Intro

Question 1

What is the origin of EBP?

Answer 1

EBP emerged in medicine due to a clear need for a better way to make clinical decisions and was fueled by developments in the field of clinical epidemiology.

Question 2

Why is EBP essential in medicine?

Answer 2

Due to a need for a better way to make clinical decisions. It means integrating individual expertise with the best available external clinical evidence from systematic research.
EBP tries to root out assessment procedures and interventions that have worked their way into accepted practice but may not be the most beneficial for the client.

Question 3

EBP is key to…

Answer 3

delivering the highest quality of healthcare and ensuring the best patient outcome

Question 4

What is the EBP process?

Answer 4

It is seen as a process that begins with clinical questions, appraisal of the evidence, application of the evidence, and ending with an evaluation of clinical outcomes.

Question 5

EBP is a problem-solving approach to clinical practice that integrates…

Answer 5

• Search, critical appraisal, and synthesis of the most relevant and best research (external evidence)
• One’s own clinical expertise, which includes internal evidence generated from outcomes management or quality improvement projects, patient assessment, and evaluation
• Patient preferences and values

Question 6

What is internal evidence?

Answer 6

Generated through rigorous research (e.g., RCTs and cohort studies) that is intended to be generalized to and used in other settings

Question 7

What is external evidence?

Answer 7

Evidence generated through practice initiatives, such as outcomes management or quality improvement projects that are not intended to be generalized to other clinical settings.

Question 8

What are the components of EBP?

Answer 8

The best available evidence
The patient’s preferences, values, and concerns
Your clinical expertise. This includes:
- Clinical judgment
- Internal evidence
- Clinical reasoning
- Evaluation and use of available healthcare resources

Question 9

Why should we use EBP?

Answer 9

Leads to the highest quality of care
Best patient outcomes
Reduction in healthcare costs
Reduction in geographic variations in care
Increase retention of healthcare workers
Despite these benefits, familiarity and implementation of EBP remains low
Without current best evidence, practice is rapidly outdated
Third-party payers are beginning to require clinicians to provide evidence for reimbursement

Question 10

What does the Institute of Healthcare Improvement’s “Triple Aim” include?

Answer 10

Enhancing the experience of care for those served
Improving the health of populations throughout the nation
Reducing per capita costs of national health care

Question 11

What initiative advance EBP?

Answer 11

Institute of Medicine’s Roundtable on Evidence-Based Medicine
- Their goal is for 90% of clinical decisions to be based on evidence by the year 2020.
United States Preventive Services Task Force (USPSTF)
Agency for Healthcare Research and Quality (AHRQ)
National Consortium for the Advancement of Pediatric and Adolescent Evidence-Based Practice (NCPAEP)
Magnet Recognition Program by the American Nurses Credentialing Center

Question 12

What are the steps of the EBP process?

Answer 12

1. Ask the burning clinical question in PICO format.
   - Using this format will aid you in your search for relevant information and will save you time.
2. Search for and collect the most relevant best evidence.
   - Key words from your PICO question will be used to search for information.
3. Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, and synthesis).
   - Is the evidence valid? Reliable? Applicable?
4. Integrate the best evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change.
   - It is the clinician’s ethical responsibility to involve the patient in treatment decisions.
5. Evaluate outcomes of the practice decision or change based on evidence.
   - Did you see the same results reported in the evidence? Why? Why not?
6. Disseminate the outcomes of the EBP decision or change.
   - Share your results with other clinicians!

Question 13

What are barriers to EBP?

Answer 13

Lack of administrative/management support and mentors
Lack of knowledge and skills relating to EBP
Misperceptions or negative attitudes about EBP
Information overload
Resistance to change
Lack of autonomy over practice and lack of incentives

Question 14

What are strategies to eliminate barriers to using EBP?

