Understanding 'Levels of Evidence' - What are Levels of Evidence?

Summary

This tutorial outlines the importance of understanding levels of evidence in physiotherapy practice, emphasizing the Pyramid of Evidence for identifying the best research studies. It highlights the hierarchy, starting from lab and animal studies to randomized control trials (RCTs), systematic reviews, and meta-analyses at the top. The video explains how higher levels of evidence, such as RCTs and systematic reviews, contribute to evidence-informed practice, guiding clinical decisions. It also introduces the concept of practice guidelines, which synthesize literature to recommend best practices, sometimes incorporating expert opinions and consensus. The tutorial aims to equip viewers with the skills to navigate the physiotherapy evidence database, PEDro, for effective clinical decision-making.

Takeaways

• 📚 The tutorial focuses on understanding levels of evidence based on research study design for evidence-informed practice in physiotherapy.
• 🔍 Evidence-informed practice combines the best available evidence, clinical expertise, and patient values to guide clinical decision-making.
• 📈 The Pyramid of Evidence illustrates the hierarchy of research study designs, with higher levels indicating more rigorous research and stronger evidence.
• 🧪 At the base of the pyramid are preliminary studies like lab investigations and animal studies, while the top includes more rigorous designs like RCTs and systematic reviews.
• 🧐 The higher the level of evidence, the more confidence one can have in applying the findings to clinical practice.
• 🤔 Not every topic will have the highest level of evidence available, especially for rare conditions or new therapies.
• 🔬 Randomized Control Trials (RCTs) are considered high-level evidence due to the random allocation of similar participants to intervention and control groups.
• 📝 Systematic reviews and meta-analyses save clinicians time by summarizing and combining the results of multiple studies, providing a comprehensive overview.
• 📊 A meta-analysis statistically combines results from studies using the same outcome measures, while a systematic review may include different measures.
• 📋 Practice guidelines are developed to assist in healthcare decisions, summarizing literature to guide best practices, and may include expert opinions and consensus.
• 🔍 The next tutorial will demonstrate how to use the Physiotherapy Evidence Database (PEDro) to find the highest levels of evidence.

Q & A

What is the main purpose of the tutorial?

The main purpose of the tutorial is to explain the levels of evidence based on research study design, helping viewers find the best evidence for their practice.

Why is it important to learn about levels of evidence in healthcare practice?

It is important to learn about levels of evidence because it ties into evidence-informed practice, aiding in the search for information and applying the best available evidence, clinical expertise, and patient values and expectations to clinical decision-making.

What does 'evidence-informed practice' mean in the context of this tutorial?

Evidence-informed practice refers to the application of the best available evidence, combined with clinical expertise and patient values and expectations, to make clinical decisions.

What does the Pyramid of Evidence represent?

The Pyramid of Evidence represents different levels of research study designs, with the most rigorous and highest level of evidence at the top and less rigorous designs at the bottom.

What types of studies are considered to be at the bottom of the Pyramid of Evidence?

At the bottom of the Pyramid of Evidence are lab investigations with test tubes or animal studies, which are considered to have a lower level of evidence.

What is a Randomized Control Trial (RCT) and why is it considered a high level of evidence?

A Randomized Control Trial (RCT) is a study where participants are randomly allocated to either a group that receives a standardized intervention or a control group that receives usual care or a placebo. It is considered a high level of evidence due to its ability to control for confounding variables and provide strong evidence for cause-and-effect relationships.

What is the difference between a systematic review and a meta-analysis?

A systematic review methodically searches, assesses, and summarizes studies according to predetermined criteria, often including RCTs. A meta-analysis, on the other hand, statistically combines the results of several studies that address a set of related research hypotheses, using the same outcome measures.

Why are systematic reviews and meta-analyses considered timesavers for clinicians?

Systematic reviews and meta-analyses are considered timesavers because they combine the results of multiple studies, saving clinicians the effort of reading numerous individual articles to answer a clinical question.

What is a practice guideline and how does it help in evidence-informed practice?

A practice guideline is a systematically developed statement that helps practitioners and patients make decisions about appropriate healthcare. It summarizes literature to guide best practice and may include opinions and consensus processes, making it a valuable resource for evidence-informed practice.

What is the physiotherapy evidence database mentioned in the tutorial, and what is its purpose?

The physiotherapy evidence database, also known as PEDro, is a resource developed for members of the physiotherapy associations. Its purpose is to help users find the highest levels of evidence to inform their clinical practice.

How can viewers find more information or tutorials like this one?

Viewers can find more information and tutorials through the organization's YouTube channel and website, as mentioned at the end of the tutorial.

