1. Introduction to the Basics
November 9, 2012

2. 1. Define EBM/EBP
2. History of EBM in AT
3. The Process
4. EBP Web-based Resources

3.  Using evidence to  The specific way you
support your clinical make decisions
practice regarding the
 “integration of the best evaluation, diagnosis,
research evidence with and treatment of your
clinical expertise and patient
patient values to make  Total integration of
clinical decisions” EBM into clinical
practice
Evidence-Based Medicine Evidence-Based Practice
(EBM) (EBP)
Jutte, LS & Walker, SE (2009). Incorporating and Teaching Evidence-Based Practice, from The Athletic Trainer's 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 Patient
Expertise 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 Educator's 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 early
2000s
 Now a mandated component of AT Education
and AT clinical practice
◦ 5th edition of AT Education Competencies
◦ Updates in BOC CEU requirements for current
professionals

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 sessions
Maher CG, Sherrington C, Elkins M, Herbert RD, & Moseley AM (July 2004).
Challenges for Evidence-Based Physical Therapy: Assessing and Interpreting
High-Quality Evidence on Therapy. Physical Therapy, 84(7): p. 645 - 654.

8. 1. Asking appropriate clinical questions
2. Acquiring medical evidence
3. Critically appraising available evidence
4. Applying evidence in context of clinical
expertise and patient values
5. Evaluating (assessing) effectiveness of
intervention

9. P: Patient or Problem
I: Intervention
C: Comparison
O: 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 as
an additional file):
PICO Worksheet
Following the completion of this activity, what questions do
you 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 of
research and how to recognize it, complete
this tutorial:
Research Design
What questions do you still have now that you
have completed this tutorial?

15.  To further explain the difference between
filtered and unfiltered information and where
to find it….. (take a look!)
Types of Information Tutorial
Understanding information and the search
process
Flow chart

16.  Now that you’re 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 in
a triangle?
Levels of Evidence
(Grade of Recommendation)

17. CEBM have since updated this
information slightly as of 2009
and is working to do so again.

19. 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?

20. Physiotherapy Evidence Database
PEDro is the Physiotherapy Evidence Database. PEDro is
a free database of over 22,000 randomised trials,
systematic reviews and clinical practice guidelines in
physiotherapy. For each trial, review or guideline,
PEDro provides the citation details, the abstract and a
link to the full text, where possible. All trials on
PEDro are independently assessed for quality. These
quality ratings are used to quickly guide users to
trials that are more likely to be valid and to contain
sufficient information to guide clinical practice. PEDro
is produced by the Centre for Evidence-Based
Physiotherapy at The George Institute for Global
Health.

21.  This database is important for you not only
because it may provide a critically appraised
article resource BUT,
 Because it also offers a way to critically
appraise research articles specific to
physiotherapy
PEDro Rating System

22.  Databases  Other Databases
◦ PubMed (publicly available)
◦ Google Scholar Beta (publicly (FREE)
available)
◦ Cochrane Library (aspects ◦ TRIP Search
publicly available) ◦ EMBASE
◦ Sage Journals Online
◦ ScienceDirect (part of ◦ SUMSearch
SciVerse… Scopus)
◦ EBSCOHost
◦ PEDro
 CINAHL  Also offers a link to a
 ERIC variety of other
 HealthSource:
Nursing/Academic Edition databases, click HERE
 MedLine
 SPORTDiscus
Those items highlighted in BLUE
are available through the
Hofstra Libraries

23.  Establishing a solid clinical question (PICO)
should help make your literature search more
effective.
Literature Search Tutorial
This will give you effective tools on how to use
PubMed
Cochrane
Google Scholar

24.  Complete this case scenario tutorial to assess
your understanding of the EBP process
Practice Case Study
PICO & Literature Search Worksheet
Example #1
*I have adapted a version as well, as a fillable pdf
form it’s attached as a separate document*

25.  Patient Oriented Evidence that Matters (POEM)
◦ An example
◦ POEM Research Summaries
 Clinical Prediction Rules (CPR)
◦ Tutorial
◦ How they’re developed
◦ Example
 Critically Appraised Topics (CAT)
 Critically Appraised Papers (CAP)
 General Resource
◦ National Guideline Clearinghouse
 Sample Guideline
◦ Clinical Evidence

26.  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.h
tml