At the conclusion of this chapter, the reader will be able to:
Define the concept of evidence-based practice (EBP) as proposed by Sackett and colleagues.
Discuss the importance of using an evidence-based approach to orthopaedic manual physical therapy (OMPT).
Describe the hierarchy of levels of evidence.
Recall the primary considerations to be addressed when appraising the strengths and weaknesses of research studies that investigate measures and interventions used in OMPT.
WHY IS THIS CHAPTER IMPORTANT?
If you are like many clinicians, a chapter like this one is readily passed over to get to the clinically relevant material that demonstrates actual treatment techniques. However, in today's clinical environment, you can quickly be overwhelmed by the array of possible techniques and approaches to common problems. You may already feel this way if you have attended more than one or two orthopaedic manual physical therapy (OMPT) continuing education courses. Many clinicians will, at this point, simply choose the approach that seems to make the most intuitive sense, or worse, choose the approach advocated by the speaker with the most charm and authority. The real answer to this dilemma, experienced by every conscientious practitioner, is to apply the process and principles of evidenced-based practice (EBP).
WHAT IS EVIDENCE-BASED PRACTICE?
Evidence-based practice can be thought of as a process of using the best available information to assist clinical decisions.1 In many respects, EBP is what thoughtful, conscientious practitioners have done for years. It simply has become more systematic and defined in the recent past. The actual process, or steps, involved in EBP are outlined in Box 3-1 and will be discussed in greater detail later in this chapter. EBP has often been erroneously thought of as a recipe for clinical practice that requires a research study to support every action. Clearly this is not practical, thus a more useful way to conceptualize EBP is proposed by Sackett et al1,2 who describe EBP as a combination of many factors that are used to assist clinical judgments. A simple definition of EBP, therefore, is using the best available research evidence interfaced with the patient's unique values and circumstances and the clinician's expertise to make clinical decisions. A fundamental premise of EBP is that research findings assist judgments but do not necessarily mandate them. The insight and skill of the practitioner cannot be ignored. This concept is well-illustrated in the practice of OMPT, which has an interactive form of decision-making; that is, the choice of which procedure to use is often based upon the patient's immediate response to the previous procedure. This phenomenon makes it challenging to design reproducible clinical studies that are able to account for the degree of variation between patients.3 This is not to suggest that EBP lacks relevance for OMPT. A central core of basic and applied research that addresses mechanisms and outcomes ...