Outlines

00:00

📚 Understanding Evidence-Based Practice

This paragraph introduces the concept of evidence-based practice in physiotherapy, emphasizing the importance of using the best available evidence to inform clinical decisions. It explains the Pyramid of Evidence, which categorizes research study designs by their level of rigor, from lab investigations and animal studies at the bottom to systematic reviews and meta-analyses at the top. The paragraph highlights the significance of distinguishing higher levels of evidence for more reliable clinical guidance and mentions that while the highest level of evidence may not always be available, especially for rare conditions or new therapies, the goal is to find the most rigorous research possible to support healthcare practices.

05:02

🔍 Navigating the Physiotherapy Evidence Database (PEDro)

The second paragraph serves as a transition, summarizing the importance of understanding levels of evidence for evidence-informed practice. It then teases the next tutorial, which will guide viewers on how to use the Physiotherapy Evidence Database (PEDro) to find the highest levels of evidence. The paragraph concludes with an invitation for viewers to explore additional tutorials available through the provided YouTube channel and website, encouraging further learning and engagement with the content.

Keywords

💡Evidence-based practice

Evidence-based practice is a clinical approach that integrates the best available evidence, clinical expertise, and patient values to make clinical decisions. It is central to the video's theme as it emphasizes the importance of using research evidence to inform healthcare practices. The script mentions that higher levels of evidence provide more confidence in clinical decision-making, highlighting the significance of evidence-based practice in the healthcare field.

💡Levels of evidence

Levels of evidence refer to the hierarchy of research designs based on their scientific rigor and reliability. In the video, the concept is crucial as it helps to distinguish between studies with varying degrees of reliability. The script explains that higher levels of evidence, such as systematic reviews and randomized controlled trials, are more reliable for guiding clinical decisions.

💡Randomized controlled trials (RCTs)

Randomized controlled trials are a type of scientific experiment that randomly assigns participants to either a treatment or control group to determine the effectiveness of an intervention. The video script highlights RCTs as a high level of evidence due to their ability to control for confounding variables and provide strong evidence for clinical effectiveness.

💡Systematic reviews

A systematic review is a comprehensive and methodical analysis of multiple studies on a specific topic, following a predefined protocol. The video script describes systematic reviews as a high level of evidence that saves clinicians time by synthesizing the results of multiple RCTs, providing a more robust conclusion than individual studies.

💡Meta-analysis

A meta-analysis is a statistical technique used to combine the results of multiple studies that address a common research question, often used in systematic reviews. The video script explains that a meta-analysis is distinct from a systematic review in that it statistically combines results from studies using the same outcome measures, enhancing the precision of the conclusions.

💡Practice guidelines

Practice guidelines are systematically developed statements intended to guide decisions about appropriate health care for specific clinical circumstances. The video script mentions that these guidelines summarize literature to guide best practices and may include expert opinions and consensus processes, making them an essential tool for evidence-informed practice.

💡Pyramid of evidence

The Pyramid of evidence is a visual representation that organizes different types of research studies by their level of evidence, from the least rigorous at the bottom to the most rigorous at the top. The video script uses the pyramid to illustrate the hierarchy of evidence and guide viewers on where to look for the best evidence when conducting research.

💡Clinical expertise

Clinical expertise refers to the professional knowledge, skills, and experience that a healthcare provider possesses. In the video, it is one of the three components, along with the best available evidence and patient values, that are combined for evidence-informed practice, emphasizing the importance of a clinician's judgment in addition to research evidence.

💡Patient values and expectations

Patient values and expectations are the personal beliefs, preferences, and desired outcomes that a patient has regarding their healthcare. The video script includes these as a critical component of evidence-informed practice, indicating that patient-centered care is essential and should be considered alongside clinical evidence and expertise.

💡Physiotherapy

Physiotherapy is a healthcare profession that focuses on the assessment, diagnosis, and treatment of movement disorders. The video script is developed for members of physiotherapy associations, indicating that the concepts discussed are particularly relevant to the practice of physiotherapy and the application of evidence-based practice within this field.

💡Pedro

PEDro is a database that indexes evidence-based physical therapy trials and provides a methodological quality rating for each trial. The video script mentions Pedro as a resource that will be demonstrated in a subsequent tutorial for finding high levels of evidence, showing its utility for physiotherapists seeking to implement evidence-informed practice.

Highlights

The tutorial explains levels of evidence based on research study design to find the best evidence for physiotherapy practice.

Evidence-informed practice combines the best available evidence, clinical expertise, and patient values for clinical decision making.

Higher levels of evidence provide more confidence in using literature to guide clinical decisions.

The Pyramid of Evidence illustrates different levels of evidence based on research study design, from lab investigations to systematic reviews and meta-analyses.

