EBP Searching Fall 2024 PDF

 ACTIVITIES FOR TODAY Review Define EBP Clinical questions Reference styles Discuss the articles you looked at EBP Step #2 Searching  Articles For Today van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM. Wh...

 ACTIVITIES FOR TODAY Review Define EBP Clinical questions Reference styles Discuss the articles you looked at EBP Step #2 Searching  Articles For Today van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train. 2012;47(4):435-43. – doi: 10.4085/1062-6050-47.4.14 – PMID: 22889660 – PMCID: PMC3396304 Bundgaard H, Bundgaard JS, Raaschou-Pedersen DET, et al. Effectiveness of adding a mask recommendation to other public health measures to prevent SARS-CoV-2 infection in Danish mask wearers : a randomized controlled trial. Ann Intern Med. 2021;174(3):335-343. – PMID: 33205991 Schachter CL, Stalker CA, Teram E. Toward sensitive practice: issues for physical therapists working with survivors of childhood sexual abuse. Phys Ther. 1999;79(3):248-61. – PMID: 10078769  SEARCHING FOR EVIDENCE GWU - PT 8351 Professional Issues in Physical Therapy Health Care Management I David Scalzitti, PT, PhD Fall 2024  KEY POINTS Utilize search engines to find research evidence that is relevant to PICO clinical questions. Analyze pros and cons of different search engines and the appropriateness of a search engine in relation to a clinical question. Select, alter, and combine search terms to maximize the amount of relevant information that is obtained in the search process.  SEARCHING FOR EVIDENCE EBP Step #2: Locating the Current Best Evidence  Steps of Evidence-Based Practice Formulate a clear clinical question from a patient’s problem Search the literature for relevant clinical articles Critically appraise the evidence for its validity and its usefulness Implement useful findings in clinical practice Evaluate our performance  Person with Plantar Fasciitis A 45-year-old who works as an operating room nurse reports a 3-month history of insidious onset left heel pain. The pain is worse upon first weight bearing in the morning, after prolonged sitting, and at the end of the workday. She denies numbness or tingling. She does not complain of pain in other joints. The patient’s goal is to be able to walk 2 miles after work as part of a weight loss program. Body Functions and Structures – Body mass index: 31.2 kg/m2. – Lower quarter screen: No significant findings in the lumbar spine, hip, or knee. – Palpation: Tenderness at medial calcaneal tuberosity. – Range of motion: Limited dorsiflexion. – Pain: 8/10 upon first weight bearing in the morning as assessed with a verbal rating scale. – Windlass test: Positive. – Dorsiflexion-eversion test: Negative. Activities and Participation – Foot and Ankle Ability Measure (FAAM) ADL subscale score: 73%. FAAM sports subscale score: 53%.  CASE 2 - Intervention Question – P: For persons with plantar fasciitis… – I: – C: – O: Your best guess at a possible answer: Best database to search:  Sources of Evidence Expert opinion Search engines Textbooks Secondary sources Peer-reviewed literature (primary sources) Preprocessed sources Original papers  Evidence Sources Health-related search engines versus databases – Database: a compilation of research evidence resources – Search engine: the user interface that allows specific articles to be identified in a database Examples in Chapter 2 – PEDro – APTA EBP Resources – Cochrane library – PubMed / Medline – Google scholar – TRIP  Evidence Sources PubMed / MEDLINE – www.pubmed.gov Also available through different vendors such as OVID – Advantages: comprehensive readily accessible free (usually) – Disadvantages: comprehensive not PT specific requires thoughtful search strategy and knowledge of structure and how articles are indexed  PubMed Basics Boolean operators (AND OR NOT) My NCBI MeSH (medical subject heading) – Articles categorized under most specific subject heading available Clinical Queries  PubMed homepage From Fetters and Tilson, Evidence Based Physical Therapy PubMed abstract From Fetters and Tilson, Evidence Based Physical Therapy Clinical Queries EXERCISE Clinical question: A 45-year-old who works as an operating room nurse reports a 3-month history of insidious onset left heel pain. The patient’s