Chapter 2: Asking a Clinical Question and Searching for Research Evidence

Pre-Test

1. Why is it important to construct a searchable clinical question?

2. Can you give an example of a background question and a foreground question?

3. What is the difference between a database and a search engine?

4. Name a search engine that anyone can access for free on the Internet. What are this tool's strengths and weaknesses for helping therapists find research evidence?

5. Name three important techniques for narrowing a search in the PubMed search engine. Do the same for expanding a search.

6. Where could you locate a repository of full-text articles mandated by the U.S. Congress?

Introduction

This chapter develops your knowledge and skills in the first two steps of evidence based practice (EBP) (Fig. 2.1):

• Step 1: Identify a need for information, and develop a focused and searchable clinical question.

• Step 2: Conduct a search to find the best possible research evidence to answer your question.

These steps take you through the process of obtaining research evidence. Most therapists find that research evidence is the most difficult type of evidence to obtain. This chapter will help you learn to obtain research evidence quickly and efficiently.

STEP 1: Identify the Need for Information and Develop a Focused and Searchable Clinical Question

How Do I Know if I Need Information?

Step 1 can be divided into two parts—identifying a need for information and then constructing a focused, searchable clinical question. How do you identify a need for information? During your physical therapy education, you are flooded with information about how to care for patients. As an evidence based therapist and lifelong learner, you will be constantly adding to your knowledge. Every patient is different, and many will present in ways that push you to find new information to optimize their care. Also, scientific evidence rapidly changes. There are now over 2000 new clinical trials published every year related to physical therapy (Fig. 2.2). You cannot know the answer to every clinical question that will arise. The key is to identify important knowledge gaps and know how to fill them with the best available evidence.

Identification of your needs for information may occur before you see a patient and throughout a patient's course of care. The American Physical Therapy Association defines patient management as having six components: examination, evaluation, diagnosis, prognosis, intervention, and outcomes measurement (Fig. 2.3).¹