Evaluate the outcome
- Evidence Based Practice (EBP)
- Step1: Formulate an answerable question
- Step 2: Find the best available evidence
- Step 3: Appraise the evidence
- Step 4: Implement the evidence
- Step 5: Evaluate the outcome
Arguably this is the most important step of the EBP process. Therapists should reflect subjectively on their ability to proceed through the first 4 steps of EBP, but should also assess patient outcomes objectively and formally in the context of best available evidence.
Straus et al have developed a series of questions to facilitate introspective self-evaluation for the evidence-based practitioner:
Self-evaluation in asking answerable questions
- Am I asking any clinical questions at all?
- Am I asking well-formulated questions about background knowledge and foreground diagnosis/management?
- Am I using a 'map' to locate my knowledge gaps and articulate questions?
- Can I get myself 'unstuck' when asking questions?
- Do I have a working method to save my questions for later answering?
A self-evaluation in finding the best external evidence
- Am I searching at all?
- Do I know the best sources of current evidence for my clinical discipline?
- Have I achieved immediate access to searching hardware, software, and the best evidence for my clinical discipline?
- Am I finding useful external evidence from a widening array of sources?
- Am I becoming more efficient in my searching?
- Am I using truncations, Booleans, MeSH headings, thesaurus, limiters, and intelligent free text when searching MEDLINE?
- How do my searches compare with those of research librarians or other respected colleagues who have a passion for providing best current patient care?
A self-evaluation in critically appraising the evidence for its validity and potential usefulness
- Am I critically appraising external evidence at all?
- Are the critical appraisal guides becoming easier for me to apply?
- Am I becoming more accurate and efficient in applying some of the critical appraisal measures (such as likelihood ratios, NNTs, and the like)?
- Am I creating any appraisal summaries?
A self-evaluation in integrating the critical appraisal with clinical expertise and applying the result in clinical practice
- Am I integrating my critical appraisals into my practice at all?
- Am I becoming more accurate and efficient in adjusting some of the critical appraisal measures to fit my individual patients (pretest probabilities, NNT/f, etc.)?
- Can I explain (and resolve) disagreements about management decisions in terms of this integration?
A self-evaluation of changing practice behaviour
- When new evidence suggests a change in practice, am I identifying barriers to this change?
- Have I carried out any check, such as audits of my diagnostic, therapeutic, or other EBM performance?
Clinical measurement instruments
Today there are many established clinical measurements and tools to quantify a patients’ status and ability and often according to structure and function, activity and participation in line with the International Classification of Functioning, Disability and Health
Assessment of patient outcomes can be objectively and formally measured using outcome measures. Physiotherapists should use reliable and valid outcome measures for every patient they see in clinical practice to ascertain if true and clinically meaningful changes in patient status occurred.
The data obtained through the use of valid and reliable outcomes tools, along with the self-evaluation of effectiveness and efficiency with the 4 steps, will enhance clinical practice.
Keep track of practice outcomes
Keep a record of your practice outcomes can easily be achieved by keeping a professional development portfolio. It is good practice to reflect on your EBP activities and record them in your professional development portfolio.
- Straus SE, Richardson WS, Glasziou P, Haynes RB. Evidence-Based Medicine: How to Practice and Teach EBM. 3rd ed. Edinburgh, UK: ChurchillfckLRLivingstone; 2005