goal is to be able to walk 2 miles after work as part of a weight loss program. Step 1: List potential Step 2: Check MeSH for Step 3: Reorder the keywords “Better” terms terms by importance  PT Specific Evidence Sources APTA Evidence Based Practice Resources https://www.apta.org/patient-care/evidence-based- practice-resources PEDro www.pedro.org.au  Evidence Sources APTA Evidence Based Practice Resources includes APTA’s Article Search for FREE full text access to: SPORTS DISCUS PROQUEST COCHRANE CINAHL  Full Text Options Medical libraries Academic institutions Personal subscriptions APTA’s Article Search ResearchGate  Have evidence find you Journal Table of Contents – Focus on the most important journals in your clinical area – E-mail or RSS feeds – Social media Pubmed Login (My NCBI) – Free – Allows you to save searches and automatically repeat at regular intervals – Save search results/citations  Additional links Clinical Trials http://www.clinicaltrials.gov Physiopedia http://www.physio-pedia.com  Other “Evidence” Sources Websites Google Blogs Podcasts Social Media Newsletters BE CAREFUL!!!  Steps of Evidence-Based Practice Formulate a clear clinical question from a patient’s problem Search the literature for relevant clinical articles Critically appraise the evidence for its validity and its usefulness Implement useful findings in clinical practice Evaluate our performance  SUMMARY Efficiently use the right database for the correct clinical question. Utilize search results to answer PICO questions. HOMEWORK: Complete Searching Assignment and Submit via Blackboard  KEY POINTS part 2 Understand relative hierarchies of evidence Understand how the 6S and 5.0 models guide the search process Integrate research evidence with clinical expertise and patient values  SEARCHING FOR EVIDENCE EBP Step #2: Locating the Current Best Evidence  Steps of Evidence-Based Practice Formulate a clear clinical question from a patient’s problem Search the literature for relevant clinical articles Critically appraise the evidence for its validity and its usefulness Implement useful findings in clinical practice Evaluate our performance Hierarchy of Intervention Evidence Systematic reviews Randomized controlled trials Cohort study Case-control study or Case reports Expert opinion or mechanism-based reasoning  6S Model Systems (Clinical decision support systems) Summaries Clinical practice guidelines Synopses of syntheses Clinical Summaries (PTNow) Syntheses Systematic Reviews, rehabmeasures.org Synopses of studies ACP Journal Club Studies PEDro, Physical Therapy, APTA section journals Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evid Based Nurs. 2009 Oct;12(4):99-101. Evidence-based healthcare pyramid 5.0 for finding preappraised evidence and guidance. Brian S Alper, and R Brian Haynes Evid Based Med 2016;21:123-125 ©2016 by BMJ Publishing Group Ltd Hierarchy of Intervention Evidence Systematic reviews Randomized controlled trials Cohort study Case-control study or Case reports Expert opinion or mechanism-based reasoning  Systematic Review A summary of the medical literature that uses EXPLICIT methods to perform a thorough literature search and critical appraisal of individual studies and that uses appropriate statistical techniques to combine these valid studies.  Randomized Controlled Trial A group of patients is randomized into an experimental group and a control group. These groups are followed up for the variables / outcomes of interest. Wolf SL, et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006 Nov 1;296(17):2095-104.  Cohort Study Involves identification of two groups (cohorts) of patients, one which did receive the exposure of interest, and one which did not, and following these cohorts forward for the outcome of interest. Standen PJ, et al. Patients' use of a home-based virtual reality system to provide rehabilitation of the upper limb following stroke. Phys Ther. 2015 Mar;95(3):350-359  Case-Control Study Involves identifying patients who have the outcome of interest (cases) and control patients without the same outcome, and looking back to see if they had the exposure of interest. Wee SK, et al. Effect of trunk support on upper extremity function in people with chronic stroke and people who are healthy. Phys Ther. 2015 Aug;95(8):1163-71.  