Evidence Based Practice (EBP)

EBP-Lecture -4 Asking Question Asking Question Responsibilities of the practitioner as individual Responsibilities of the practitioner as individual Responsibilities of the practitioner as member of the discipline Responsibilities of the practitioner as member of the discipline Responsibilities of the practitioner as representative of the discipline. Responsibilities of the practitioner as representative of the discipline.

Asking Question Well-built Question will help the clinician to understand the condition. Well-built Question will help the clinician to understand the condition. The clinician will focus on the best intervention. The clinician will focus on the best intervention. Discussion will be focused with expert clinician. Discussion will be focused with expert clinician. Search will be easy for the answer. Search will be easy for the answer.

Sources of answerable question Professional practice Professional practice Professional trends Professional trends Existing published research Existing published research Your own curiosity Your own curiosity Existing Theory Existing Theory

How to ask an answerable Question ? There are four essential components of the answerable question: Situation: A specific client group or population Situation: A specific client group or population Intervention: The assessment, treatment or other clinical issues Intervention: The assessment, treatment or other clinical issues Comparison :Comparison will help to look for the most effective intervention. Comparison :Comparison will help to look for the most effective intervention. Outcome :The outcome in which you are interested Outcome :The outcome in which you are interested

Steps To Search Evidences Step 1.Difine an answerable question by using the PICO criteria. Step 1.Difine an answerable question by using the PICO criteria. Step 2.Information source selection Step 2.Information source selection Step 3. Select the best databases or print sources Step 3. Select the best databases or print sources Step 4. Apply a search strategy using subject terms or key words Step 4. Apply a search strategy using subject terms or key words Step 5.Modify your strategy to achieve a more efficient search Step 5.Modify your strategy to achieve a more efficient search

Clinical Scenario 80 years old man referred to physical therapy after ® hip fracture because of his poor balance, he is the 5 th person in the last month with the same problem. 80 years old man referred to physical therapy after ® hip fracture because of his poor balance, he is the 5 th person in the last month with the same problem. Using PIOC criteria what will be the answerable question ? Using PIOC criteria what will be the answerable question ?

PICO Question P ( Situation): 80 years old man with ® hip fracture due to poor balance P ( Situation): 80 years old man with ® hip fracture due to poor balance I (Intervention) Balance training with ROM and muscle strengthening program. I (Intervention) Balance training with ROM and muscle strengthening program. C (Comparison) 5 patients with same age had hip fracture due to same problem C (Comparison) 5 patients with same age had hip fracture due to same problem O (Outcomes) Fall prevention in old age population to live independent. O (Outcomes) Fall prevention in old age population to live independent.

An answerable Question What will be the affective intervention strategies for poor balance in old age population ? What will be the affective intervention strategies for poor balance in old age population ? Could hip fracture be prevented with balance training in the old age population? Could hip fracture be prevented with balance training in the old age population?

Responsibilities of the practitioner as individual Facilitating knowledge development as insights emerge in daily practice Facilitating knowledge development as insights emerge in daily practice Evaluating effectiveness of the information Evaluating effectiveness of the information Willingness to use information to abandon ineffective methods and/or erroneous ideas and beliefs in favor of more effective options. Willingness to use information to abandon ineffective methods and/or erroneous ideas and beliefs in favor of more effective options.

Facilitating knowledge Individual professionals are responsible for facilitating knowledge development as insights emerge in daily practice. Individual professionals are responsible for facilitating knowledge development as insights emerge in daily practice. They must first develop awareness of their own belief. They must first develop awareness of their own belief. Professional should know that knowledge is not a prerequisite for a belief. Professional should know that knowledge is not a prerequisite for a belief. Belief emerge from experiences, viewpoints of those we trust, and sociocultural influences. Belief emerge from experiences, viewpoints of those we trust, and sociocultural influences.

Evaluating effectiveness of the information Challenging the current information and look for new answers should be a continuous process. Challenging the current information and look for new answers should be a continuous process. Beliefs and conceptual frameworks are interwoven Beliefs and conceptual frameworks are interwoven Professional must conduct critical review of the literatures. Professional must conduct critical review of the literatures. Participate in quality reviews & also participate in formal data collection activities. Participate in quality reviews & also participate in formal data collection activities.

Willingness to use information Professional must participate in activities that are effective in their practice Professional must participate in activities that are effective in their practice Professional must share their emerging insights and broader beliefs with others Professional must share their emerging insights and broader beliefs with others Open dialogue and the ability to request feedback in practice encourages the development of efficacious practices. Open dialogue and the ability to request feedback in practice encourages the development of efficacious practices. The professionals make sure that the evidence should support that the intervention is effective. The professionals make sure that the evidence should support that the intervention is effective.

Professionals within a discipline Professionals within a discipline have collective responsibilities to contribute to evidence-based knowledge Professionals within a discipline have collective responsibilities to contribute to evidence-based knowledge The growth of knowledge in a discipline is possible only when the members and interested others challenge current beliefs and theories. The growth of knowledge in a discipline is possible only when the members and interested others challenge current beliefs and theories. Professional community requires its members to constantly push the limits imposed by current working paradigms. Professional community requires its members to constantly push the limits imposed by current working paradigms. New ideas should be encouraged because that will provide base for further growth of the profession New ideas should be encouraged because that will provide base for further growth of the profession The members of the professional community should be vigilant because new ideas could harm the profession too. The members of the professional community should be vigilant because new ideas could harm the profession too.

Professionals across discipline Professionals must remain open to other points of view Professionals must remain open to other points of view Collaboration is necessary among the disciplines to share and receive new ideas of interest Collaboration is necessary among the disciplines to share and receive new ideas of interest To recognize and facilitate awareness about the similarities and differences in approaches to problem solving and knowledge development for each discipline To recognize and facilitate awareness about the similarities and differences in approaches to problem solving and knowledge development for each discipline Clear communication among the disciplines Clear communication among the disciplines The collective knowledge of different professionals expends the possible solutions for barrier-free environment. The collective knowledge of different professionals expends the possible solutions for barrier-free environment.

Points to remember EBP five steps process. EBP five steps process. Sources of answerable question Sources of answerable question Professional have different responsibilities for knowledge development (As individual, within the discipline and across the discipline) Professional have different responsibilities for knowledge development (As individual, within the discipline and across the discipline)

References Sharon E. Strauss, W. Scott Richardson, Paul Glasziou, R. Brian Haynes,(2005) Evidence- based Medicine: How to Practice & Teach EBM, 3rd Ed., New York, Churchill Livingstone Sharon E. Strauss, W. Scott Richardson, Paul Glasziou, R. Brian Haynes,(2005) Evidence- based Medicine: How to Practice & Teach EBM, 3rd Ed., New York, Churchill Livingstone Law,M.(2002)Evidence-Based Rehabilitation,Hamilton,Canada,Slack. Law,M.(2002)Evidence-Based Rehabilitation,Hamilton,Canada,Slack.