Higher levels of research evidence are generally more rigorous and provide greater confidence for clinical practice.

Not all topics may have the highest level of evidence available, especially for rare conditions or new therapies.

Randomized control trials (RCTs) are considered a high level of evidence, with participants randomly allocated to intervention or control groups.

The quality of an RCT can be assessed using various appraisal tools to determine its validity.

Systematic reviews and meta-analyses save clinicians time by combining results from multiple studies to answer clinical questions.

A systematic review methodically searches, assesses, and summarizes studies according to predetermined criteria, often focusing on RCTs.

A meta-analysis statistically combines results from multiple studies that use the same outcome measures.

Practice guidelines are systematically developed statements that help practitioners and patients make informed healthcare decisions.

Practice guidelines may summarize literature to guide best practice, but the methodology used can vary.

The tutorial will demonstrate how to use the Physiotherapy Evidence Database (PEDro) to find the highest levels of evidence.

The next tutorial will provide practical steps for using PEDro to enhance evidence-informed physiotherapy practice.

The tutorial emphasizes the importance of understanding levels of evidence to improve clinical decision making in physiotherapy.

Transcripts

this tutorial will explain levels of

evidence based on research study design

so that you can find the best evidence

for your practice using a database it

was developed by the physiotherapy

Association of British Columbia for pabc

members and for members of the Ontario

physiotherapy

Association you may be wondering why it

is important to learn about levels of

evidence it is important because of how

it ties into evidence in form practice

and how it can Aid in your search for

information evidence informed practice

aims to apply the combination of one the

best available evidence two your

clinical expertise and three the patient

values and expectations to clinical

decision making generally the higher the

level of evidence the more comfortable

you will be in using the evidence in the

literature to guide your clinical

decision- making so distinguishing

higher levels of evidence from lower

levels is an important skill in

providing evidence in formed

practice this image shows the Pyramid of

evidence based on the research study

design when we are looking for the best

evidence available we can consider what

types of studies have been

published at the bottom of the pyramid

research may involve investigations in

the lab with test tube or animal studies

based on the amount of research that

already exists and the specific

questions that researchers are trying to

answer there are other types of study

designs these may include ideas and

opinions randomized control trials

systematic reviews and meta analyses at

the top of the pyramid generally the

higher up on the pyramid the more rigor

there is involved in the research and

thus the greater the level of

evidence however the highest level of

evidence will not be available for every

topic you're searching typically for a

rare condition a very new therapy or a

type of treatment which ethically can't

be randomized a case study found Midway

up the pyramid may be the highest level

of evidence available to you for many

diseases conditions and Therapies in

healthcare higher levels of research

evidence are available this may include

rcts systematic reviews metaanalyses and

practice guidelines when this research

has been published you can start your

research by looking at the top of the

pyramid

first let's review the different types

of research studies the randomized

control trial or RCT is a very high

level of evidence it is distinguished

from other types of studies because

participants who are very similar at

Baseline are allocated randomly to one

of two groups while one group receives

the standardized intervention the other

group the control group doesn't receive

the standardized intervention instead

they receive usual care or a placebo

intervention

instead

as we will see in part two of this

tutorial the quality of an RCT may be

determined by one of many different

appraisal tools a wonderful timesaver

for clinicians is to try and find a

systematic review or a metaanalyses

first as we will see these studies save

you from Reading 20 different rcts to

answer your clinical question because

they systematically and rigorously

combine the results of a collection of

previous articles published on the

topic another research study with a high

level of evidence is a systematic review

a systematic review methodically

searches for assesses and summarizes

studies according to predetermined

criteria most often these studies are

rcts however systematic reviews can also

include a metaanalysis a metaanalysis

combines the results of several studies

that address a set of related research

hypotheses the difference between a

systematic review and a meta analysis is

that a systematic review combines the

results of a group of previously

published articles that use different

outcome measures while a metaanalysis

combines statistically the results of a

group of previously published articles

that use the same outcome

measures a practice guideline is a

systematically developed statement that

helps practitioners and patients with

decisions about appropriate Healthcare

such as how to treat fibromyalgia it may

be multidisiplinary in nature such as

osteoporosis guidelines for MDS which

might include exercise guidelines

relevant to

physiotherapists most importantly a

practice guideline summarizes literature

in order to guide best practice it may

or may not have used a rigorous

methodology such as a systematic review

to determine the

recommendations in addition it includes

opinions and usually consensus

process in this tutorial we have

reviewed levels of evidence and how this

can help your evidence inform form

practice the next tutorial will

demonstrate how to use the physiotherapy

evidence database otherwise known as

Pedro to find the highest levels of

evidence thanks for watching please

check our other tutorials available

through our YouTube channel and website