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Chapter 3 The Quest for Evidence: Getting Started

Chapter 3 The Quest for Evidence: Getting Started. Formulate clinical questions that are: Derived from the patient/client’s problem(s) Specific Reasonable Relevant Use appropriate search engines to find best available evidence to answer the question. Objectives.

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Chapter 3 The Quest for Evidence: Getting Started

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  1. Chapter 3 The Quest for Evidence: Getting Started

  2. Formulate clinical questions that are: Derived from the patient/client’s problem(s) Specific Reasonable Relevant Use appropriate search engines to find best available evidence to answer the question Objectives

  3. 65-year-old male reports 2 month history of shoulder pain and difficulty reaching over head after his dog tried to run after a cat and yanked hard on his leash Self-referred (direct access) Patient Scenario

  4. What do you want to know?

  5. Background Normal physiology or behavior Pathophysiology Basic patient diagnostic and treatment information Foreground Selection and interpretation of diagnostic tests or clinical measures Prediction of specific patient prognoses Comparative risks and benefits of various treatment strategies Potential outcomes and their measurement Types of Questions

  6. Patient Diagnostic test or measure, prognostic indicator, intervention, clinical predication rule, outcome, or self-report outcome measure (Comparison…if available) Consequence (what you want to achieve by using the test, measure, prognostic factor, intervention, clinical prediction rule, outcome or self-report outcome measure) Elements of a good question

  7. Simple: Which is the most accurate special test to use to rule in a rotator cuff tear in a 65 year-old-male with shoulder pain? Comparative: Is the Neer’s Test more accurate than the Hawkin’s Test for ruling in a rotator cuff tear in a 65-year-old male with shoulder pain? Example: Diagnostic Test Question

  8. Simple: Is a manual muscle test a reliable and valid measure of shoulder girdle strength in a 65-year-old male with shoulder pain? Comparative: Is a manual muscle test as reliable and valid as a hand held dynamometer for measuring shoulder girdle strength in a 65-year-old male with shoulder pain? Example: Clinical Measure Question

  9. Simple: Does hand dominance predict return to function in a 65-year-old male with shoulder pain? Comparative: Is hand dominance a more accurate predictor of return to function than duration of symptoms in a 65-year-old male with shoulder pain? Example: Prognosis Question

  10. Simple: Is joint mobilization effective in restoring functional use of the UE in a 65-year-old male with shoulder pain? Comparative: Is joint mobilization plus exercise more effective than exercise alone in restoring functional use of the UE in a 65-year-old male with shoulder pain? Example: Intervention Question

  11. Simple: Can a clinical prediction rule predict the outcome in a 65-year-old male with shoulder pain whose first physical therapy consultation occurred 6 weeks prior? Comparative: Is a clinical prediction rule more accurate for predicting outcome at 6 weeks or 6 months in a 65-year-old male who seeks an initial physical therapy consultation for shoulder pain? Example: Clinical Prediction Rule Question

  12. Simple: Will a 65-year-old male with shoulder pain achieve a meaningful change in outcome with modalities? Comparative: Will a 65-year-old male with shoulder pain achieve a meaningful change in outcome with modalities or with therapeutic exercise? Example: Outcomes Question

  13. Simple: Is the DASH (Disability of the Arm, Shoulder and Hand) scale sensitive to change in function after physical therapy for a 65-year-old male with shoulder pain? Comparative: Which scale is more sensitive to change in function after physical therapy in a 65-year-old male with shoulder pain: the DASH or the SPADI (Shoulder Pain & Disability Index)? Example: Self-Report Outcomes Measure Question

  14. General plan of attack Prioritize type of study that can give you the most information Determine which database will be most useful or efficient for your search Identify search terms and their synonyms to use in the search Finding the Evidence

  15. General plan of attack Use the search engine features to expand or collapse your search Be prepared to reformulate your question or work with evidence that is indirectly related to your question Aim for the highest quality articles you can find Finding the Evidence

  16. Primary Original research reports Found in: Peer reviewed journals Proceedings from professional meetings Theses and dissertations Websites Secondary Summary reviews of works of other researchers Found in: Systematic and narrative reviews in peer-reviewed journals Text books Practice guidelines Websites Sources of Evidence

  17. General Medical (health care) Databases PubMed CINAHL Cochrane Library Physical Therapy Specific Databases PEDro Hooked on Evidence Relevant Search Engines

  18. Produced by the US National Library of Medicine “Free” to the public Online version of Index Medicus Links may be included to online journals Comprehensive, but…not all health care journals are indexed, especially in allied health professions PubMed

  19. Clinical Queries Clinical studies by category Find systematic reviews MeSH Database Synonyms (keywords) to use for your searches Tutorials Comprehensive Limits Option Search History Tracking “My NCBI” Alert, Storage and Retrieval Option PubMed – Key Features

  20. Primary search engine for allied health literature, especially from journals not indexed by PubMed Links may be included to online journals Subscription fee Cumulative Index to Nursing & Allied Health Literature (CINAHL)

  21. Easy search feature CINAHL headings mapping function Some different limits options not included in PubMed Search history tracking CINAHL – Key Features

  22. International collaboration Produces systematic reviews and meta-analyses of individual studies Rigorous search, selection and quality assessment methodology Updated regularly Abstracts are free Subscription fee for full reviews Cochrane Library

  23. Easy search feature MeSH terms feature Full review provided Only controlled trials reviewed for intervention questions Cochrane Library – Key Features

  24. Physiotherapy Evidence Database http://www.pedro.org.au/ Free access Bibliographic details and abstracts of randomized controlled trials, systematic reviews and evidence-based clinical practice guidelines in physiotherapy. Most trials in the database have been rated for quality PEDro

  25. PT relevant drop down menus for searching Type of therapy Body part Subdiscipline Research method PEDro – Key Features

  26. APTA database and search engine regarding physical therapy interventions Membership or subscription required Studies of human subjects in English language peer-reviewed journals with at least 1 PT intervention included Clinical scenarios to which evidence in the database is linked Hooked on Evidence

  27. Information is abstracted from articles that addresses key concerns about research design and results Clinical scenarios to which evidence in the database is linked Articles added to the database by APTA members so some practice areas or interventions may not be well represented Hooked on Evidence – Key Features

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