Evidence Based Practice: Unit II Asking and Answering Clinical Questions: Intervention

1. Evidence Based Practice: Unit II Asking and Answering Clinical Questions: Intervention Mount St. Mary’s College Doctor of Physical Therapy Program Faculty Online Instruction

2. Asking Clinical Questions Objectives: • Understand the difference between background and foreground questions. • Understand the need for background and foreground questions in physical therapy education. • Given a patient scenario write an answerable question related to diagnosis, prognosis, intervention and outcomes using the PICO method.

3. . • Domain V • Evaluate Use of evidence • Assess EBP skills and use of evidence. • Share and store critical appraisals • Monitor literature for new evidence Identify Learning or Developmental Need . • Domain I • Ask Focused Questions • Identify category of evidence (Diagnosis, Prognosis, Intervention) • Formulate four-part clinical question Client/Patient Problem EBP begins and ends here! Domain IV Apply Findings Interpret evidence in the context of the specific issues related to the client/patient problem. • Domain II • Search for Evidence • Use evidence hierarchy to guide search: • Search for meta-analyses, systematic reviews first. • Search primary literature • Domain III • Critically Appraise Evidence • What is the level of evidence? • Is the evidence valid? • Are the results important? Modified by Slavin, 2005

4. Client/Patient ProblemEBP begins and ends here! • A patient problem that cannot be answered with existing knowledge. • A challenge to one’s own existing knowledge– does literature support our best judgment??

5. Identify Learning or Developmental Need • Diagnosis • Prognosis • Therapy (Intervention)

6. Evidence in Practice • Is there evidence that performing joint manipulation under local anesthetic block might be more effective than continuing a program of joint mobilization, stretching, and mobility exercises in a woman with recalcitrant adhesive capsulitis of the shoulder? • Whitman, Fritz, Boyles. Physical Therapy . Volume 83 . 2003. pp 486-496.

7. Domain IAsk Focused Questions • Intervention • Formulate a focused clinical question • P atient • I ntervention • C omparison groups • O utcomes

8. Domain IISearch for Evidence • Use evidence hierarchy to guide search: • Search for meta-analyses, systematic reviews first. • Search primary literature • PubMed’s Clinical Queries & Cochrane Library are useful tools.

9. Systematic Reviews and Meta-Analyses Randomized Controlled Trials Cohort Studies Case Control Studies Opinions, Letters Animal Research In vitro Research

10. Domain IIICritically Appraise Evidence • What is the level of evidence? • Is the evidence valid? • Are the results important?

11. Number Needed to Treat (NNT) • How do we make decisions based on p values? • How do we REALLY know which treatment wins?

12. NNT 1 NNT = Pi - Pc TiTc

13. McKenzie vs. Mobilization Schenk et al., J of Man & Manip Ther. 11:95-102, 2003

14. Therapy • Was the assignment of patients to treatment randomized? Was the randomization list concealed? • Was follow-up of patients sufficiently long and complete? • Were all patients analyzed in the groups to which they were randomized?

15. Therapy • Were patients and clinicians kept blind to treatment? • Were groups treated equally, apart from the experimental therapy? • Were the groups similar at the start of the trial?

16. Domain IVApply Findings Interpret evidence in the context of the specific issues related to the client/patient problem.

18. Domain VEvaluate Use of evidence • Assess EBP skills and use of evidence. • Share and store critical appraisals (CATs) • Monitor literature for new evidence