Implementing Evidence Based Practice
Evidence Based Practice relies on background knowledge of disease and disorder to formulate a clinical question. While respecting scope of practice, a PTA should be able to self-identify a need for more information, research the question, and appropriately apply the outcome of the researched information in clinical practice. Steps in Implementing EBP can be summarized as follows:
- Convert the purpose or need for information (prevention, diagnosis, prognosis, therapy, causation, etc.) into an answerable question
- Find the best evidence to help you answer your question
- Evaluate your evidence for validity (is it truthful?), impact (size of its effect), applicability (usefulness in your setting with your patient)
- Integrate evidence with your clinical expertise and unique patient needs, values and circumstances
- Evaluate outcomes in the context of evidence and patient outcomes
- Assess your effectiveness and efficiency in performing steps 1-4 above; identify areas for improvement
- Repeat, repeat, repeat!
Consider a scenario you have recently practiced in lab to reinforce how clinical reasoning, and reflecting on clinical reasoning and evidence, reinforces your understanding and effectiveness in applying electrical stimulation to a clinical case:
Henry is a 55 yo male 7 days s/p L RTC repair in a sling with pain rated 9/10 immediately following PROM exercises last visit. He has not been taking his pain medication regularly due to stomach irritation. Decreasing pain and increasing PROM are treatment goals and therex, pain management, patient education, modalities, and functional training is in the plan of care. The PT has asked you to select a modality for symptom management and to help progress the patient. The pt. is not allowed muscle contraction for 3 more weeks.
1. What is our clinical purpose in this situation? Is there a need for additional information?
2. Evidence: PTA 101lecture, Dutton text, web searches, lab experiences
3. Evaluate: What modality will you select based on your research?
4. What additional "evidence" (clinical reasoning, patient information and feedback) will you use to finalize your treatment approach?
5. What tests, measures, or other data will you collect to help determine the treatment outcome?
6. Was the treatment outcome expected or unexpected? Why? What, if anything, will be done differently?
7. Repeat all these processes next visit.....
In short, evidence-based practice and active clinical reasoning are integrating. Thinking about your thinking and questioning assumptions and reasons for outcomes will prompt more questions....
(just for fun)
http://www.ted.com/talks/stuart_firestein_the_pursuit_of_ignorance.html )
