Foreword

I rarely read forewords, so I will keep this one short and cut to the chase. The last few decades have seen a revolution in medical care, particularly in physiotherapy. Research is shedding light on many old and new practices. Harnessing this research for the benefit of patients means that modern practitioners will need new skills—evidence based practice (EBP)—that are complementary to the clinical skills and patient-centeredness needed for good care. Good clinical practice now requires the three pillars shown in Chapter 1, Figure 1.1, of this book: (1) clinical expertise (gained by good training plus years of experience with feedback), (2) understanding of patient values (requiring good history-taking skills and shared decision-making skills), and (3) skills in locating and appraising research literature. All three are the subjects of this book.

The ideas behind EBP—the empirical testing of theories about treatment and diagnosis by careful study in groups of patients—date back many centuries to at least the 10th century and Al Razi in Persia (for those interested in learning more about Al Razi, Lind, Bradford-Hill, and the whole history of clinical trials, an excellent resource is www.james-lindlibrary.org). The 20th century saw a rapid development in the methods for both clinical research and connecting this research directly to clinical practice. A pivotal moment in this long development was Gordon Guyatt’s coining of the term “evidence based medicine” for a series of articles—the “user guides”—published in the Journal of the American Medical Association (JAMA) in the 1990s. The new term and the JAMA series helped spark the interest of clinicians across countries and disciplines. Professional curricula have been slowly catching up with this revolution. Whereas some educational programs still debate the need to include EBP, for many others, it has become the norm. The three pillars of EBP are seen as essential skills in the lifelong learning now needed in the fast-moving world of clinical care.

Physiotherapy has undergone its own revolution in the past few decades, emerging from its apprenticeship craft to become a more scientifically focused discipline. The growth in research has been astonishing. The Physiotherapy Evidence Database (PEDro) (www.pedro.org.au) now contains over 37,000 randomized trials, systematic reviews, and clinical practice guidelines in physiotherapy, and it continues to grow rapidly. Currently, the number of randomized trials in physiotherapy doubles about every 7 years (see Chapter 7, Fig. 7.1). This implies that the last 7 years have seen as many trials as in all the previous history of physiotherapy. Whereas some trials merely confirm current practice as correct, some will overturn ideas, and others will introduce new methods and practices. This growth, challenge, and change is potentially a great blessing for patients. However, for that blessing to reach the bedside, clinicians must be highly skilled in accessing, interpreting, and applying this wealth of research evidence.

The goal of this book is to support the learning of those skills. This new edition has a modified and extended range of content based on observed learners’ use of the text. It now includes more on clinically relevant statistics, knowledge translation, and technology to support evidence based practice. Additionally, the case studies are better integrated and run through several chapters.

However, EBP must be adapted to be adopted. Although the fundamental principles are the same, the needs and contents of each health-care discipline require the principles of EBP to be framed and applied in ways that suit its special issues and research base. EBP looks somewhat different in medicine, psychiatry, nursing, and physiotherapy. This book, then, is an essential bridge to assist the application of EBP to physiotherapy. Dr. Fetters and Dr. Tilson have done an excellent job in describing the fundamentals of EBP and expertly adapting them to the needs of physiotherapists, using everyday clinical examples to illustrate the processes. Using this book will help in learning these vital skills for 21st-century practice. But that is not enough. The methods of EBP must also be practiced as any skill would; the exercises in this book will help. But the most difficult part is integrating these skills into your professional life and clinical care for the real benefits to patients to be seen. I wish you well with that vital task.