There are too many research studies, how can I possibly find the BEST evidence based articles?! I don't have time to sit down and search through hundreds of abstracts to find an applicable one!
How may of you have heard this before: "I read an article that says THIS treatment (fill in the blank) is better that that one." The question then is: What level of evidence is this article? What comparisons were made between the two interventions? Is that evidence applicable to THIS patient's particular case?
In this clinical commentary published in IJSPT (October 2012), Dr. Manske and Dr. Lehecka put together a very comprehensive step by step approach for sports physical therapists to approach looking AND using Evidence Based Practice.
The article starts out by stating: "The American Physical Therapy Association 2020 Vision Statement suggests that physical therapists and physical therapist assistants will render evidence-based services throughout the continuum of care and improve quality of life for our society. This statement is in sharp contrast to what actually occurs in typical practice."
Unfortunately, the authors are correct in stating that too often we do not use evidence enough, nor in the way we envisioned it. One of the problems they believe plays a role is that many journals publish low quality studies. Obviously it is very difficult to publish high quality studies with funding and time commitment but isn't that the point? Is it not our duty as physical therapists to push for ways to fund and take the time to publish high quality data?
"Many sports physical therapists are still not completely sure of how to integrate EBM into daily clinical practice and how to use it as a part of their continued professional growth." The authors recognize how difficult it can be to not only find quality evidence but also how to use the evidence in the clinic. Therefore, they focused the rest of the article on how to define best evidence ("best research evidence=clinically relevant research"), how to find it, how to decide if it is clinically relevant for your sports patients, and what to do if it is not. The 5 point system they use is outlined below:
1) Convert the need for information (about prevention, diagnosis, prognosis, therapy, causation, etc.) into an answerable, clinically relevant question.
2) Track down and search for best evidence with which to answer the question.
3) Critically appraise the evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in our clinical practice).
4) Integrate the critical appraisal with clinical expertise and with your patient’s unique biology, values and circumstances.
5) Evaluate effectiveness and efficiency in executing steps 1-4 and seeking ways to improve upon them before next time.
Each one of these points is throughly explained to help the sports physical therapist understand how to perform each step. Some of the highlights of the explanations include: how to use clinical queries, how the Centre for Evidence Based Medicine describes the quality of evidence, Hooked on Evidences' grading of evidence, and PEDro.
If you've been paying attention to the Gait Guys' blog, you may have noticed a string of running posts lately. They have ranged in topics from injuries to examination to training techniques. Two of the posts focused on potential causes for injury. The first post discussed the issue of running only one direction on a track. Turning one direction leads to asymmetries in muscle strength and stresses placed on the body. It's not a surprise that people get injured from this! The second post was about banking your head during turns. The authors review the importance of the cervical region's role in preparing the rest of the body for movement. This further emphasizes the need to look at the entire body when we are evaluating our patients!
The third post isn't necessarily restricted to runners. It's an examination technique called the standing tripod test. The tripod is formed by the calcaneus and heads of the 1st & 5th metatarsals. As expected, the patient stands on one LE at a time, while the examiner observes the entire body for any reactions. This is a more intricate test than the standing trendelenburg test, because we should be looking at more than the hip. The authors present a case in this post that demonstrates the relationship between forearm pronation/supination and foot/ankle adjustments in maintaining balance. Very cool! The final article we wanted to include is not from the Gait Guys. Triathlete presents 5 training drills with the purpose of improving running form. While the reasoning behind them is theoretically plausible, it is by no means a scientific study. But definitely still interesting to consider and potentially a research idea!
Chris Beardsley is a biomechanics researcher and author of a book about scientific posterior chain training. He wrote an article up for Mike Reinold's blog this past winter on leg strength and power in baseball pitching.
The article discusses the research that has looked at leg strength in baseball pitching with regards to pitching velocity, injury, and overall mechanics. As Chris points out very early on in the article, there has not been a lot of research done in this area. The two fundamental questions Chris focuses on are:
1. What does the research say about proximal-to-distal kinematic sequencing in pitching?
2. What does the research say about leg muscle activity in pitching?
Check out the article and the evidence behind leg strength in pitching. It might just help you focus your rehabilitation programs on pitchers a little better with return to sport.