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At the completion of this chapter, the reader will be able to:

  1. Provide a historical perspective on the evolution of evidence-informed practice (EIP)

  2. Discuss the importance of EIP

  3. List some of the reasons why EIP became important in healthcare

  4. Describe the various research designs and their advantages and disadvantages

  5. Differentiate among the experimental, quasi-experimental, and nonexperimental research designs

  6. Differentiate between the form and uses of the null and research hypotheses

  7. Differentiate among and discuss the roles of independent, dependent, and extraneous variables

  8. Discuss the concept of research validity of a study

  9. List the various threats to validity

  10. Describe the different types of reliability and the roles they play in EIP

  11. Discuss the various hierarchies of evidence

  12. Discuss how EIP can be used in clinical decision-making


An important component of the Vision 2020 statement set forth by the American Physical Therapy Association (APTA) is achieving direct access through independent, self-determined, professional judgment and action.1 In light of the APTA’s movement toward realizing Vision 2020, an operational definition of autonomous practice and the related term autonomous physical therapist practitioner is given by the APTA’s board as follows:

  • “Autonomous physical therapist practice is practice characterized by independent, self-determined professional judgment and action.”

  • “An autonomous physical therapist practitioner within the scope of practice defined by the Guide to Physical Therapist Practice provides physical therapy services to patients who have direct and unrestricted access to their services, and may refer as appropriate to other healthcare providers and other professionals and for diagnostic tests.”2

Evidence is used comprehensively in clinical decision-making within the healthcare professions. The physical therapy profession has expressed a commitment to the development and use of evidence through various initiatives, including the APTA’s introduction of a periodic feature in their journal, “Evidence in Practice,” and a database of research articles, “Hooked on Evidence.” Evidence-informed practice (EIP) refers to a practice that is associated with epidemiological evidence and healthcare needs.3


The production of evidence to support physical therapy services is only truly effective when practitioners integrate evidence into their practice.

EIP refers to integrating the best available evidence with clinical expertise and patient values and circumstances to produce specific evidence-supported interventions.4 This contrasts with the old-fashioned reliance on knowledge gained from authority, hearsay, habit, or tradition.


The goals of using EIP in physical therapy are to:

  • Improve the quality of care

  • Standardize certain facets of care

  • Achieve the best patient outcomes

The relatively recent interest in the use of EIP has resulted from some issues, including5-12

  • The continued increase in healthcare costs.

  • Extensive documentation of apparently unexplained practice variations in the management of a variety of conditions.

  • An increase in publicity surrounding medical errors.

  • The identification of potential or actual harm resulting from ...

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