Module 1

• Evidence based Medicine before Evidence Based Practice
• Evidence Based Medicine

  • produced by clinical epidemiologist
  • Sackett, Rosenberg, Haynes, Gray, Richardson
  • research not applied on clinical practice
  • research to improve healthcare services
• Quick timeline

  • 1970s to 1980s: doing cheaper, doing better (efficiency, quality improvement)
  • 1990s: doing things right (effectiveness, internet)
  • 21st: doing the right things the right way
• Mitigating Factors

  • Increase choices in healthcare
  • Increase accountability of what we do
  • Increase justification of services
  • Increase interest in use of internet
  • Empowered Stakeholders
• Sackett

  • use of research only in clinical judgement
  • too narrow, not holistic
• Gray

  • use of research + consultation with patients
  • but what about the therapist?
• Jewell

  • research + patients+ clinical judgement
  • for optimized results
• Dawes

  • holistic definition
  • research + patient + clinical judgement
  • recent not outdated
• 3 components of EBP

  • Best available research
  • Professional experience
  • Patient's values and preference
• Best available research evidence

  • Empirical in nature (scientific, systematic, methodological)
  • Low bias
  • Relevant to Clinical questions
  • Clinical Utility
• Professional Experience

  • Practice knowledge
  • Clinical expertise
  • Individual and collective
  • Available resources of the therapist
• Patient's Values and Preferences

  • Beliefs, preferences, expectations
  • Context, condition, access to care, support
• Barriers of EBP in 1990s

  • Lack of time
  • Large caseloads
  • Limited searching skills
  • Limited appraisal
  • Lack of access to research databases
  • Lack of organizational support
  • Lack of appropriate evidence researches
• 21st Century Practice

  • Address barriers
  • Identify and implement strategies
  • Institute education programs for EBP skills training
  • Create research more usable for practice
  • Provide time and support for clinicians and practitioners
  • Increase in available pre-appraised sources
• Steps of the EBP Process

  • Ask: Forming an answerable questions
  • Acquire: Search for appropriate evidence
  • Appraise: Critically appraise the evidence
  • Incorporate & Communicate
  • Apply: Integrate the evidence and apply in practice
  • Assess: Evaluate the outcomes
• User

  • Restricted set of skills
  • Tracking & using pre-appraised resources of evidence
  • Applying applicable conclusions
• Practitioner

  • Higher level skills
  • Independent searching of evidence
  • Critical appraisal
  • Apply the best evidence
• Research VS EBP

  • Both results should be communicated
  • Starts with an ask
• Research: general (doesn't need further decision), publications

  EBP: specific (needs further decision), verbally