Chapter 9: Evidence-Based Practice

INTRODUCTION

INTRODUCTION

Ever-increasing healthcare expenditures, both nationally and internationally, have resulted in changes in the healthcare delivery system. In the effort to contain cost while preserving quality, the burden of patient recovery and improvement has been transferred more to clinicians. The United States is currently operating in a functional outcome-based healthcare model. This has resulted in increased research by physical therapists and related rehabilitation professionals to justify and support physical therapy patient management based on evidence. Included in these efforts are patient examination/evaluation and physical therapy interventions to demonstrate that physical therapy has a positive impact on maximizing a patient’s functional abilities. The American Physical Therapy Association (APTA)¹ recognizes the need for an evidence-based practice (EBP) (Figure 9-1).

Jette et al² demonstrated that within a random sample of 1,000 physical therapists (APTA members) about 72% of clinicians believed that EBP can help in the clinical decision-making process, 79% believed that EBP improves the overall quality of patient care, 90% agreed strongly with the fact that EBP is necessary, and about 82% believed that research literature can help the clinician guide clinical decision-making during patient care.

EBP is based on three equally important pillars: clinical expertise, the patient’s belief system, and the research evidence. The challenge for each practitioner is that the effective application of the EBP practice model is based on the ability of the clinician to demonstrate the combination of the best available research evidence and the patient’s belief and opinions regarding their medical issues and needs. This combination will be different in each individual case, resulting in variations in treatment interventions for similar medical conditions that should still lead to effective outcomes.

Clinical expertise is the ability of the clinician to be proficient in the clinical assessment, decision making and documentation of proper judgment regarding the case and knowing how to integrate research evidence.

Clinical research provides clinicians with the ability to determine the usefulness of traditional clinical tests and results in replacement with more powerful, accurate, and safer tests. Research can inform the clinician about the use of standardized reliable, and valid outcome assessment tools, the interpretation of the score of such tools, and the selection of the optimal therapeutic approaches. Based on research and application of the evidence, ...