Application of evidence (FS-10)

STRATEGIES TO IMPROVE THE APPLICATION OF EVIDENCE TO INDIVIDUAL PATIENTS

Elkins M¹, van der Wees P², Costa L³, Craik R⁴, Lamb S⁵¹University of Sydney, Sydney Medical School, Sydney, Australia, ²Radboud University Medical Center, IQ Healthcare, Nijmegen, Netherlands, ³Universidade Cidade de São Paulo, São Paulo, Brazil, ⁴Arcadia University, Glenside, United States, ⁵University of Oxford, Oxford, United Kingdom Learning objectives: 1. Understand the value of using high-quality clinical research to guide management of individual patients 2. Identify key challenges and solutions to evidence-based practice 3. Develop skills to address challenges to evidence-based practice Description: Learning objective 1: Understand the value of using high-quality clinical research to guide management of individual patients
Learning objective 2: Identify key challenges and solutions to evidence-based practice
Learning objective 3: Develop skills to address challenges to evidence-based practice
Description: Evidence-based practice is physical therapy informed by relevant, high-quality clinical research (1), which involves asking clinical questions, acquiring evidence, appraising the evidence, applying the evidence to clinical practice, and assessing effectiveness (2). While evidence-based practice is encouraged in physical therapy (3), physical therapists often experience challenges that can impede the use of evidence to guide clinical decision-making. These challenges include: navigating the large volume of published research; applying research on groups to individual patients; recognising when reporting of published evidence is misleading; developing skills in interpreting effect size and confidence intervals; and dealing with incomplete descriptions of the intervention (4). This symposium aims to develop participants' knowledge and skills in overcoming these challenges, thereby facilitating evidence-based practice. Specifically, the symposium will introduce a range of solutions to each of these challenges:
Strategies to assist in making sense of the large number of trials being published will include: use guidelines and systematic reviews instead of individual trials; follow living systematic reviews as these come online (5); make use of free services that efficiently direct you to high-quality evidence; and make use of free services that pre-appraise study quality.
Strategies to ensure that accurate results are received by clinicians and consumers will include: techniques to identify 'spin' in published research; what to look for beyond the abstract; directing consumers to plain-language summaries of high-quality evidence; get involved in post-publication peer review.
Strategies to maximise the use of 95% confidence intervals will include: understanding that confidence intervals provide more useful information than p-values; understanding the limitations in the methods used to estimate the smallest worthwhile effect (SWE) of an intervention; how to discern a patient's individual SWE, which may differ from the one used in the published research report; how to easily calculate a confidence interval from the data in the paper; and consider what the new study adds to the existing pool of evidence (6).
Strategies to assist in accessing complete descriptions of interventions will include: prefer journals that enforce use of reporting checklists; access the published protocol; and access electronic appendices.
Implications / Conclusions: Developing skills in recognising challenges inherent in evidence-based practice and learning how to apply solutions will improve physical therapists' ability to use high-quality clinical research to guide their management of individual patients. Implications/conclusions: Developing skills in recognising challenges inherent in evidence-based practice and learning how to apply solutions will improve physical therapists' ability to use high-quality clinical research to guide their management of individual patients. Key-words: 1. evidence-based practice 2. clinical research 3. Funding acknowledgements: Nil