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  1. What is health literacy?

  2. Who are the decision makers in physical therapy?

  3. What is knowledge translation?


Locating and appraising evidence is only a relevant process if it is integrated into your practice and it is successfully communicated to others (Fig. 11.1). Throughout this book we use examples of how to integrate best evidence into your physical therapy practice. A part of the integration process is to communicate the evidence for best practice to other people who are making decisions regarding physical therapy. These decision makers include patients, families, other professionals, managers, insurance companies, and makers of social policy. Each of these people or groups has a different set of questions, uses evidence for different purposes, and has different abilities to understand and effectively use what we communicate.


Step 4 in the EBP process is the integration of research evidence; clinical expertise; and patient's values, goals, and expectations.

Integration of Research, Clinical Expertise, and the Patients' Values and Circumstances

Health Literacy

"Health literacy" can be defined as our ability to understand the factors and contexts that relate to our health, both in terms of prevention and how to manage our health conditions. Health education is aimed at improving health literacy. Effective health education requires an understanding of the social, educational, and economic realities of people's lives.1

One of our goals as physical therapists is to improve the health literacy of all health-care decision makers involved with physical therapy, beginning with our patients. To effectively communicate with our patients and their families, we must understand their comprehension of what we are saying, their ability to read materials that we give them, and their understanding of the value of our recommendations to them in the context of their lives. Effective communication requires careful listening to our patients and incorporating time within the physical therapy sessions to determine the success of our communications. We may tell our patients about a home exercise program; we may write instructions for the program, and we may verbally stress the importance of our recommendations for their recovery. However, effective communication requires that we listen to our patient describe their home program; tell us which is better, written instructions or pictures; and tell us the importance of our recommendations in their everyday lives. Understanding a patient's reading level ensures that any written instructions are appropriate. A patient may not be able to read or may have a limited ability to do so, which may be embarrassing to the patient and so must be probed for carefully. However, knowing a patient's reading and comprehension levels is critical to effective physical therapy management.

The Harvard School of Public Health, Health Literacy Studies Web site (

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