EVIDENCE BASED MEDICINE/PRACTICE IN SPORTS PHYSICAL THERAPY

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.  


Final Points: 

• The authors make an emphasize that just because you found quality evidence does not necessarily mean it is applicable to your patient at that time  
• Clinical Guidelines provide the best available evidence for common problems
• We must make a focus to use outcome measures more often to assess our clinical performance and determine if the evidence we used was helpful or not

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