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Writing a book successfully needs a spark to begin, a passion to continue, and a determination to finish. The spark for this book came from reflection on the patterns of practice exhibited by the expert physical therapists we studied for the text, Expertise in Physical Therapy Practice, written with our colleagues Gail Jensen, and Katherine Shepard.1 Before the concepts of evidence based practice had become known in the United States, the experts we interviewed were describing a pattern of practice that was deeply imbedded in a unified sense of practice, something we called a philosophy of practice. This philosophy grew from clinical judgment— making good decisions, knowledge—arising from available literature and from patients; virtue—a passion to do the right thing; and movement—using their own bodies and influencing their patients to produce the desired effect. Based on responses from our readers and from colleagues with whom we discussed our results, we knew that this pattern of practice was intriguing and important and that physical therapists wanted to emulate it.

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The passion came as each of us began to work in the evidence based practice (EBP) world, teaching both entry-level and experienced clinicians the tenets of EBP. Both of us have been teaching since the days when the accepted way to prepare practitioners to use research in guiding their care was to teach them how to do research. We remember year after year of doing this and year after year being told by our graduates that they did not use this material because they were not researchers. Clearly there was a disconnect between our goal of producing thoughtful clinicians who use contemporary research and the way we were teaching them to do that. But EBP changed all of that. Graduates were finally reporting that they sought new literature and were asking how they could maintain access to literature databases.

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The passion for writing this text really flamed when Dr. Hack had the opportunity to participate in a group of ethics teachers and researchers, known as the Dreamcatchers. One member of this group offered that she thought EBP had the potential to be unethical.2 This was a surprising comment that caused much reflection. After a time, what became clear was that the application of information from the literature without exercising good clinical judgment and without honoring patient values and circumstances was indeed unethical, as it denied the obligation we have to meet the duties of patient autonomy, benefi cence, non-maleficence, and justice. On the other hand, it seems to us, that to practice without using the unified principles of EBP—clinical judgment, patient values and circumstances, and evidence from the literature—was also unethical. So was born the idea for this text, to present the full picture of EBP, not focusing only on evidence from the literature, as other texts have, but providing depth and breadth across all three aspects so that our readers could truly embrace evidence based practice and offer their patients the care they deserve.

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The determination to complete the text (and it takes lots of determination!) came from the support we provided each other, first through many visits between Durham and Philadelphia and then through our weekly Skype working sessions. We were able to keep each other going through many life changes and challenges that threatened to eat up our time and energy. It has been said that the only thing harder than doing research with colleagues is doing it alone. The same can be said for writing a book. We brought different perspectives and experiences to this text, and we think it is richer for our collaboration.

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We wish to thank the FA Davis staff who patiently helped us through to completion, including Margaret Biblis, for agreeing with us that this was a good idea; Melissa Duffield, for gently keeping us on the path; and Margaret (Peg) Waltner, for greatly reducing the confusion in our writing.

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We hope that you find the book an inspiration in your practice. Providing health care and, for us particularly, physical therapy is a privilege of the highest calling. Providing it by using your best clinical judgment, by understanding and respecting your patients' values and circumstances, and by appropriately applying evidence from the literature means that we all truly honor our calling.

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Laurie Hack

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Philadelphia, Pennsylvania

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Jan Gwyer

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Durham, North Carolina

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1Jensen G, Gwyer J, Hack L, Shepard K; Expertise in Physical Therapy Practice, 2nd Ed, St. Louis, Saunders Elsevier, 2006.

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2Royeen C, in Purtillo R, Jensen G, Royeen C, Eds, Educating for Moral Action: A Sourcebook for Health and Rehabilitation Needs, F. A. Davis, 2004.

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