EBP presentation geared towards Physical Therapy students enrolled in PT 610 at the University of South Alabama

1. Clista Clanton, MSLS, AHIP August 27, 2009

4. Adapted from: Sackett D.L., Rosenberg M.C., Gray J.A., Haynes R.B., Richardson W.S. (1996). Evidence based medicine: what it is and what it isn't. BMJ, 312, 71-72.

9. PICO: Components of an answerable, searchable question Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare : A guide to best practice . Philadelphia, PA: Lippincott Williams & Wilkins. Patient population/disease The patient population or disease of interest - age - gender - ethnicity - with certain disorder (e.g., hepatitis) Intervention The intervention or range of interventions of interest - Exposure to disease - Prognostic factor A - Risk behavior (e.g., smoking) Comparison What you want to compare the intervention against - No disease - Placebo or no intervention/therapy - Prognostic factor B - Absence of risk factor (e.g., non-smoking) Outcome Outcome of interest - Risk of disease - Accuracy of diagnosis - Rate of occurrence of adverse outcome (e.g., death)

10. In patients with chronic pain , does the use of progressive muscle relaxation lead to a lessening of pain ? In patients with post polio syndrome , are strengthening exercises contraindicated ? Is the 6-minute walk test useful in assessing the functional capacity of COPD patients ? In patients with low back pain , are specific stabilization exercises or general strengthening exercises more effective? In patient with [Patient/ Problem] does [Intervention] or [Comparison, if any] affect [Outcome]

13. Type of Question Suggested Best Type of Study Therapy RCT > cohort > case control > case series Diagnosis Prospective, blind comparison to gold standard Etiology / Harm RCT > cohort > case control > case series Prognosis Cohort study > case control > case series Prevention RCT > cohort study > case control > case series Clinical Exam Prospective, blind comparison to gold standard Cost Economic analysis Questions of therapy, etiology and prevention which can best be answered by RCT can also be answered by a meta-analysis or systematic review.

14. Hierarchy of Evidence Case Series/Case Reports Case Control Studies Cohort Studies Randomized Controlled Trial Systematic Review Meta-analysis/ Meta-synthesis Animal Research/Expert Opinion Start at the top and work your way down.

15. Systems Computerized decision support Summaries Dynamed, ACP PIER, Clinical Evidence, EBP guidelines Synopses TRIP, ACP Journal Club Syntheses Cochrane Systematic Reviews, DARE, PEDro Studies PubMed, Scopus, CINAHL Haynes RB. Of studies, summaries, synopses, and systems: the “5S" evolution of services for finding current best evidence. ACP Journal Club . 2001;134: A11–13. Adapted from Haynes (2001)