Answer 14

Establishing a clear philosophy and organizational vision in which EBP is valued and expected
Developing a strategic plan to create a culture and environment that fosters EBP
Dispelling misperceptions about EBP
Teaching the basics of EBP
Encouraging questions about currently used clinical practices
A determined effort is often required in order to address barriers and facilitate the implementation of EBP

Question 15

What is evidence-based rehabilitation?

Answer 15

It is a clear method of consulting with the client to educate them on the appropriate and relevant research available for treatment.
Evidence based rehabilitation allows clinicians to use evidence as part of the complex decision making required when assessing and treating clients.

Question 16

What are the important concepts of evidence-based rehabilitation?

Answer 16

Awareness – the clinician is aware of the evidence that influences his/her clinical decisions and is aware of the strength of that evidence.
Consultation – the clinician uses the best evidence available and consults with the client to determine the best option for treatment strategies.
Judgement – therapists must use good sound judgement to determine how to apply the best evidence in their everyday practice.
Creativity – Learning EBP is both a science and an art, it requires a great deal of creativity and insight to work correctly.

Question 17

What is scientific research?

Answer 17

A process of testing rather than proving, and it implies an objectivity that lets the data lead where it will.
It is considered the highest form of acquiring knowledge.
Systematic, controlled, empirical, amoral, public, and critical investigation of natural phenomena.

Question 18

What is the scientific method?

Answer 18

The scientific method is recognizing a problem, collecting data, and drawing a conclusion based on the data.

Question 19

What is the method of science?

Answer 19

It is widely heralded as the most powerful and objective means available to gain new knowledge.
Can endorse currently held beliefs, but it can also call those beliefs into question

Question 20

___ is considered the highest form of acquiring knowledge.

Answer 20

Scientific research

Question 21

Describe the systematic and controlled aspect of scientific research.

Answer 21

The scientific investigation is conducted in a manner that rules out other alternative explanations.
Making sure the execution of a study is controlled ensures confidence in the findings of the research.

Question 22

Describe the empirical aspect of scientific research.

Answer 22

This means that “the beliefs must be subjected to outside independent tests.

Question 23

Describe the amoral aspect of scientific research.

Answer 23

This simply means that research findings do not have moral value, that is they are neither “good” nor “bad” they are indeed just factual based on their reliability and validity.

Question 24

Describe the public aspect of scientific research.

Answer 24

This simply means that the scientific research is evaluated by other independent individuals of equal knowledge or training before they are published in a professional journal (peer review).

Question 25

What are the 2 distinct lines of inquiry of scientific research?

Answer 25

Empiricism and rationalism

Question 26

What is empiricism?

Answer 26

Knowledge is gained through experience and evidence.
Empiricists use inductive reasoning that is, they rely on evidence from specific cases to make inferences about general therapeutic principles.

Question 27

What is rationalism?

Answer 27

Knowledge is gained through logical thought.
Rationalists rely on deductive reasoning – the use of general principles to make inferences about specific cases

Question 28

Describe inductive and deductive reasoning.

Answer 28

Question 29

What is basic research?

Answer 29

Basic research is used to acquire empirical data that can be used to develop, refine, or test a theory.
Basic research is used to develop knew knowledge (i.e., researchers who study how blood cells function or examine functions of the brain). Basic research may lead to practical applications, such as developing a treatment for leukemia or grafting brain cells to treat Parkinson’s disease.

Question 30

What is applied research?

Answer 30

Directed towards solving problems and developing functional solutions or applications, and testing those theories that direct our practice.
Applied research is conducted under actual practice conditions on subjects who represent the group to which the results will be applied. Most all clinical research falls into this category.

Question 31

What is basic and applied research?

Answer 31

A continuum exists between the two extremes. We recognize that rehabilitation and health care are applied sciences, but that many of the theories that guide practice are founded on basic science principles. Today, clinical research is often a hybrid, combining elements of both basic and applied science. Many studies provide clinical application as well as new knowledge that contributes to a theoretical understanding of behavior.

Question 32

What is experimental research?

