Evidence Based Practice Evidence Based Practice (EBP)(EBP)

EBP-Lecture -4 EBP-Lecture -4

Asking QuestionAsking Question Responsibilities of the practitioner as Responsibilities of the practitioner as

individualindividual Responsibilities of the practitioner as member Responsibilities of the practitioner as member

of the disciplineof the discipline Responsibilities of the practitioner as Responsibilities of the practitioner as

representative of the discipline.representative of the discipline.

Asking QuestionAsking Question

Well-built Question will help the clinician to Well-built Question will help the clinician to understand the condition.understand the condition.

The clinician will focus on the best The clinician will focus on the best intervention.intervention.

Discussion will be focused with expert Discussion will be focused with expert clinician.clinician.

Search will be easy for the answer.Search will be easy for the answer.

Sources of answerable questionSources of answerable question

Professional practiceProfessional practice Professional trendsProfessional trends Existing published researchExisting published research Your own curiosityYour own curiosity Existing TheoryExisting Theory

How to ask an answerable How to ask an answerable Question ?Question ?

There are four essential components of the answerable There are four essential components of the answerable question:question:

Situation: A specific client group or population Situation: A specific client group or population Intervention: The assessment, treatment or other Intervention: The assessment, treatment or other

clinical issues clinical issues Comparison :Comparison will help to look for the Comparison :Comparison will help to look for the

most effective intervention.most effective intervention. Outcome :The outcome in which you are interested Outcome :The outcome in which you are interested

Steps To Search EvidencesSteps To Search Evidences

Step 1.Difine an answerable question by using Step 1.Difine an answerable question by using the PICO criteria.the PICO criteria.

Step 2.Information source selectionStep 2.Information source selection Step 3. Select the best databases or print Step 3. Select the best databases or print

sourcessources Step 4. Apply a search strategy using subject Step 4. Apply a search strategy using subject

terms or key wordsterms or key words Step 5.Modify your strategy to achieve a more Step 5.Modify your strategy to achieve a more

efficient searchefficient search

Clinical ScenarioClinical Scenario

80 years old man referred to physical therapy 80 years old man referred to physical therapy after ® hip fracture because of his poor after ® hip fracture because of his poor balance, he is the 5balance, he is the 5thth person in the last month person in the last month with the same problem.with the same problem.

Using PIOC criteria what will be the Using PIOC criteria what will be the answerable question ?answerable question ?

PICO QuestionPICO Question

P ( Situation): 80 years old man with ® hip P ( Situation): 80 years old man with ® hip fracture due to poor balancefracture due to poor balance

I (Intervention) Balance training with ROM I (Intervention) Balance training with ROM and muscle strengthening program.and muscle strengthening program.

C (Comparison) 5 patients with same age had C (Comparison) 5 patients with same age had hip fracture due to same problemhip fracture due to same problem

O (Outcomes) Fall prevention in old age O (Outcomes) Fall prevention in old age population to live independent. population to live independent.

An answerable QuestionAn answerable Question

What will be the affective intervention What will be the affective intervention strategies for poor balance in old age strategies for poor balance in old age population ?population ?

Could hip fracture be prevented with balance Could hip fracture be prevented with balance training in the old age population?training in the old age population?

Responsibilities of the practitioner as Responsibilities of the practitioner as individualindividual

Facilitating knowledge development as Facilitating knowledge development as insights emerge in daily practiceinsights emerge in daily practice

Evaluating effectiveness of the informationEvaluating effectiveness of the information Willingness to use information to abandon Willingness to use information to abandon

ineffective methods and/or erroneous ideas ineffective methods and/or erroneous ideas and beliefs in favor of more effective options.and beliefs in favor of more effective options.

Facilitating knowledgeFacilitating knowledge

Individual professionals are responsible for Individual professionals are responsible for facilitating knowledge development as insights facilitating knowledge development as insights emerge in daily practice.emerge in daily practice.

They must first develop awareness of their own They must first develop awareness of their own belief.belief.

Professional should know that knowledge is not a Professional should know that knowledge is not a prerequisite for a belief.prerequisite for a belief.

Belief emerge from experiences, viewpoints of those Belief emerge from experiences, viewpoints of those we trust, and sociocultural influences. we trust, and sociocultural influences.

Evaluating effectiveness of the Evaluating effectiveness of the informationinformation

Challenging the current information and look for new Challenging the current information and look for new answers should be a continuous process.answers should be a continuous process.

Beliefs and conceptual frameworks are interwovenBeliefs and conceptual frameworks are interwoven Professional must conduct critical review of the Professional must conduct critical review of the

literatures.literatures. Participate in quality reviews & also participate in Participate in quality reviews & also participate in

formal data collection activities.formal data collection activities.

Willingness to use informationWillingness to use information

Professional must participate in activities that are Professional must participate in activities that are effective in their practiceeffective in their practice

Professional must share their emerging insights and Professional must share their emerging insights and broader beliefs with othersbroader beliefs with others

Open dialogue and the ability to request feedback in Open dialogue and the ability to request feedback in practice encourages the development of efficacious practice encourages the development of efficacious practices.practices.

The professionals make sure that the evidence should The professionals make sure that the evidence should support that the intervention is effective.support that the intervention is effective.

Professionals within a disciplineProfessionals within a discipline Professionals within a discipline have collective Professionals within a discipline have collective

responsibilities to contribute to evidence-based knowledgeresponsibilities to contribute to evidence-based knowledge The growth of knowledge in a discipline is possible only when The growth of knowledge in a discipline is possible only when

the members and interested others challenge current beliefs the members and interested others challenge current beliefs and theories.and theories.

Professional community requires its members to constantly Professional community requires its members to constantly push the limits imposed by current working paradigms.push the limits imposed by current working paradigms.

New ideas should be encouraged because that will provide New ideas should be encouraged because that will provide base for further growth of the professionbase for further growth of the profession

The members of the professional community should be The members of the professional community should be vigilant because new ideas could harm the profession too.vigilant because new ideas could harm the profession too.

Professionals across disciplineProfessionals across discipline Professionals must remain open to other points of viewProfessionals must remain open to other points of view Collaboration is necessary among the disciplines to share and Collaboration is necessary among the disciplines to share and

receive new ideas of interestreceive new ideas of interest To recognize and facilitate awareness about the similarities To recognize and facilitate awareness about the similarities

and differences in approaches to problem solving and and differences in approaches to problem solving and knowledge development for each disciplineknowledge development for each discipline

Clear communication among the disciplinesClear communication among the disciplines The collective knowledge of different professionals expends The collective knowledge of different professionals expends

the possible solutions for barrier-free environment.the possible solutions for barrier-free environment.

Points to rememberPoints to remember

EBP five steps process.EBP five steps process. Sources of answerable questionSources of answerable question Professional have different responsibilities for Professional have different responsibilities for

knowledge development (As individual, within knowledge development (As individual, within the discipline and across the discipline)the discipline and across the discipline)

ReferencesReferences

Sharon E. Strauss, W. Scott Richardson, Paul Sharon E. Strauss, W. Scott Richardson, Paul Glasziou, R. Brian Haynes,(2005)Glasziou, R. Brian Haynes,(2005) Evidence- Evidence-based Medicine: How to Practice & Teach based Medicine: How to Practice & Teach EBM,EBM, 3rd Ed., New York, Churchill 3rd Ed., New York, Churchill Livingstone Livingstone

Law ,M.(2002)Evidence-Based Law ,M.(2002)Evidence-Based Rehabilitation,Hamilton,Canada,Slack.Rehabilitation,Hamilton,Canada,Slack.