Ch 2: Evidence-Based Practice Flashcards
Evidence-based practice
Scientific evidence (external): Symptoms and treatments that are scientific, best available information from scientific literature
Clinical expertise (internal): Experience, and knowledge about symptoms and treatments
Your critical reasoning acquired from your education/experiences
Client perspective: Preferences, perspectives, values, and choices of client/caregiver, help them make more informed decisions
EBP Summary
Process by which clinician integrates those 3 areas of knowledge to arrive at the best plan of action for a particular client
The triangle is dynamic and consistently moving, very rarely an equilateral triangle; however, you must not ignore one side
Types of clinical questions for scientific evidence
- Screening/diagnosis
- Therapy: What kind of intervention would be right for my client?
- Etiology: What causes certain disorders?
- Quality of life/perspectives
5 Steps to finding scientific evidence
- Ask PICO question
- Find evidence
- Evaluate evidence
- Combine evidence with expertise and client perspective
- Evaluate effectiveness and efficiencies
- Ask PICO questions
P: patient
I: Intervention
C: Comparison
O: Outcome
Guideline: For this person, will this intervention or this other possible comparison intervention be more likely to result in desired outcome?
Developing list of search terms
Extract key words from PICO question and consider synonyms and other relevant study designs
Search string using AND and OR
We might be limiting ourselves if we don’t include everything!
- Find evidence
Library database, google scholar
ASHA journals/Evidence maps (great place to start)
Cochranel library, what works clearing house
- Evaluate evidence
Treatment research question for clinical decision-making:
Does this really show that people who got this treatment showed enough improvement that I should adopt it over other methods?
No good outcome: DON’T READ IT
Evidence that something doesn’t work: READ IT
- Combine evidence with expertise and patient perspectives
EBP
External evidence is not a rigid prescription but a dynamic part of client-centered approach
- Evaluate effectiveness
Reflect: Did I ask the right question, was this desired outcome, did I combine EBP?
Evaluate: Did I implement the intervention with fidelity? What evidence do I have that my client improved?
Research designs
Meta-analysis and systematic Review
Experimental study
Single case design
Quasi-experimental study
Quantitative observational
Qualitative study
Meta-analysis and systematic review
Highest confidence, looking at all information from different sources and combining previously studied studies
Experimental study
Some variable has been altered/manipulated and controlled by the experimenter
Requires random assignment
Single case design
Experimental and controlled, but no need for random assignment as it follows an individual and takes repeated measurements from them
Quasi-experimental design
Variables are controlled/manipulated, but no random assignment because of premade groups such as classrooms or gender
Quantitative observation study
Observational, no control or random assignment but may follow variety of people
Cross sectional or long term
Involves some method of counting and doing math
Qualitative research
No control, but not quantitative counting variable
Tests for quality of life and client perspective
Case study
Sections of research article
Title/abstract: overview/summary
Introduction: Review of literature, set up problem, purpose, research question and hypothesis
Method: What was done with whom and how, the participants, materials, and procedures
Results: What was found
Discussion: How does this relate to other findings, limitations of a study and how can we use this information?
Approach and answering questions from research articles
- Review the title and abstract
- Does the purpose address and align with PICO?
- Participants: Does is match with population/patient
- Results: Main table/graph, is it significant and efficient?
- Measurement: How did the researcher do measurements and was it valid?
- Intervention procedures: what did they do? context and fidelity
- Discussion: Understand context and clinical application limits
