Evidence-based practice is, “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” 1 PT and PTA students should think about Evidence-Based Practice as a three-legged table, where each leg represents an integral part of the process. These three “legs” or principles are 1) scientific evidence, 2) clinical judgment and 3) patient characteristics. All three principles should be considered when treating a patient.
Scientific evidence provides information about what works and what doesn’t. Clinical judgment grows over time and includes the sum of our knowledge and experiences. Patient characteristics include age, held beliefs, individual pathophysiology, and socioeconomic status, among other things. Missing one of three legs of a table, creates an unstable situation.
The best patient care considers the available scientific evidence, in the context of what the PT or PTA has learned by providing physical therapy to a variety of patients in the past. A course of action the PT or PTA wishes to take is then formulated while considering the characteristics of the patient. For example, current best evidence shows that early physical therapy produces better outcomes for patients following a total knee arthroplasty. However, the PT knows from experience that patients tend to be quite groggy from the effects of general anesthesia. These two “legs of the table” should steer the PT in the direction of treating that patient early, but with safety measures in place should that patient’s confusion or sleepiness due to medication affect the treatment session. However, as the PT arrives to the read the medical record, the patient presents with abnormal blood loss during surgery and a low hematocrit. This third piece of information, or third leg of our table, creates stability in the situation, in that it steers the PT to decide to hold off on the evaluation pending further information.
To learn more about Evidence-Based Practice, click on the links below.
Resources for Stroke Rehabilitation: StrokEngine blog post
1. Sackett DL, Rosenberg WMC, Gray JAM, et al: Evidence based medicine: What it is and what it isn’t, BMJ 312:71-72, 1996.
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