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It is better to read a little and ponder a lot than to read a lot and ponder a little.

—Denis Parsons Burkitt

*Mr. Ketterman's Case

I found an article contrasting aerobic endurance exercises with strength training of the upper limbs for patients with heart failure, but I'm not really sure if the study was done properly. So I don't know if I should apply this evidence to my care. (See Appendix for Mr. Ketterman's health history.)

Evidence based practice is built on a process that begins with a clinician's need to know something in order provide the best care to the patient. The clinician translates the information needed into an answerable question and then efficiently finds the best type of evidence related to the question. In this chapter we will focus on determining the utility of individual studies, the base of the 6S pyramid described by DiCenso et al.1,2 shown in Figure 13-1, in helping to make good clinical decisions. Since individual studies are the most prevalent form of evidence that clinicians use, it is important to know how to assess them. We will provide the reader with the most currently used criteria, based on the principles discussed in Chapter 12, to assess the value of evidence derived from experimental and observational research.

Figure 13-1

Sources of information about evidence. (From DiCenso A, Bayley L, Haynes RB, Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Evid Based Nurs. 2009;12:99–101.)


As Schardt tells us in Chapter 11, as of 2011, there are over 17,000,000 individual articles referenced in Medline, so it is clear that the individual study is the most common form of evidence available to clinicians. In addition, most of these studies are published in journals that use masked peer review. As we discussed in Chapter 10, this means that experts in the field have reviewed the authors' report of their research methods and findings and have found them acceptable for publication, without knowing who the authors were. These studies can be found at all of the many sources reviewed in Chapter 11.

Studies Focused on Physical Therapy

Physical therapists can and should find articles of interest in all major health care literature. Journals with a broad focus, such as the New England Journal of Medicine (NEJM), the Journal of the American Medical Association (JAMA), the British Medical Journal (BMJ), journals with a specialty focus such as the Journal of Bone and Joint Surgery (JBJS), Neurology, Pediatrics, Journal of the American Geriatric Society, the Archives of Internal Medicine, and journals that focus on rehabilitation, such as the Archives of Physical Medicine and Rehabilitation, can all provide many articles that address the care ...

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