Foreword

The world's robust health and health care research enterprise produces a burgeoning flow of innovative methods for improving the well-being of people. Unfortunately, this ongoing research bounty poses important challenges for clinicians, including learning about and critically appraising new evidence on the diagnosis, prognosis, prevention, and management of clinical problems; adopting the most validated and effi cacious innovations; off ering these innovations to clients when appropriate, taking into account their preferences and capabilities; and “exnovation,” eliminating practices that research has shown to be ineffective or harmful.

It is only recently in the history of health care that clinicians in any profession have been taught the skills to try to meet these challenges, and it is interesting to reflect on the relatively rapid (and painfully slow) evolution of evidence based clinical practice. Initially, beginning in the 1980s,¹ a decade of publications on “critical appraisal of the medical literature” described the key concepts of science that provide a foundation for valid assessment of screening and diagnostic tests, prognosis and clinical prediction, causal claims, and health care interventions. Although these concepts quickly became popular in health professional education circles, it was obvious that changing the habits of practicing clinicians was much more diffi cult than just teaching basic principles of critical appraisal.

The term “evidence based medicine” was coined at the beginning of the 1990s to try to galvanize the process of using research evidence in clinical care.^2,3 This was a “call to arms” to abandon traditional ways of clinical practice. It provocatively pitted evidence based medicine against eminence based medicine and denounced the tradition of relying on pathophysiology as the main pillar of practice. This call captured a great deal of attention, but it also raised many antibodies and, at least partially, correctly. Pathophysiology does have much to do with clinical practice. Experience (if not eminence) is essential.

A somewhat more mature model soon emerged, attempting to integrate evidence from research not only with clinical expertise but also with the patients' circumstances and their preferences and capabilities.⁴ The authors of Evidence into Practice: Integrating Judgment, Values, and Research have embraced this model and advanced it a great deal, delving into what is known of clinical decision making, assessing patient's preferences, working in a team, and many related aspects of current practice.

Recognition of the opportunities for evidence based decision making has now spread worldwide throughout the health professions, but the tools for making this decision making happen effectively and consistently in clinical practice are still under development. One reason is that the resources for evidence based practice must be tailored to the purposes, needs, and mode of practice of each clinical discipline and, ultimately, to the needs and capabilities of each patient. We are still learning how to do this. This volume tackles these challenges for physical therapists, when working individually and in the rapidly evolving teams that are needed to deal with complex disease conditions and the multiple disease afflictions that inevitably arise when life is prolonged, whether it be for premature infants, children or adults with disabilities, or elders with chronic diseases.

Readers will learn a great deal about their profession, ways and means to provide evidence informed care, and how to continue to learn when knowledge for the benefit of patients keeps advancing. Unless someone turns off the faucet of knowledge, this book is a must for physical therapists and other health professionals.

R. Brian Haynes, OC, MD, PhD, FRCPC

Professor,

Department of Clinical Epidemiology and Biostatistics

McMaster University