EVIDENCE BASED PRACTICE EBP

Aims of the Session

To increase your understanding of Evidence Based Practice (EBP), including: What EBP is Why use EBP How to be an evidence based practitioner

What is Evidence Based Practice? A process whereby research evidence, clinical knowledge and reasoning are used to make decisions about interventions that are effective for a specific client(s)

What is EBP?
A review of the evidence in relation to a clinical practice question EBP is only a part of the decision making process EBP considers clients preferences, beliefs and views Aims to improve the quality of care and life for the client

Research vs. EBP

Research= systematic process of gathering and synthesising empirical data to generate knowledge about a given topic EBP= the conscientious, explicit and judicious use of best current evidence in making decisions about care for clients

EBP is not about conducting research it is about using research

Why is EBP important?

Clinical decisions can be clearly explained and justified to clients and their families Demonstrate interventions are clinically and cost effective to colleagues, managers and administration Maintaining and improving therapists knowledge base and the evidence base of rehabilitation for the future

How to use EBP

Overview Five Steps: Identify and formulate a clear review question Search the literature for relevant clinical articles and evidence Critically appraise the evidence Implement the evidence within practice Evaluate the impact of the evidence

Step 1: Formulate a review question The cause of a condition Diagnosis and assessments Prevention of conditions Prognosis of conditions Treatment outcomes Client concerns Economic evaluation

Clinical vs. Review Questions

Clinical Question: A general question relating to a clinical practice situation Review Question: Comes from a clinical question It is clear and specific to guide the search A useful question consists of a problem, intervention and outcome and often takes the form of:
What is the evidence for the effectiveness of X (intervention) for Y (outcome) in a client with Z (problem or diagnosis)

How to Write a Review Question

Use PICO format: P= The population or problem you are group, problem) I= C= O= interested in (client

The intervention that you are interested in The comparison or alternative intervention (if relevant) The outcome or reason for using the intervention

Example of PICO Question

What evidence is there for the validity and relevance of the Barthel Index vs. the COPM as an assessment of occupational performance for stroke patients who have a physical disability?

Critiquing an EBP Question

Identify the PICO components of the following question: Are self management strategies more effective than rehabilitation care alone for improving health status, quality of life and function amongst adults with stroke ?

Critiquing an EBP Question

P
People aged over 35yrs, with coronary heart disease

I
Self management interventions

C
Rehabilitation interventions

O
Health Status, quality of life, rehabilitation performance

Activity: writing a review question

Work in groups of 2 or 3, from the following scenario
Identify

a clinical question a review question (using PICO)

Formulate

Step 2: Searching the literature to find the evidence

Need to use an organized and systematic approach Develop search strategies before you start, including:

Databases you will use Key terms to search under Set limits of your search

Databases to Use
Is your focus medical or broader? Is your focus rehabilitation specific? Do you want literature from a particular country or area? (Australia or Asia) Is there a specific research method you want to focus on? (systematic review)

Key Terms and Search Limits

Pull out the key terms from your review question
Generally the problem, intervention and outcome Consider alternative or related terms (rehabilitation and activity)

Set limits for your search, including

Language of the article Research design Date of publication

Step 3: Critically analyzing the Evidence

Assess the value and trustworthiness of the evidence No research is without its flaws, need to ask: Do the flaws make me question the conclusion? 3 broad areas to analyze:
The rigor of the research Significance of the results Impact upon your physiotherapy practice

Levels of Evidence
Consider the type of research conducted: (hierarchical list)
Systematic reviews, meta analysis Randomised controlled trials (RCTs) Non-randomised controlled trials Case controlled trials Cohort studies Descriptive studies Qualitative studies Expert opinion

Questions for Critiquing Evidence

Some general questions to ask include: What is the question? What is the purpose of the research? Did the research design allow the question to be answered? What were the results? Were the researchers interpretations valid? Are the results relevant and useable in practice?

Step 4: Implementing the evidence

Examples of strategies to implement evidence into practice include:

Apply the results to one or a group of clients Reconsider treatment plans/goals Develop handouts on topics (with other professionals)

Considerations when implementing evidence

Who is the right therapist to be implementing the evidence? What does the evidence say the right thing to do is? What is the right way to implement the intervention? What is the right place for the implementation? What is the right time to implement?

Step 5: Evaluating the impact of the evidence When evaluating the impact, consider: The clients outcomes Cost effectiveness Client satisfaction Therapist satisfaction

Barriers to EBP
Some barriers to EBP that have been discussed in literature include:
Access and availability to information Limited time Lack of EBP skills Confidence in the value of the evidence Support from management Conflict with client centered philosophy of OT

HOWEVER, BARRIERS CAN ALWAYS BE OVERCOME

Becoming an Evidence Based Practitioner

Strategies include:
Regularly ask clinical reflective questions Take time to track down the best evidence to support your therapy Use the evidence in your therapy Evaluate the impact of this evidence on your therapy

Useful Resources
AMED- rehab and therapy for allied health professions, accessed through www.silverplatter.com/catalog/amed.htm CINAHL- mainly nursing literature but some allied health, www.cinahl.com/ Cochrane Library- RCTs and Systematic Reviews, www.cochrane.co.uk/

Useful Resources
HealthWeb: tutorials and guides to searching literature, www.healthweb.org British medical journals: articles relating to EBPhttp://bmj.bmjjournals.com/ Canadian Centre for Health Evidence: description of EBP, www.cche.net