Research

• What is evidence based practice?

  interaction between a practitioner and an individual
• EBP is the synthesis of ...

  - patient focus

  - therapist expertise

  - research foundation
• Synthesis of patient focus

  - goals

  - unique traits between individuals
• Synthesis of therapist expertise

  - therapist skill

  - experience (years practicing)
• Synthesis of research foundation

  - clinically relevant

  - patient centered

  - validate or invalidate current practice
• Evidence based medicine

  integration of best research evidence with clinical expertise and patient values
• EBP process

  1. identify research question

  2. design the study

  3. implement the study

  4. analyze the data

  5. disseminate findings

  
• Between what steps of the EBP process does EBP take place?

  between steps 5 and 1
• A good research question reveals ___

  more questions at the end of the process (hence why EBP takes place between steps 5 and 1)
• Goals of EBP (Cleland et al, 2008)

  - decrease practice variation, standardize care around best practice patterns to maximize clinical outcomes and cost effectiveness
• Other EBP goals

  - incorporate best practice into pt care

  - apply critically reviewed current research to outcome analysis

  - bridge from research to practice

  - discontinue ineffective methods

  - promote better edu and decision making (for pt and therapist)

  - suggest future research

  - support APTAs vision
• PICO

  a method used to structure research methods and form a research question
• PICO: P

  population of interest

  - who is receiving the therapy
• PICO: I

  intervention received

  - what therapy will be used?

  - when will the population receive the therapy?

  - where will the therapy be delivered?

  - TIDier process
• PICO: C

  comparison to standard of care or alternative treatments

  - control may not be ethical

  - why is the intervention better than others?
• PICO: O

  outcome measure

  - how do we know it worked?
• Unfiltered information

  - background information

  - case-controlled studies, case series/reports

  - cohort studies

  - randomized controlled trials
• Filtered information

  - critically-appraised individual articles

  - critically appraised topics

  - systematic reviews
• Level 1 evidence

  evidence comes from systematic reviews
• Level 2 evidence

  includes well-designed individuals RCTs or observational studies
• Level 3 evidence

  includes less well-designed studies that do not have strong controls of bias

  - nonrandomized studies

  - retrospective cohorts
• Level 4 evidence

  descriptive studies
• Level 5 studies

  decisions founded on logical, but not scientifically confirmed connections
• Single subject studies

  - research design in which data is collected from a single subject

  - subject serves as own control
• Meta-analysis

  combines the results from many different studies and runs an analysis on comprehensive findings
• Barriers to EBP

  - gaps in knowledge

  - evidence

  - pt improves despite evidence to the contrary

  - potential threat

  - productivity standards

  - reliance on clinical expertise

  - resistance to change

  - resource availability

  - third parties may only pay for proven interventions

  - time consuming
• Barriers to student EBP implementation

  lack of

  - faculty modeling

  - library support

  - understanding

  - time
• Barriers to EBP implementation: understanding

  - literature critiques

  - research methods

  - statistical analysis