- Brad Fentor DPT
Evidence Based Practice
As physical therapists we are constantly seeing a variety of presentations and pathologies in the clinic. Our patients often have questions about how we proceed with our plan of care and how we make decisions. This decision making relates back to how we are trained and most PT programs in the country focus on Evidence Based Practice as the core of their curriculums. This involves several aspects but can be distilled into 3 main categories: research, clinical expertise, and patient expectation. These should be 3 pillars of clinical practice and for the basis of care each patient receives. These areas are too vast to be covered in a short blog post so, this article will focus on research and how this is incorporated into clinical practice.
One of the biggest aspects of being a practicing clinician is staying current with the latest research. There is a constant influx of new research coming out every year in various peer-reviewed journals. This gold standard for research design is a randomized control trial where an experimental group and control group are utilized to determine the effect a variable (e.g. manual therapy) has on outcomes. Other research designs also exist such as observational studies or case reports but these are usually not considered as robust as an RTC. While the details of research can often be confusing this is the best method available to determine what treatments have real effects for patients. Researchers will also combine multiple studies into systematic reviews which provide even greater levels of evidence. If 10 studies are reviewed and 9 indicate that exercise is the best treatment for low back pain while 1 contradicts this, then the vast majority of the evidence points towards exercise as the best option.
Research articles are always being published in scholarly journals, and the difficulty as clinicians is staying current with the latest information. While in physical therapy school, staying current is fairly easy, since all the information being taught is constantly updated.
Also, accessing the journals is also simple since university libraries have access to everything needed. Most students do not realize how expensive it is for universities to maintain access to journal databases. After graduation this becomes more challenging due to both cost and access. Many therapists have access to journals specific to our area of interest through the APTA. A common one is the Journal of Orthopedic and Sports Physical Therapy (JOSPT). I receive this journal each month and try to review this to keep updated with any new evidence for treatment.
Clinical practice guidelines are also updated periodically as well, and this is often the best place to start as therapists in terms of broad updates to our knowledge. This past spring, new guidelines were published for lateral ankle sprains which I have tried to integrate for all of my patients with this pathology. Guidelines for low back pain were also recently updated which is an important area of focus given the ubiquity of this presentation. Many clinicians will also utilize podcasts to help stay current. JOSPT publishes weekly podcasts highlighting the latest published research which is very helpful and much easier to utilize than combing through very dense articles.
A good example of changes to treatment can be found with ACL recovery.
The old paradigm used to be based on returning to sports as quickly as possible, sometimes 6 months or less. This was considered best practice and indicated a healthy recovery. With more research and evidence we now know the re-tear rate is extremely high with quick returns to sports. Based on that information the recommendations have drastically changed and now 9-12 months is a much better and more realistic time frame to reduce chances of re-injury.
It is obvious that using the best evidence in treatment for patients is incredibly important. This evidence often changes over time, and it is incumbent upon therapists to stay current with the latest information. Many times during PT school, I can remember being told that the techniques and treatments being taught then should look different in a decade from that time. This change is often incremental but still important for providing the best treatment for our patients.