EVIDENCE BASED PRACTICE IN PHYSICAL

THERAPY
What do you mean by EVIDENCE BASED PHYSICAL THERAPY?

The practice of evidence-based physiotherapy should be informed by relevant, high

quality clinical research, patient’s preferences and physiotherapists’ practice
knowledge (reference: Practical Evidence-Based Physiotherapy, text book by Rob
Herbert et.al. 2005)

High quality clinical research: High quality clinical research is that which is
carried out in a way that it has low risk of bias and is relevant to our questions.

Patient’s preferences: patients will be given an opportunity to contribute to,

and share, decisions involving their health(Edwards & Elwyn 2001).

Practice knowledge: practice knowledge is knowledge arising from professional

practice and experience (Higgs & Tichen 2001)

Clinical decision – making : Clinical decision-making brings together information

from high quality clinical research, information from patients about their
preferences, and information from physiotherapists within a particular cultural,
economic and political context. It requires clinical reasoning to analyse, synthesize,
interpret and communicate relevant information from and to the patient in a
dynamic and interactive way.

Levels of evidence [Oxford centre for evidence based medicine levels of

evidence (march 2009)]:

Level 1a : Systematic Reviews (with homogeneity) of multiple Randomized

controlled trials validated for different populations, conducted in different clinical
centres

Level 1b : Individual Randomized controlled trials (with narrow confidence

intervals) validated in single population conducted within one clinical centre.

Level 1c : All or none case-series.

Level 2a : Systematic Reviews(with homogeneity) of cohort studies.

Level 2b : individual cohort study (including low quality Randomized Controlled

Trial).

Level 3a : Systematic Reviews (with homogeneity) of case control studies.

Level 3b : Individual case control study.

Level 4 : Case- series(and poor quality cohort and case control studies).

Level 5 : Expert opinion without explicit critical appraisal or based on physiology,

bench research or “first principles”

Steps in Evidenced Based Practice (Adhikari N, Shrestha S, Ansari I 2006):

1. Identifying the problem

2. Formulate the question

3. Finding the evidence

4. Appraisal of evidence for its validity(closeness to the truth) and

applicability(useful in clinical practice)

5. Integrate that evidence with clinical expertise, patient preferences and apply
to in practice

6. Evaluate your performance with this patient

Finding the evidence:

s.no Web Databases URL

.

1. PEDro www.pedro.fhs.usyd.edu.au

2. MEDLINE www.ncbi.nlm.nih.gov

3. OVID www.ovid.com

4. EMBASE www.embase.com

5. COCHRANE LIBRARY www.cochrane.org

Critical appraisal of evidence guidelines:

s.no Study design URL (guidelines)

.

1. Randomized Controlled Trials www.consort-statement.org

2. Systematic Review/ Meta www.prisma-statement.org

analyses

4. Observational studies www.strobe-statement.org

Compiled by:

J. Andrews Milton, MPT(ortho),

Associate professor,

Dr. M.V. Shetty College of physiotherapy, Mangalore, Karnataka, India.

Email: therapistandrews@gmail.com mobile: +91 9448593186