EBP - Part1

Summary

This course on Evidence-Based Practice (EBP) in athletic training emphasizes six key objectives, including developing answerable clinical questions, identifying literature search strategies, and evaluating evidence quality. It explores the integration of research evidence, clinical expertise, and patient values to enhance clinical decision-making. Key concepts like Hayward's Evidence-Based Information Cycle and the PICO format for question development are introduced. The course highlights the importance of understanding EBP’s role in improving patient outcomes and navigating the growing volume of medical research. It concludes with practical guidance on constructing clinical questions and searching for the best available evidence.

Takeaways

• 😀 Evidence-Based Practice (EBP) is defined as the conscientious use of the best evidence in making healthcare decisions, integrating research, clinical expertise, and patient values.
• 😀 The EBP process involves five key steps: ask, acquire, appraise, apply, and assess. These steps may not always follow a linear progression and can be revisited as needed.
• 😀 Clinical expertise is essential in EBP. It involves using clinical skills and past experiences to make sound decisions while considering the patient's unique circumstances.
• 😀 Incorporating patient values is a core component of EBP. It involves shared decision-making with the patient, not simply doing what they ask but considering their preferences in the decision process.
• 😀 Evidence for clinical decisions can come from multiple sources beyond just research studies, including clinical experience, colleagues, and patient feedback, but it must always be critically appraised.
• 😀 When developing clinical questions, it’s important to focus on foreground questions that are specific and patient-centered, rather than broad background questions.
• 😀 The PICO format (Patient, Intervention, Comparison, Outcome) helps structure clinical questions and ensures that all relevant components are considered.
• 😀 Not every clinical question requires a comparison (C). In cases where no comparison is needed, the PICO format can be reduced to PIO.
• 😀 There are different types of clinical questions: intervention/therapy, diagnosis, prognosis, etiology, and meaning, each requiring different types of evidence to answer effectively.
• 😀 A well-written clinical question provides direction for literature searches, ensuring that the search process is efficient and effective in answering the question.
• 😀 EBP aims to improve patient outcomes, and while there is a wealth of research available, it is the clinician's responsibility to identify, appraise, and apply the best available evidence in their practice.

Q & A

What is evidence-based practice (EBP) in healthcare and athletic training?

Evidence-based practice (EBP) is the conscientious, explicit, and judicious use of the best available evidence, combined with clinical expertise and the patient's unique values and circumstances, to make decisions about patient care. It involves a process of lifelong self-directed learning aimed at improving patient outcomes.

How is evidence-based practice different from a cookbook approach to healthcare?

EBP is not a cookbook approach, meaning it is not a set formula that applies the same treatment to every case. Instead, it is a fluid and adaptable process that must be continuously altered depending on the specific circumstances of the clinician and the patient's needs.

What are the five steps in Hayward's evidence-based information cycle?

The five steps in Hayward's evidence-based information cycle are: Ask, Acquire, Appraise, Apply, and Assess. These phases are interconnected and can be revisited based on new evidence or changing circumstances.

Why is patient values and clinical expertise important in evidence-based practice?

Patient values and clinical expertise are key components of EBP because they help tailor decisions to the individual needs and preferences of the patient, ensuring that care is personalized and effective. Clinical expertise is gained through experience, and patient values are integral to shared decision-making.

What is the purpose of developing an answerable clinical question in the EBP process?

Developing an answerable clinical question is critical because it provides a focused direction for searching for evidence. A well-constructed question ensures that the evidence found is relevant and helps prevent being overwhelmed by too much or too little information.

What are the two types of clinical questions, and how do they differ?

The two types of clinical questions are background and foreground questions. Background questions are broader and seek general knowledge, such as understanding treatment options for a condition. Foreground questions are more specific and help determine the best clinical decisions for a particular patient.

What is the Pico format and how does it help in developing clinical questions?

The Pico format is a tool that helps break down clinical questions into key components: P (patient/population), I (intervention), C (comparison), O (outcome), and T (time). It helps ensure all necessary information is included and aids in identifying appropriate terms for evidence searching.

Can you give an example of how to apply the Pico format?

For example, in a case of a 12-year-old female with anterior knee pain, the Pico format could break down the question like this: P = adolescent with anterior knee pain, I = taping, C = bracing, O = reduction in pain and improvement in function, T = within 2 weeks. The clinical question would be: 'In adolescents with anterior knee pain, is taping or bracing more effective at reducing pain and improving function within 2 weeks?'

Why is it important to identify the type of clinical question you are constructing?

Identifying the type of clinical question helps determine the best kind of evidence to search for. There are five main types of questions: intervention, diagnosis, prognosis, etiology, and meaning. Each type of question requires a different approach to evidence.

What are the five primary types of clinical questions?

The five primary types of clinical questions are: 1) Intervention or therapy questions, which seek the best treatment or intervention. 2) Etiology questions, which focus on identifying the cause of a condition. 3) Diagnosis questions, which determine the most accurate diagnostic tests. 4) Prognosis questions, which predict the course of a condition. 5) Meaning questions, which explore the experience and perspective of the patient.