Exam Two - Intro EBP Flashcards
definition of EBP
conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients
what is the goal of EBP
educated decisions and transparency in patient care
open and thoughtful clinical decision making integrates:
- best available evidence
- clinical judgement
- patient values
- clinical circumstances
What is evidence informed practice?
(Willson’s likes this word better)
- without clinical expertise, practice risks becoming evidence tyrannized
- ex: a treatment with no evidence may be desirable like using a parachute when jumping out of planes
EBP in NOT
- replacement for individual clinical expertise
- “cook book” therapy
- a “cost cutting” measure
- ONLY RCTs
replacement for individual clinical expertise
- You decide whether the evidence applies to each patient!
- best treatment for one patient may not be the same as the average
- use clinical findings AND available evidence to educate the patient and be as transparent as possible
“cook book” therapy
EBP does not require patients to go through a “treatment tunnel”
(assumes same management is appropriate and the same outcomes are important to each patient)
a “cost cutting” measure
- may raise or lower the cost of care
- derive the most effective interventions which will maximize patient function and quality of life
(Willson’s example was sometimes you have to advocate for your patient to get more sessions approved using evidence)
ONLY RCT
- high quality RCTs have not been conducted for many research questions
- some questions are best answered using different designs
t or f: the 2009 oxford levels of evidence had systematic and review as the top level of evidence based entirely on design
true - problematic because thats not always the best study design to answer a question
How is the 2011 oxford level of evidence chart organized?
vertical column you pick what type of question you’re trying to answer with your study and horizontally has the levels of evidence
T or F: the 2011 oxford evidence chart has mostly systematic reviews under level one evidence
true
Where are RCTs in the 2011 oxford evidence chart?
level two
T or F: you don’t need clinical expertise AND best available external evidence
false, you MUST have both. Without evidence, practice risks becoming rapidly out of date (and can be detrimental to patient care)
What is the Dunning-Kruger effect?
you have extremely high confidence when you know nothing, lowest confidence once you gain experience in your field, and confidence rises (but not to level of stupid confidence) when you’re an expert
BEWARE of:
the overly confident clinician
T or F: you will need more knowledge related to patient management weekly
false, DAILY!
T or F, you will learn everything you ever need to know while in PT school
lol false, you WILL need more training
What are some barriers to EBP from therapists?
- lack of knowledge, skills, and/or confidence
What are some barriers to EBP from the PT profession
- lack of evidence conducted
- healthy respect for authority and tradition in our field
What are some barriers to EBP from the PT system?
- lack of time
- lack of access to full text
- not reimbursable
- lack of administrative support
- political challenges
be prepared to work with the best ______ when you can’t find the best ________.
available, possible
What is the cycle of EBP once you have a question
1 - ask an answerable question (PICO)
2 - search the evidence
3 - critically appraise the evidence for its validity, impact, and applicability
4 - ACT: integrate critical appraisal with clinical expertise and the patient’s unique case
5 - evaluate patient outcome in the context of your clinical decisions
(bonus - evaluate and improve your search skills)
PICO stands for:
Patient (problem)
Intervention
Comparison (alt. intervention)
Outcome of interest
3 tips for effective searching
1 - use limits and filters
2 - be creative and persistent (keep track of your results/search terms too)
3 - cross reference (the citations)
What does the PEDro site offer?
- scores
- physiotherapy evidence database
- has RCTs, systematic reviews, and practice guidelines
what is the DiTA good for?
database of diagnostic test accuracy
(Sen, spec, +LR, -LR, PPV, NPV)
APTA EBP
- full text articles
- outcome measures
- practice guidelines
10 ways to get the full text of an article
1 - click the link on search page
2 - pubmed central (free!)
3 - research gate (network site to share papers - email & ask)
4 - APTA EBP
5 - google scholar
6 - internet search for journal article name
7 - check author CV/website for links
8 - email the corresponding author
9 - access through another library with different privileges
10 - interlibrary loan
2009 level of evidence
1a
systematic review (meta-analysis) of RCTs
1b
high quality RCT (PEDro> or = 6)
2a
systematic review of cohort studies
2b
low quality RCT (<6)
prospective or retrospective cohort
3a
systematic review of case-control studies
3b
case-control studies
4
case series. quasi-experimental study
5
expert opinion. bench study
A strong evidence =
preponderance (3 or more) level 1 studies that agree with each other
strong effect on practice!
B moderate evidence =
1-2 high quality RCTs or a preponderance of level 2 studies
weak effect on practice!
C weak evidence =
1-2 level 2 studies or a preponderance of level 3&4 studies. also includes consensus statements
weak effect on practice!
D foundational evidence =
preponderance of evidence from animal, cadaver, or bench studies
weak affect on practice!
F expert opinion
clinical experience, guidelines, review article
weak effect on practice!
is a single article enough to influence your practice?
lol no
What does a strong recommendation mean for your practice?
- recommendation applies to most patients in most circumstances
- balance of evidence of a benefit is clear relative to a specific alternative
- further research is very unlikely to change our confidence in the benefit
What does a weak recommendation mean for your practice?
- balance of benefit is not clear or low quality
- more research necessary
- alternatives are reasonably equivalent
- “indirectness” of PICO issue
- best action may differ depending on patient and setting circumstances
