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Physical Therapy: Searching the Literature: EBP

A guide to literature searching.

Defining EBP

Evidence-Based Practice (EBP) is the framework for your clinical decision-making process. It is the integration of

  • your knowledge, skills, and past experience (Clinical Expertise);
  • the unique preferences, concerns and expectations of your patient (Patient Characteristics); and
  • valid and clinically relevant research (Best Evidence).

 

      

 

5 A's - Steps for Acquiring Information

                    

               - Review the Situation (Assess)

             - Define the clinical problem as a question (Ask)

             - Select resources, design a strategy, and search for the

               answer (Acquire)

             - Summarize the evidence yield (Appraise)

             - Apply the evidence (Apply)

Types of Clinical Questions

Therapy - What is the treatment for a disease?

Diagnosis - power of a test to differentiate between those with and without a disease?

Prognosis - a patient’s likely course over time due to factors other than interventions?

Etiology/Harm - effects of potentially harmful agents on the patient?

Levels of Evidence

Levels of Evidence help you target the likely best type of evidence.

Level of Evidence Type of Study
1a Systematic reviews of randomized controlled trials (RCTs)
1b Individual RCTs with narrow confidence interval
2a Systematic reviews of cohort studies
2b Individual cohort studies and low-quality RCTs
3a Systematic reviews of case-control studies
3b Case-controlled studies
4 Case series and poor-quality cohort and case-control studies
5 Expert opinion

Physiopedia. (2018). Grades and levels of evidence. Retrieved from http://www.physio-pedia.com/grades_and_levels_of_evidence

Study Design

 

Type of Question Suggested Best Type of Study
Therapy RCT > prospective cohort
Diagnosis Prospective, blind comparison to a gold standard
Etiology/Harm RCT > cohort > case control > case series
Prognosis cohort study > case control > case series
Prevention RCT > cohort study > case control > case series
Clinical Exam prospective, blind comparison to gold standard
Cost economic analysis