L1 Introduction Flashcards
what is evidence based practice
the integration of 3 components to provide best possible care for clients and patients
what are the 3 components of EBP
clinical expertise/expert opinion
evidence - internal and external
client/patient/caregiver perspectives
what is clinical expertise/expert opinion
the knowledge, judgement and critical reasoning acquired through your training and professional experiences
what is evidence - internal and external
the best available information gathered from scientific literature (external evidence) and from data and observations collected on your individual client (internal evidence)
what is client/patient/caregiver perspectives
the unique set of personal and cultural circumstances, values, priorities and expectations identified by your client and their caregivers
why is it important to stay current on EBP
research grows and changes - what was best practice two years ago may not be best practice today
advantage of being aware of the evidence base
optimisation of clinical load planning
rather than wasting time on interventions which have no evidence behind them eg. NSOMES, we can use that time wisely to provide evidence-backed interventions (eg. Van Riper’s articulation therapy)
one resason why a clinician may not provide gold standard care
lack of available resources eg. LSVT is gold standard for hypokinetic dysarthria - however it is very time intensive and may not be feasible for a clinic to provide
cochrane reviews
named after EBP founder Archie Cochrane, these are reviews which are considered to be very high quality evidnce, they must be updated every few years and have very strict criteria for research inclusion
challenges associated with EPB
- evidence changes quickly
- people have their own agendas in desseminating information and influencing the acceptance of EPB
- finding credible sources
- discerning what is good evidence and what is bad evidence
- Where to find the evidence
- how to keep up with the evidence
- sometimes there is no evidence
key steps in EBP
step 1: ask a clinical question
step 2: acquire the best evidence
step 3: appraise the evidence
step 4: apply the evidence
step 5: assess your performance
types of evidence
- clinical state and circumstance
- research evidence
- systematic review
- randomised control trial
- meta analysis
- patient preference and actions
what is clinical state and circumstance evidence
epidemiology studies - nature, risk, prevalence, course of the acquisition
why is clinical state and circumstance evidence useful
helps us understand conditions and plan services
what is research evidence
focused on experimental design, carefully controlled interventions and measurable outcomes
why is research evidence useful
helps us understand efficacy of interventions and diagnostic accuracy of tests
what is a systematic review
a summary of all the available primary research or evidence in response to a research question. A systematic review uses all the existing research and is sometimes called ‘secondary research’ (research on research). They are often required by research funders to establish the state of existing knowledge and are frequently used in guideline development. (Clarke 2011)
what is a randomised control trial
- a study design that randomly assigns participants into an experimental group and/or a control group.
- The only expected difference between the control and experimental groups in a randomized controlled trial (RCT) is the outcome variable being studied.
what is a meta analysis
a combination of a group of studies to reach a conclusion statistically about the effect of an intervention. the results are depicted on a forest plot
issue with meta-analyses
researchers often use different outcome measures and tests eg. Frenchay and AIDS
what is a core outcome set
the solution to the meta-analysis issue - they are international standards where researchers use a specific test/outcome measure so that a meta analysis can encompass them all
what is patient preference and action evidence
qualitative studies - interviews, surveys, quality of life instruments, autobiographical accounts
how is patient preference and actions evidence useful
it helps us understand the perspectives of key stakeholders, impact of conditions on lives, tolerance of procedures etc.
PICO formula
- Patient or Problem
- Intervention (cause, prognostic factor, treatment) - what intervention am I considering
- Comparison intervention (if necessary) - is this intervention Y better than intervention X
- Outcomes - what can I hope to achieve, can this be measured
