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Kinesiology: Evidence Based Practice

What is Evidence Based Practice?

"Evidence-based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. That is, it integrates the best external evidence with individual clinical expertise and patients' choice". (Dr. David Sackett)

Evidence-based practice (or evidence-based medicine) involves 5 steps: 

1. Ask a focused question to satisfy the health needs of a specific patient

  • What is your clinical question? Use the PICO model to help inform your research question.
  • What type of clinical question are you considering? 
  • What is the best study design to answer this type of clinical question? 

Type 

Explanation

Types of evidence to answer 
Therapy (Treatment) Questions look at the effectiveness of interventions in improving outcomes in sick patients/patients suffering from some condition. Most frequently asked type of question.  Randomised Controlled Trial (RCT)
Prevention Questions examine the effectiveness of an intervention or exposure in preventing morbidity and mortality. When assessing preventative measures, it is important to evaluate potential harms as well as benefits.  RCT or Prospective Study 
Diagnosis Questions look at the ability of a test or procedure to differentiate between those with and without a condition or disease.  RCT or Cohort Study 
Prognosis (Forecast) Questions root out the probable cause of a patient's disease or the likelihood that she or she will develop an illness.  Cohort Study and/or Case-Control Study 
Etiology (Causation) Questions about the harmful effect of an intervention or exposure on a patient  Cohort Study 
Meaning Questions concerning patients' experiences  Qualitative Study
This table is adapted from  Fineout-Overholt, E. & Johnston, L. (2005), Teaching EBP: asking searchable, answerable clinical questions. Worldviews on Evidence-Based Nursing, 2, 157–160. doi: http://dx.doi.org/10.1111/j.1741-6787.2005.00032.x

2. Find the best evidence by searching the literature 

  • What is the highest level of evidence/literature available to support your question? 
  • Where should begin to look for this material? 

EBP levels of evidence pyramid

Meta Search Engines (searches all levels of evidence at once)

TRIP Database, The Cochrane Library 

Systematic Reviews or Meta-Analyses  Medline, PubMed, Cochrane Database of Systematic Reviews (CDSR)
Critically Appraised Topics  DynaMed PLUS
Critically Appraised Articles ACP Journal Club, JAMAevidence 
RCTs, Cohort Studies, and Case-Controlled Studies Medline, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL)
Background Information or Expert Opinion  Textbooks, periodicals, editorials 

3. Critically appraise the literature. You are testing for validity, clinical relevance, and applicability 

What are the results of the study?

4. Apply the results in clinical practice 

5. Evaluate the outcomes in your patient 

Adapted from: the Centre for Evidence-Based Medicine and Sackett DL, Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2.

New Evidence Based Journal Articles in Kinesiology

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PICO Model

Breaking up your question into these 4 elements (which you can easily remember with the mnmeonic device PICO) will make your literature search process easier:

Patient, population, or problem
  • Description of the patient, population and/or the target disorder of interest
  • What are the most important characteristics of the patient?
  • How would you describe a group of patients similar to yours?
  • What is the disorder and condition of interest?
Intervention
  • Which intervention, prognostic factor, diagnostic tool, or exposure are you considering?

Comparison intervention

  • What alternative do you want to compare with the intervention?
  • Examples: standard of care, reference standard, Placebo

Outcome

  • What outcome you hope to accomplish or measure?

Clinical Guidelines