Evidence Based Practice(EBP) in Physiotherapy: Difference between revisions
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Anecdote and word of mouth have lost credibility and are replaced by scientific scrutiny and the rigour of evidence from carefully controlled and sufficiently powerful trials. The evidence-based practice (EBP) movement has gained ground steadily in physiotherapy over the past decade.Influential researchers and clinicians have argued that physiotherapists have a moral and professional obligation to move away from assessment and treatment methods based on anecdotal testimonies or opinion. <ref name="karen">Karen Grimmer-Somers;Editorial — Incorporating research evidence into clinical practice decisions; Physiotherapy Research International;Volume 12, Issue 2, pages 55–58, June 2007</ref> | Anecdote and word of mouth have lost credibility and are replaced by scientific scrutiny and the rigour of evidence from carefully controlled and sufficiently powerful trials. The evidence-based practice (EBP) movement has gained ground steadily in physiotherapy over the past decade.Influential researchers and clinicians have argued that physiotherapists have a moral and professional obligation to move away from assessment and treatment methods based on anecdotal testimonies or opinion. <ref name="karen">Karen Grimmer-Somers;Editorial — Incorporating research evidence into clinical practice decisions; Physiotherapy Research International;Volume 12, Issue 2, pages 55–58, June 2007</ref> | ||
== Paradigmal Shift == | == Paradigmal Shift == | ||
The EBP or the scientific research has brought quite a few paradigmal shifts in the field of physiotherapy and its practice. Some of them to mention includes | The EBP or the scientific research has brought quite a few paradigmal shifts in the field of physiotherapy and its practice. Some of them to mention includes: | ||
#'''Strengthening Exercise in Cerebral palsy :''' A widely used physical therapy intervention for children with cerebral palsy (CP) has been based on the Bobath neurodevelopmental treatment (NDT) approach.This approach focused on consideration of abnormal tone and postures during treatment '''and interventions were not based on scientific research'''. The use of strengthening exercises was strongly discouraged by proponents of the approach because they believed that excessive effort would increase co-contraction, spasticity, and associated reactions. The rationale for the NDT approach was based on a reflex-based or hierarchical view of motor control. It was felt that the patient's primary problem in producing a voluntary movement was antagonist restraint, not agonist muscle weakness. Emphasis was placed on interventions to prevent abnormal postures and excessive muscle co-contraction. Clinicians following this treatment approach avoided exercises with maximum efforts in people with the spastic form of CP.<ref name="fowler">Fowler EG1, Ho TW, Nwigwe AI, Dorey FJ ;The effect of quadriceps femoris muscle strengthening exercises on spasticity in children with cerebral palsy ;Phys Ther. 2001 Jun;81(6):1215-23.</ref> | #'''Strengthening Exercise in Cerebral palsy :''' A widely used physical therapy intervention for children with cerebral palsy (CP) has been based on the Bobath neurodevelopmental treatment (NDT) approach.This approach focused on consideration of abnormal tone and postures during treatment '''and interventions were not based on scientific research'''. The use of strengthening exercises was strongly discouraged by proponents of the approach because they believed that excessive effort would increase co-contraction, spasticity, and associated reactions. The rationale for the NDT approach was based on a reflex-based or hierarchical view of motor control. It was felt that the patient's primary problem in producing a voluntary movement was antagonist restraint, not agonist muscle weakness. Emphasis was placed on interventions to prevent abnormal postures and excessive muscle co-contraction. Clinicians following this treatment approach avoided exercises with maximum efforts in people with the spastic form of CP.<ref name="fowler">Fowler EG1, Ho TW, Nwigwe AI, Dorey FJ ;The effect of quadriceps femoris muscle strengthening exercises on spasticity in children with cerebral palsy ;Phys Ther. 2001 Jun;81(6):1215-23.</ref> | ||
<u>'''Shift :'''</u> Investigators have demonstrated the benefits of strengthening exercises in individuals with CP. Improvements in muscle performance have been demonstrated for people with CP using isometric exercise,isotonic exercise,isokinetic exercise and a combination of isotonic exercise and weight machines.The finding refutes the premise that the performance of exercises with maximum efforts will result in a large, or detrimental, increase in spasticity. Damiano et al <ref name="damiano">Diane L Damiano, Luke E Kelly and Christopher L Vaughn;Effects of Quadriceps Femoris Muscle Strengthening on Crouch Gait in Children With Spastic Diplegia; Physical Therapy August 1995 vol. 75 no. 8 658-667</ref> suggests resistance exercise is an effective treatment strategy and as such should be considered as one component in the habilitation of children with cerebral palsy. | |||
