1. Introduction to the Basics November 9, 2012

2. 1. Define EBM/EBP2. History of EBM in AT3. The Process4. EBP Web-based Resources 3. Using evidence to The specific way you support your clinicalmake decisions practice regarding theintegration of the best evaluation, diagnosis, research evidence with and treatment of your clinical expertise and patient patient values to makeTotal integration of clinical decisionsEBM into clinicalpracticeEvidence-Based MedicineEvidence-Based Practice(EBM)(EBP)Jutte, LS & Walker, SE (2009). Incorporating and Teaching Evidence-Based Practice, from The Athletic Trainers Pocket Guide to Clinical Teaching(ed. by Weidner TG), p. 43 - 59; Slack, Inc.Steves, R & Hootman, JM (2004). Evidence-Based Medicine: What is it and How Does it Apply to Athletic Training. JAT, 39(1): 83-87. 4. EBM Current Evidence Clinical PatientExpertise Values 5. Keeping up to date Conducting research Using knowledge Using a cookbook About the patient About the clinician Stagnation Advancement EBP is.EBP is NOT.Starkey, C (Feb. 26, 2011). Evidence: It Can Be For Us or Up Against Us; Athletic Training Educators Conference, Washington, DC.Steves, R & Hootman, JM (2004). Evidence-Based Medicine: What is it and How Does it Apply to Athletic Training. JAT, 39(1): 83-87. 6. EBM originally coined in 1992 Began gaining momentum in AT in early2000s Now a mandated component of AT Educationand AT clinical practice 5th edition of AT Education Competencies Updates in BOC CEU requirements for currentprofessionals 7. Overall Lack of outcome effectiveness studies Available evidence is inconclusive or contradicting Personal Current health policies Complexity of practice Incomplete access to information Difficulty interpreting data Organizational barriers Ineffective CE sessionsMaher CG, Sherrington C, Elkins M, Herbert RD, & Moseley AM (July 2004).Challenges for Evidence-Based Physical Therapy: Assessing and InterpretingHigh-Quality Evidence on Therapy. Physical Therapy, 84(7): p. 645 - 654. 8. 1. Asking appropriate clinical questions2. Acquiring medical evidence3. Critically appraising available evidence4. Applying evidence in context of clinical expertise and patient values5. Evaluating (assessing) effectiveness of intervention 9. P: Patient or ProblemI: InterventionC: ComparisonO: Outcome 10. Follow this link for a PICO tutorial. PICO Tutorial This worksheet can be used to help you develop future PICO/Clinical Questions (or use version I have attached asan additional file):PICO WorksheetFollowing the completion of this activity, what questions doyou have about creating PICO questions? 11. Understanding types of information Understanding types of research Understanding Levels of Evidence Key databases 12. Expert Opinion Case Report Case Series Cohort Study Prospective vs. Retrospective Case Control Study Systematic Reviews (SR) Compare to narrative review: HERE Meta Analysis (MA) Randomized Control Trial (RCT)*Click on each study for an example* 13. For a very clear explanation of each type ofresearch and how to recognize it, completethis tutorial:Research DesignWhat questions do you still have now that youhave completed this tutorial? 14. To further explain the difference betweenfiltered and unfiltered information and whereto find it.. (take a look!) Types of Information Tutorial Understanding information and the searchprocess Flow chart 15. Now that youre familiar with: Research design (MA, RCT, cohort study, etc.) Prospective v. retrospective research Filtered v. unfiltered information The next question is why are they depicted ina triangle?Levels of Evidence (Grade of Recommendation) 16. CEBM have since updated thisinformation slightly as of 2009and is working to do so again. 17. National Athletic Trainers Association Position Statement: Preventing Sudden Death in Sports Review the article and note that following each recommendation made there is a grade. This grade can be interpreted by looking at the SORT Level of Recommendation scale on the previous slide. What is the difference between an A, B, C recommendation? 18. Physiotherapy Evidence DatabasePEDro is the Physiotherapy Evidence Database. PEDro isa free database of over 22,000 randomised trials,systematic reviews and clinical practice guidelines inphysiotherapy. For each trial, review or guideline,PEDro provides the citation details, the abstract and alink to the full text, where possible. All trials onPEDro are independently assessed for quality. Thesequality ratings are used to quickly guide users totrials that are more likely to be valid and to containsufficient information to guide clinical practice. PEDrois produced by the Centre for Evidence-BasedPhysiotherapy at The George Institute for GlobalHealth. 19. This database is important for you not onlybecause it may provide a critically appraisedarticle resource BUT, Because it also offers a way to criticallyappraise research articles specific tophysiotherapyPEDro Rating System 20. Databases Other Databases PubMed (publicly available) Google Scholar Beta (publicly (FREE)available) Cochrane Library (aspects TRIP Searchpublicly available) EMBASE Sage Journals Online ScienceDirect (part of SUMSearchSciVerse Scopus) EBSCOHost PEDro CINAHL Also offers a link to a ERICvariety of other HealthSource:Nursing/Academic Editiondatabases, click HERE MedLine SPORTDiscus Those items highlighted in BLUEare available through the Hofstra Libraries 21. Establishing a solid clinical question (PICO)should help make your literature search moreeffective. Literature Search TutorialThis will give you effective tools on how to use PubMedCochrane Google Scholar 22. Complete this case scenario tutorial to assessyour understanding of the EBP processPractice Case Study PICO & Literature Search Worksheet Example #1*I have adapted a version as well, as a fillable pdfform its attached as a separate document* 23. Patient Oriented Evidence that Matters (POEM) An example POEM Research Summaries Clinical Prediction Rules (CPR) Tutorial How theyre developed Example Critically Appraised Topics (CAT) Critically Appraised Papers (CAP) General Resource National Guideline Clearinghouse Sample Guideline Clinical Evidence 24. Information provided by NATA http://www.nata.org/EvidenceBasedEdu Centre for Evidence Based Medicine http://www.cebm.net/index.aspx?o=1001 Webinar on Literature Searches http://mediasite.ics.uwex.edu/mediasite5/Viewer/?peid=916b24591eb14050b0e66b769fb9d6e81d NATA CEU Online Course (3 CEUs) http://cf.nata.org/quizcenter/courses/evidence/index.html