Case Reports Case Reports describe various aspects of clinical practice related to the field of physical therapy. A Case Report may include one or more patients. Case Reports differ from Research Reports in that they do not test hypotheses or establish cause-and-effect relationships. Carlson M, Hadlock T. Physical therapist management following rotator cuff repair for a patient with postpolio syndrome. Phys Ther. 2007 Feb;87(2):179-192 Evidence-based healthcare pyramid 5.0 for finding preappraised evidence and guidance. Brian S Alper, and R Brian Haynes Evid Based Med 2016;21:123-125 ©2016 by BMJ Publishing Group Ltd  SYNTHESES – Clinical Summaries APTA Evidence Based Practice Resources Synthesized Summaries  SYNTHESES – Outcome Measures Rehab Measures Database https://www.sralab.org/rehabilitation-measures Syntheses of the psychometric properties of outcome measures used in rehabilitation Also includes links to instruments and instructions in administration of the tests Integrates recommendations from the EDGE taskforce (Evaluation Database to Guide Effectiveness)  SYNTHESES – Outcome Measures APTA Evidence Based Practice Resources  CLINICAL PRACTICE GUIDELINES APTA – www.orthopt.org – www.apta.org PEDro – www.pedro.org.au ECRI Guidelines Trust – https://guidelines.ecri.org/ Academy of Orthopaedic Physical Therapy  Systematic Reviews COCHRANE – Access through Himmelfarb (free to GW) – Access through APTA (free to APTA members) – Access through cochrane.org (fee) PEDro  Cochrane Collaboration – Includes Cochrane Database of Systematic Reviews Database of Abstracts of Reviews of Effects Cochrane Central Register of Controlled Trials (CENTRAL) Cochrane Methodology Register NHS Economic Evaluation Database Health Technology Assessment Database  STUDIES PEDro DiTA PubMed CINAHL Sports Discus APTA Evidence Resources (Article Search) Individual journals – Including Phys Ther – www.apta.org or academic.oup.com/ptj PEDro DiTA Diagnostic Test Accuracy dita.org.au  APTA Article Search APTA Evidence Based Practice Resources Physical Therapy  Review Searching Resource Perche (why) PubMed/MEDLINE* Comprehensive , free, covers many areas of medicine, mesh, clinical queries, filters, links to full-text Dr. Scalzitti/expert Clinical expertise /expert option PEdro Intervention – CPG, SR, RCT PT specifici dita Diagnosis PT specific Cinahl* Allied health including PT Sports discus* Sports Cochrane SR Physiopedia Background questions – pt specific Proquest* Includes other medical journals APTA Free access for members, all levels of evidence pt specific APTA sections/academies ortho section Lots of CPGs Textbooks Background questions himmelfarb Background/foreground –many of the others Rehab Measures – Shirley Ryan Summaries for Rehab specific outcome measures  Where to start? Intervention: – Guidelines – Cochrane Systematic Reviews – PEDro vs PubMed Diagnosis: – Rehab Measures > DiTA – PubMed (Clinical Queries) Prognosis: – PubMed (Clinical Queries) Background Questions: – PubMed vs Textbooks vs Wikipedia PUTTING IT TOGETHER  From: A Proximal Hamstring Injury—Getting Off a Slippery Slope JAMA Intern Med. Published online November 30, 2015.1-2 doi:10.1001/jamainternmed.2015.6795 Figure Legend: Fluid-Sensitive Magnetic Resonance Imaging Scans A, The image of the thigh shows that the conjoint semitendinosis- biceps femoris tendon (arrowhead) is ruptured, retracted from ischial tuberosity, and surrounded by hemorrhage. B, The image of the thigh shows edema of semitendinosis and biceps femoris muscles (arrowheads) and hemorrhage in surrounding fascial planes. F indicates femur. Copyright © 2015 American Medical Date of download: 12/3/2015 Association. All rights reserved.  Steps of Evidence-Based Practice Formulate a clear clinical question from a patient’s problem Search the literature for relevant clinical articles Critically appraise the evidence for its validity and its usefulness Implement useful findings in clinical practice Evaluate our performance  SUMMARY Organize the search process to maximize efficiency. Screen articles for relevance related to the clinical question. Select the most appropriate study given the clinical question. ANY QUESTIONS? [email protected] THANK YOU!