EVIDENCE-BASED

PRACTICE: INTRODUCTION
Dr Sarah Ehsan
 Learning Outcome
• At the end of this lecture you will be able to

– Define Evidence Based Practice

– Enlist importance of Evidence Based Practice (EBP)

– What is high quality clinical research

– Patient Preferences

– Module handbook
Evidence-based
practice:
what, how and
why?
 What is Evidence?
• Proof
• Facts
• Information
• Truth
• Reality
• Attestation
• Confirmation
 How?
• Books
• Internet
• Literature
• Senior Doctor
• Personal Experience
• Patient Experience/Preference
 I want to travel to Islamabad. What
conveyance and route is earliest?
• How would I get the answer?
– Internet/Phone
– Bus station/air station
– Peer experience
– My experience
– My preference
• What is my Aim?
– Decision which is BEST FOR ME
 EVIDENCE BASED
PRACTICE/MEDICINE
• Integration of the best research evidence with
clinician’s expertise and patient values .
(Straus, 2005).

• It is an approach to decision-making in which

the clinician uses the best available evidence
in consultation with the patient, to find the
best treatment option for the patient.
(Muir Gray JA, 1997).
 EVIDENCE BASED
PRACTICE/MEDICINE

• "Evidence based medicine is the

conscientious, explicit, and judicious use of
current best evidence in making decisions
about the care of individual patients.”
(Sackett, D.L. et al. (1996).
 WHAT IS ‘EVIDENCE-BASED
PHYSIOTHERAPY’?
The practice of evidence-based physiotherapy
is informed by relevant, high quality clinical
research, patients’ preferences and
physiotherapists’ practice knowledge in
Clinical Decision Making..
EBP is INTEGRATION OF THREE
ELEMENTS…

Patient
Preferences

EBP

High Quality Practice

Clinical Research Knowledge
WHAT DO WE MEAN BY ‘HIGH QUALITY
CLINICAL RESEARCH’?

The term clinical research is usually used to mean

research on patients, conducted in clinical
settings.

It generates knowledge with experiments and

observation rather than theory.

High quality clinical research is carried out in a

way that allows us to trust the results
(it has a low risk of bias) and is relevant to our
questions.
 WHAT DO WE MEAN BY ‘PATIENT
PREFERENCES’?

• Traditional clinical model versus

contemporary model of clinical decision
making.
• Patients are invited to contribute their
experiences, preferences and values to the
decision-making process.
• Physiotherapists communicate to patients
the risks and benefits of alternative actions,
which requires communication skills,
empathy & flexibility from physiotherapists.
 WHAT DO WE MEAN BY‘PRACTICE
KNOWLEDGE’?
• Practice knowledge is knowledge arising from
professional practice & experience (Higgs &
Titchen 2001).
• Created through reflective processes that
enable practitioners to evaluate their practice
& learn from their experience.
• Practice knowledge contributes to the
professional judgements that have to be made
with patients.
Why EBP

Importance
 Patient (A)
• My improvement gone well at start but now it
stop?
• What is my problem?
• When will I be OKAY?
 FOR PATIENTS :-

• The safest and most effective

interventions.
• it will produce the best possible clinical
outcomes.
• Patients will need assistance to identify
high quality clinical research.
 FOR PROFESSIONAL AND THE
PROFESSION

– We assert that we are “professionals”

– Unique characteristic of being a professional
• Trustworthiness
• Strives to do good,
• Patient’s best interests at heart
• High ethical standards
• Is aware of what the evidence says.

– If we don’t use Evidences in our clinical decision;

• Our claim to be “professionals” is questionable.
FOR FUNDERS OF MEDICAL SERVICES

• Medical services are either funded by

-the public through their taxes
-or by individuals in a fee for service
(FFS) payment depemds on quantity of
treatment services are paid seperately
-or by insurance payments
WHY IS EVIDENCE-BASED PHYSIOTHERAPY
IMPORTANT?
FOR FUNDERS OF PHYSIOTHERAPY SERVICES

Needs to assure that….

• Health care does good, and not harm.
• Good value for money.
• Decisions are made to invest to benefit the
health of the population as a whole.
• Decisions on investment of health services
need to be based on evidence.
 WHY IS EVIDENCE-BASED PRACTICE
IMPORTANT?

“with autonomy comes

responsibility”
Ultimate goal of EBP is

?
 Reference Book
Evidence Based Physical Therapy: Linda Fetters,
Julie Tilson
 Summary
• EBP is using best clinical proofs
available
• For better health care of patients
• High quality clinical research
according to patient preferences
Any Question?