Answer 32

Compares two or more conditions to determine a cause and relationship. This type of research accounts for the effects of extraneous factors and provides the greatest degree of confidence in the validity of outcomes allowing the researcher to draw conclusions about observed differences.

Question 33

What is the gold standard of experimental research?

Answer 33

Randomized Control Trial (RCT) is considered the gold standard in experimental research designs. Involves the controlled comparison of an experimental intervention and a placebo.

Question 34

What is descriptive and exploratory research?

Answer 34

Research that explores data to determine relationships between variables. This type of research examines a phenomenon of interest and then explores its dimensions and how it relates to other factors. Research that describes a group of individuals or a set of variables to document and describe their characteristics.

Question 35

What is the hierarchy of evidence?

Answer 35

Level I: Systematic reviews and well-designed meta-analyses of several Randomized Controlled Trials (RCTs)
Level II: Well-designed RCTs
Level III: Well-designed nonrandomized quasi-experimental studies
Level IV: Controlled non-interventional descriptive studies, including correlational and case control studies
Level V: Uncontrolled non-interventional studies, including case reports, and qualitative studies
Level VI: Expert opinion of respected authorities

Question 36

What are the 3 scientific principles?

Answer 36

Testability – ask specific research questions instead of vague questions, because specific questions will be evaluated and answered.
Replication – reproducing the findings in one research study in a second research study is valuable.
Objectivity – research questions and findings should be addressed and interpreted without bias, and alternative interpretations should be considered

Question 37

What is the first step of the research process?

Answer 37

First you identify a research question ….. - what do you want to know or discover?? It is a process of asking and answering questions.
Scientific principles guide the research process in communication sciences

Question 38

What are the 3 types of research questions?

Answer 38

Descriptive research question – “What is?” or “What exists?”
Difference research question – “What is the difference?”
Relationship research question – “What is the relationship?”

Question 39

Describe each part of the PICO question.

Answer 39

P stands for Patient or Population
- What is the target population?
I stands for Intervention
- What is the intervention that you want to study?
C stands for Comparison
- What comparison or control condition to do want to study? Compare 2 interventions or 1 intervention vs. no intervention.
O stands for Outcome
- What is the outcome of your interest?

Question 40

What is a hypothesis?

Answer 40

A hypothesis is a prediction about how the research question will be answered.

Question 41

What is a null hypothesis?

Answer 41

The null hypothesis is about what will happen if the hypothesis does not come true

Question 42

What are the steps of the research process?

Answer 42

1. Ask a burning question
2. Research existing evidence and determine hierarchy of relevant evidence.
3. Critically appraise the evidence:
   - Are the results of the study valid? (Validity) Did the researchers conduct the study using the best research design and methods possible?
   - What are the results? (Reliability)
4. Integrate the best evidence with clinical expertise and patient preferences

Question 43

How do you determine if evidence should be used to make a practice change?

Answer 43

Once an environment conducive to EBP is established, it needs to be remembered that the confidence to make an evidence-based change comes from a combination of:

Question 44

Describe the implementation step of the research process.

Answer 44

This step is the synthesis of the external and internal evidence, the practitioner expertise, and the patient/family preferences that produces the implementation of a practice change.

Question 45

What are outcomes?

Answer 45

Evaluate outcomes of the practice decision or change based on evidence.
Measurement of outcomes is important to determine and document impact of the EBP change on healthcare quality and/or patient outcomes.
Essential in determining whether the change based on evidence resulted in the expected outcomes when implemented in the real-world clinical practice setting.

Question 46

What are some strategies for sharing outcomes?

Answer 46

Internal communication strategies can include e-mail messages, reports at unit/department meetings, dashboards, and scorecards.
External communication strategies include podium or poster presentations at conferences and professional publications.

Question 47

What is the peer review process?

Answer 47

Peer review involves having the author’s scholarly research reviewed and scrutinized by other experts in the same field to make sure the content of the research is valid and suitable for publication. The peer review process allows scientists to “check” and “review” scholarly research before it is published.