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Throughout the first three sections of this text, we have presented principles to guide us in each of the three elements of evidence-based practice. Section I focuses on our clinical judgment and decision making processes; Section II on the importance of knowing and respecting our patients' values and choices; Section III on identifying and appraising evidence from the literature. In all three sections, we have provided examples of clinical application of these principles. But a central question remains: Can and do clinicians actually use these principles in their own clinical practices?

In this concluding section, we explore the answers to this question. Research has shown us that human beings need time to adopt recommended changes and that there are some typical steps in that adoption process. In addition, we know that there are barriers to adoption that are also fairly consistent across all types of change in many different groups of people.1 In Chapter 17, we present what is known about the diffusion of change in general, what we know about the adoption of evidence in health care, and the barriers to and opportunities for change in the future.

In health care we have come to rely on the patient record as the source of information about all aspects of patient care.2 In Chapter 18, Kristin von Nieda discusses the importance of documentation as the basis for understanding our response to change in our practices, the importance of good outcome measures in this documentation, and the linkage of good documentation to quality measurement and improvement activities.

In Chapter 19, Christopher Bise and Anthony DeLitto delve more deeply into the connections of evidence based practice and quality improvement. They describe a successful program to assess the clinical performance of the therapists in their practice regarding a specific patient population. This example demonstrates that, indeed, we can put evidence based practice principles into practice!


1. +
Rogers  EM. Diffusion of Innovations 4th ed. New York: The Free Press; 1995.
2. +
Erickson  M, McKnight  R, Utzman  R. Physical Therapy Documentation: From Examination to Outcome. Slack; 2008.

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