Physical Therapy

WHAT IS EVIDENCE BASED PRACTICE?

The most common definition of EBP is taken from Dr. David Sackett, a pioneer in evidence-based practice. EBP is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematicresearch." (Sackett D, 1996)

EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician's cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002) 

A meta-analysis and a systematic review are both methods used to synthesize research findings, but they differ in their scope and methodology.

1. Systematic Review:

   • Purpose: A systematic review aims to comprehensively collect, evaluate, and synthesize all relevant studies on a specific research question or topic.
   • Process: It follows a structured and predefined protocol that includes a thorough search of the literature, selection of studies based on strict criteria, assessment of the quality of included studies, and a qualitative or quantitative synthesis of the findings.
   • Outcome: The result is a detailed, unbiased summary of the evidence on the topic, often highlighting gaps in research and providing recommendations for practice or further study.

2. Meta-Analysis:

   • Purpose: A meta-analysis is a subset of a systematic review that quantitatively combines the results of multiple studies to arrive at a single conclusion about the effect of a treatment or intervention.
   • Process: After identifying and selecting studies through a systematic review, a meta-analysis statistically aggregates the data from these studies, typically using effect sizes, to produce an overall estimate of the effect.
   • Outcome: The result is a more precise estimate of the effect size or association, often presented in the form of a pooled average with confidence intervals.

In summary, a systematic review can exist without a meta-analysis, but a meta-analysis is always part of a systematic review if the data allows for quantitative synthesis.

Here are the basic types of scientific articles commonly used in evidence-based practice:

1. Original Research Article (Empirical Study):

   • Purpose: Presents new research findings from original experiments, clinical trials, or observational studies.
   • Structure: Typically follows the IMRaD format—Introduction, Methods, Results, and Discussion.
   • Significance: Provides primary evidence on the effectiveness of interventions, diagnostic accuracy, or risk factors, contributing directly to evidence-based practice.

2. Systematic Review:

   • Purpose: Synthesizes all relevant studies on a specific research question using a systematic and transparent method.
   • Structure: Includes a comprehensive literature search, selection criteria, quality assessment, and summary of findings.
   • Significance: Provides a high level of evidence by integrating results from multiple studies, often used to guide clinical practice guidelines.

3. Meta-Analysis:

   • Purpose: Combines data from multiple studies (usually included in a systematic review) to produce a single, quantitative estimate of an intervention's effect.
   • Structure: Uses statistical techniques to aggregate results, typically presented with pooled effect sizes and confidence intervals.
   • Significance: Offers a more precise estimate of the effect size, often considered the highest level of evidence when available.

4. Clinical Practice Guidelines:

   • Purpose: Provides evidence-based recommendations for clinicians on the diagnosis, management, and treatment of specific conditions.
   • Structure: Developed by expert panels, usually based on systematic reviews and meta-analyses, with graded recommendations.
   • Significance: Guides healthcare professionals in making informed decisions, ensuring that patient care is based on the best available evidence.

5. Case Report/Case Series:

   • Purpose: Describes the clinical presentation, diagnosis, treatment, and outcomes of a single patient (case report) or a small group of patients (case series).
   • Structure: Detailed account of individual cases, often highlighting unusual or novel aspects.
   • Significance: Provides evidence that may lead to the generation of new hypotheses or contribute to the body of knowledge on rare conditions.

6. Cohort Studies:

   • Purpose: Observes a group of individuals over time to study the outcomes associated with specific exposures or interventions.
   • Structure: Follows participants prospectively or retrospectively, comparing outcomes between exposed and unexposed groups.
   • Significance: Provides evidence on the association between risk factors and outcomes, helping to inform clinical decision-making.

7. Randomized Controlled Trial (RCT):

   • Purpose: Tests the effectiveness of an intervention by randomly assigning participants to an experimental group or a control group.
   • Structure: Includes randomization, blinding, and controlled conditions to reduce bias.
   • Significance: Considered the gold standard in clinical research for establishing causality and guiding evidence-based practice.

These types of articles form the backbone of evidence-based practice, helping to inform clinical decisions and policy-making with the best available scientific evidence.