2. '''Bed rest for Back ache : ''' | |||
== Barriers == | == Barriers == | ||
Revision as of 16:51, 16 November 2014
Original Editor - Sheik Abdul Khadir
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Introduction [edit | edit source]
Evidence based practice (EBP) is 'the integration of best research evidence with clinical expertise and patient values.[1] Evidence Based Practice (EBP) describes about the steps involved and the problems with EBP. Physical therapy being the widely recognised health care profession has to upgrade its method of practice to remain alive in the era of scientific research.As the number of physiotherapy trials and systematic reviews increase, we could hope that we are developing a robust evidence base to inform patient care.[2]
Anecdote to Evidence[edit | edit source]
Anecdote and word of mouth have lost credibility and are replaced by scientific scrutiny and the rigour of evidence from carefully controlled and sufficiently powerful trials. The evidence-based practice (EBP) movement has gained ground steadily in physiotherapy over the past decade.Influential researchers and clinicians have argued that physiotherapists have a moral and professional obligation to move away from assessment and treatment methods based on anecdotal testimonies or opinion. [3]
Paradigmal Shift[edit | edit source]
The EBP or the scientific research has brought quite a few paradigmal shifts in the field of physiotherapy and its practice. Some of them to mention includes:
- Strengthening Exercise in Cerebral palsy : A widely used physical therapy intervention for children with cerebral palsy (CP) has been based on the Bobath neurodevelopmental treatment (NDT) approach.This approach focused on consideration of abnormal tone and postures during treatment and interventions were not based on scientific research. The use of strengthening exercises was strongly discouraged by proponents of the approach because they believed that excessive effort would increase co-contraction, spasticity, and associated reactions. The rationale for the NDT approach was based on a reflex-based or hierarchical view of motor control. It was felt that the patient's primary problem in producing a voluntary movement was antagonist restraint, not agonist muscle weakness. Emphasis was placed on interventions to prevent abnormal postures and excessive muscle co-contraction. Clinicians following this treatment approach avoided exercises with maximum efforts in people with the spastic form of CP.[4]
Shift : Investigators have demonstrated the benefits of strengthening exercises in individuals with CP. Improvements in muscle performance have been demonstrated for people with CP using isometric exercise,isotonic exercise,isokinetic exercise and a combination of isotonic exercise and weight machines.The finding refutes the premise that the performance of exercises with maximum efforts will result in a large, or detrimental, increase in spasticity. Damiano et al [5] suggests resistance exercise is an effective treatment strategy and as such should be considered as one component in the habilitation of children with cerebral palsy.
2. Bed rest for Back ache :
Barriers[edit | edit source]
A recent systematic review analysed What do physical therapists think about evidence-based practice? [6] and concluded that the barriers most frequently reported were: lack of time, inability to understand statistics, lack of support from employer, lack of resources, lack of interest and lack of generalisation of results. Although the majority of physiotherapists have a positive opinion about EBP, they consider that they need to improve their knowledge, skills and behaviour towards EBP. They also faced barriers that might hinder the implementation of EBP.
References[edit | edit source]
- ↑ Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2
- ↑ Alison Rushton,Mel Calvert,ChrisWright, Nick Freemantle;fckLRPhysiotherapy trials for the 21st century – time to raise the bar?; J R Soc Med 2011: 104: 437–441. DOI 10.1258/jrsm.2011.110109
- ↑ Karen Grimmer-Somers;Editorial — Incorporating research evidence into clinical practice decisions; Physiotherapy Research International;Volume 12, Issue 2, pages 55–58, June 2007
- ↑ Fowler EG1, Ho TW, Nwigwe AI, Dorey FJ ;The effect of quadriceps femoris muscle strengthening exercises on spasticity in children with cerebral palsy ;Phys Ther. 2001 Jun;81(6):1215-23.
- ↑ Diane L Damiano, Luke E Kelly and Christopher L Vaughn;Effects of Quadriceps Femoris Muscle Strengthening on Crouch Gait in Children With Spastic Diplegia; Physical Therapy August 1995 vol. 75 no. 8 658-667
- ↑ Tatiane Mota da Silva, Lucíola da Cunha Menezes Costa, Alessandra Narciso Garcia, Leonardo Oliveira Pena Costa, What do physical therapists think about evidence-based practice? A systematic review, Manual Therapy, Available online 24 October 2014, ISSN 1356-689X, http://dx.doi.org/10.1016/j.math.2014.10.009.fckLR(http://www.sciencedirect.com/science/article/pii/S1356689X1400191X)
