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INTRODUCTION

QUESTIONS TO CONSIDER

  1. Can you explain to someone what EBP is and why it is important?

  2. Can you describe the three primary sources of evidence for EBP?

  3. What are the five steps of EBP?

  4. What is known about EBP in the real world?

CHAPTER-AT-A-GLANCE

This chapter will help you understand the following:

  • The definition and purpose of evidence based practice (EBP)

  • The three principal sources of evidence for EBP: research, patient values and circumstances, and clinical expertise

  • The five steps of EBP: identify a question, search, appraise, integrate, evaluate

  • The challenges of and solutions for EBP in the real world

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Evidence based practice (EBP) is a method of clinical decision-making and practice that integrates the best available scientific research evidence with clinical expertise and a patient’s unique values and circumstances.1 For the evidence based therapist, these three sources of evidence (clinical expertise, scientific research, and patient values and circumstances) form a foundation from which you and your patients work together to determine the best course of physical therapy care in any given circumstance (Fig. 1.1). The goal of evidence based therapists is to ensure that the best available evidence informs patient care, optimizing the benefit that patients gain from therapy.

FIGURE 1.1

The three pillars of evidence that support optimal outcomes for patients. The patient and the therapist contribute evidence to the decision-making process. As the evidence is collected, the therapist and the patient engage in a dynamic process using evidence to make a shared informed decision.

WHAT IS EBP, AND WHY IS IT IMPORTANT?

As an evidence based therapist, you will provide care that is grounded in scientific research, guided by clinical expertise, and ultimately directed by your patients’ individual values and circumstances. Third-party payers, patients, and the general health-care community have an expectation that the practice of physical therapists is evidence based. For example, when research evidence has consistently shown that one intervention is more effective than another for a particular patient problem and circumstance, it is expected that therapists share this with patients and, in general, recommend the more effective treatment.

The effort that you put into EBP not only fulfills the expectations of others, but it enhances the quality and credibility of your services (see Box 1.1). This leads to enhanced confidence and ability to assist patients in choosing their best options for physical therapy care. EBP moves the physical therapy profession away from practice based on habit, which may not be most effective for patients, and toward a careful, systematic assessment of the best available evidence to inform patient care. By carefully appraising what is known from multiple reference points, you are better prepared to provide your patients with the best care that physical therapy has to offer.

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