How to practice based on evidence?

EBP Process

Greetings everyone! Welcome to the third edition of the newsletter.

In the previous edition, we had a look at what comprises evidence-based practice or what are the pillars on which EBP stands! The question after that arises how as a clinical physiotherapist, I can use those three pillars (clinical expertise, best current evidence, and patient's values and expectations).

The answer to the question is to follow some basic steps that will aid us to use evidence in our practice. These steps are commonly called as EBP process. Let’s explore those steps using a case report.

Let’s assume you had a 15-year-old male presenting to your clinic with pain in the anterior aspect of the right knee. The pain has a gradual onset with no history of trauma. He reports that he plays volleyball recreationally at school. On inspection, there is marked tenderness over the tibial tubercle. He reports that he had a similar symptom last year while participating in a volleyball tournament.

What will we do in this scenario? We assess our patient; we receive the history and examine the patient.

Step I- ASSESS the patient. Start with the patient; determine a clinical problem or question that arises from the care of the patient.

The basic assumption is that we encounter queries in our clinical practices. These queries arise when we interact with/assess our patients. For example, in our patient there can be a query related to X-ray, should we refer him for a scan or not? We can use this information to create a clinical searchable question.

Step II- Ask a focused clinical question.

Using the information from our patient, we can generate a question, and using the same question we may look for the specific evidence. There are different formats suggested in the literature for formulating a question, for example, PICO. I believe these formats can be a good tool for a beginner to frame questions. You can frame a question without these formats too.

Step III- Search and Critically Appraise the Evidence

Next thing we do is to search the evidence using various search engines like google scholar, PubMed, Pedro, etc. You will collect articles (evidence) that are relevant to your patient. After that, the most important thing to do is to critically appraise the evidence that you may have collected. Critical appraisal is “A process of carefully and systematically examining research to judge its trustworthiness, value, and relevance in a particular context”.

The quality of the evidence must be judged before implementing it. There are various tools available for judging the quality or you can follow your own approach to evaluate the quality. In the subsequent newsletter, we may look at ways to critically appraise.

Step IV- Integrate appraised evidence with own clinical expertise and patient’s preferences

This is where we reach a clinical decision that is evidence derived. For example, we may decide in our patient not to go for a scan based on the evidence that we collected and appriased. Again, there are different clinical decision-making models that may be used to reach a decision. Basically, we use the pillars of EBP and reach a conclusion.

Step V-Evaluate

So finally, we evaluate our effectiveness and efficiency in executing Steps 1-4 and seek ways to improve them both for next time. For implementing these steps, we must have a basic understanding of how to look and read research other than that we just need an open mind to embrace new things into our practice.

So, this is it for this edition. I would like to know your thoughts on what I should write for the next edition. My plan is to write about “how to read a research paper”, but I’m open to suggestions. We may also expand on some of the topics we have already discussed.

Thanks for reading!

Ammar Suhail PT