Evidence Based Practice (EBP)

Evidence Based Practice

the integration of best research evidence with clinical expertise and patient values.

The basic concept of evidence-based practice is the making of clinical decisions based on the integration of clinical expertise acquired through formal education and experience accumulated from daily practice; with the patients' own personal and unique concerns, expectations, and values; and the most clinically relevant and methodoligically sound research. This integration defines a clinical decision and therefore practice as evidence-based.

The 5 Steps

1. Formulate an answerable question

One of the fundamental skills required for EBP is the asking of well-built clinical questions. By formulating an answerable question you to focus your efforts specifically on what matters. These questions are usually triggered by patient encounters which generate questions about the diagnosis, therapy, prognosis or aetiology.

2. Find the best available evidence

The second step is to find the relevant evidence. This step involves identifying search terms which will be found in your carefully constructed question from step one; selecting resources in which to perform your search such as PubMed and Cochrane Library; and formulating an effective search strategy using a combination of MESH terms and limitations of the results.

3. Appraise the evidence

It is important to be skilled in critical appraisal so that you can further filter out studies that may seem interesting but are weak. Use a simple critical appraisal method that will answer these questions: What question did the study address? Were the methods valid? What are the results? How do the results apply to your practice?

4. Implement the evidence

Individual clinical decisions can then be made by combining the best available evidence with the your clinical expertise and your patients values. These clinical decisions should then be implemented into your clinical pra into your practice which can then be justified as evidence based.

5. Evaluate the outcome

The final step in the process is to evaluate the effectiveness and efficacy of your decision in direct relation to your patient. Was the application of the new information effective? Should this new information continue to be applied to practice? How could any of the 5 processes involved in the clinical decision making process be improved the next time a question is asked?

Resources

Cleland JA, Noteboom JT, Whitman JM, Allison SC (2008) A primer on selected aspects of evidence-based practice relating to questions of treatment, part 1: asking questions, finding evidence, and determining validity, J Orthop Sports Phys Ther. 2008 Aug;38(8):476-84

Noteboom JT, Allison SC, Cleland JA, Whitman JM (2008) A primer on selected aspects of evidence-based practice to questions of treatment, part 2: interpreting results, application to clinical practice, and self-evaluation, J Orthop Sports Phys Ther. 2008 Aug;38(8):485-501