Developing Evidence Based Research from your Own Practice

1. Developing Evidence Based Research from your Own Practice • What is it? • “…use of treatment methodologies for which there is scientifically collected evidence that the treatment works.” (Stout and Hayes, 2005) • Two ways to have an Evidence-Based Practice • Inform your practice by reading the scientific literature of your field and continually educate yourself as to standard protocols that have been scientifically supported. • Develop standards for your own practice that shows evidence that your treatment intervention was actually the variable that has produced the changes seen in your clients.

2. Clinicians Practice Scientific Method • At the HEART of every practicing clinician is a Scientist! • We use Scientific Method to investigate the complex nature of our client’s ailments.

3. What are the fundamentals of Scientific Method? Example: Mary comes to the office complaining of the following symptoms: She cannot concentrate, she is often irritable, she experiences shortness of breath, and lately she has had much trouble sleeping. She has also experienced an increase in back pain for the past several weeks. She finds that she can cry “at the drop of a hat” and there is nothing in her life right now that would be causing this. • Observe • Describe • Predict • Test • Analyze • Draw conclusions • Replicate

4. Observe • Gather info from Mary about her symptoms and make own observations • Describe • Write down your formal descriptions as objectively and clearly as possible • Cluster of symptoms= diagnosis (Psychologists) • Cluster of symptoms = “totality of symptoms” (Homeopaths) • Predict • Form an hypothesis (due to the totality of symptoms I think it is A B • Test • Give Mary a remedy based on your hypothesis • Analyze • “See” if Mary starts to feel better (her symptoms decrease) after you’ve given the remedy • Draw conclusions • Every time I give X ( the remedy), the symptoms decrease • Replicate • When I gave X for a similar “totality of symptoms” (another client) the symptoms decreased • Other clinicians show similar results with similar cases

5. Scientific Scrutiny : Are our conclusions valid ? • In the Past… we relied on • Our Ethical Intent (Hippocratic Oath- “Do no Harm”) • Our Clinical Judgment (I think my treatment is working) These are necessary conditions to have but they are not sufficient to show that our conclusions are valid. We need to show that it is our treatment and not some other variable that is causing the change in symptoms.

6. Franz Anton Mesmer 1700’s physician Cured physical and mental ailments with “animal magnetism” –there were “magnetic fluids in nature” that could be used to cure disease. “All the rage” Mozart and Marie Antoinette were advocates. King commissioned French Academy of Sciences to investigate claim Ben Franklin (one of those on commission) had Mesmer’s asst. D’Eslon magnetize a tree and others were not magnetized. Blindfolded a 12 yr. old boy who embraced series of trees, as he moved further away from magnetized tree, he said he was experiencing stronger magnetic forces which resulted in his fainting. (one of the first placebo controlled tests). Commission reported that there was NO SCIENTIFIC EVIDENCE it was “animal magnetism” rather it was a form of “self-delusion”

7. Internal Validity • When we test our hypothesis, we need to be able to show evidence that it is our independent variable (supposed cause, or in our case, our treatment) that is producing the effect, NOT some other variable. • In Mesmer’s case, the experiment showed that it was some other variable (a “form of self-delusion”) that produced the results. His treatment was unfortunately labeled “quackery”. Perhaps if he would have known a little more about scientific research strategies he could have supported his theory better.

8. External Validity • Because we are practitioners, we collect evidence about 1 client at a time. • Makes it less likely that we will be using randomized control groups and/or trials to collect evidence. • Risk Factor- can our treatment and results from 1 client be generalized to other clients, other settings, and even with other practitioners?

9. Design Practice Protocol for Scientific Rigor Outcome Data! what are we measuring? is it objective or subjective? how clearly are we measuring it? can we put it on a graph? can we show progress by repeated measures?

10. Florence Nightingale Founder of Nursing Pioneer in use of “Statistical graphics” (circular histogram or “Nightingale’s Rose Diagram”)

11. Our Evidenced Based Practice • Cluster of symptoms • Diagnosis • Functional impairments • Keep track of them • Likert scale • Global assessment of functioning scale (0-100) • Cluster of symptoms • Totality of Symptoms • Functional impairments • Keep track of them • Intensity of symptoms scale • Mild = 1 • Moderate= 2 • Severe = 3 • Energy scale (0-100) Psychologists Homeopaths

12. Evidence Based Protocol • Presenting Problem • Functional Impairments • Treatment Plan • Progress Note • Evaluation of measurements • Show by repeated measures • Stable state behavior • trends

13. Single Subject Research DesignThe 1 subject serves as his own control- see stable state/trends Kazdin, 2011

14. Single Subject Design used by Behavior Analysts – different treatments Phillips, 1968

15. Single Subject Design –no reversal-different treatments in Education Ingram,2005

16. Single subject for practice based primary care Janosky, 2005

17. Single Subject Design in Physical Therapy Roy et al., 2009

18. Experiential Exercise • Design your outcome measures • Make your own progress note to include Likert scales and graphing capabilities • How can you measure baseline? • How can you measure reversals or withdrawal of treatment? • What is your scale and wording for energy level?