.

4. Hierarchy of Evidence (Evidence Pyramid) Source: Med Research Library Brooklyn

5. Key Databases for Evidence-Based Physical Therapy Practice • PubMed@UCSF • CoChrane Library • PEDro • TRIP (Turing Research into Practice) • CINAHL • Hooked on Evidence (APTA)

6. Developing Search Strategies • Formulate a well-built clinical question (PICO). • Break your question into multiple concepts. • Locate the appropriate MeSH (indexed term) for each concept. • Run the search using AND, OR, NOT • Apply limit options (date, language, age, publication type, gender), major headings and subheadings • Modify your search strategies and rerun your search.

7. Boolean Operators (upper case) • AND Combine different concepts to narrow your search. aged AND women  aged women • OR Broaden your search to include similar concepts. HIV OR AIDS  AIDS patients • NOT Exclude a concept from your search. AIDS NOT hearing aids  AIDS patients

8. Searching PubMed: MeSH Terms • Using the MeSH Database to locate MeSH terms; using MeSH terms to increase the precision of your search results

9. When to use Keyword search? • New studies not yet indexed e.g. PubMed – in process PubMed – as supplied by publisher Do a keyword search and limit search results for the past few months. search sample: (ACL OR anterior crucial ligament) reconstruction

10. PubMed: Clinical Queries • Finding the highest levels of evidence: systematic reviews and meta-analyses faster and easier • Providing further analysis of randomized controlled trials • Graft choice in ACL reconstruction

11. Setting up Evidence-Based Filters Using my NCBI • Filters help sort search results faster • Set up EB filters for systematic reviews, meta-analyses, RCTs, practice guidelines

12. Set Up EB Filters Using My NCBI • Register My NCBI. • Setting up filters for systematic reviews, RCT, meta-analysis, practice guideline and outcomes assessment • Select ‘Filters’ in the far left menu, and then select PubMed. • Select ‘Browse’ to choose specific filters or select ‘Search’ to enter a specific filter. • For example: Select “Search” to look up ‘systematic reviews’. Select Systematic reviews under the matching filters list and then check the ‘Add’ box to automatically add systematic reviews as one of your filters. • Go back to ‘Search’ and repeat this with ‘meta-analysis”, “randomized controlled trial”, “practice guideline” and “outcomes assessment.”

13. MyNCBI (Save Search, Updates) • Save search strategies and set up email updates • Set up user preferences – highlight search • words in your retrieval. • Setting up “User Preferences” for color highlighting: Click “User Preferences” in the far left menu and choose a color for highlighting.

14. Cochrane • Cochrane Database of Systematic Reviews • Database of Abstracts of Reviews of Effects (DARE) • Cochrane Central Register of Controlled Trials

15. PEDro • Physiotherapy evidence-based database, produced by the Centre for Evidence-Based Phsiotherapy in Australia • Covers RCTs, systematic reviews, clinical practice guidelines in physiotherapy • Trials rated for quality

16. TRIP • Searches over 75 sites of high quality medical information • Provides you direct, hyperlinked access to the evidence-based material on the web as well as articles from premier online journals such as BMJ, JAMA, NEJM and the Lancet

17. CINAHL • 55% of overlap with MEDLINE • Indexes journal articles, books, book chapters, dissertations, AV materials, conference proceedings • Controlled vocabulary/thesaurus: Nursing headings Special Interest: Evidence-Based Practice

18. Evidence-Based Practice Guidelines • National Guidelines Clearinghouse http://www.guideline.gov/

19. Literature Search Online Tutorials • PubMed Quick Tours • CINAHL, Basic Searching, Advanced Searching

20. Exercises • Formulate a clinical question. • Effectiveness of strength training for stroke patients • Graft choice in ACL reconstruction • Effectiveness of education in school children with low back pain • Heat or cold for low back pain • Literature Search PubMed, NGC, Cochrane, PEDro, TRIP, CINAHL

21. Managing Citations Endnote vs. RefWorks RefWorks • a FREE web-Based citation management tool • Check the class schedule http://www.library.ucsf.edu/edtech/class/ and reserve a space for the RefWorks class.