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Evidence-based Medicine Practice in Sports Physical Therapy

This commentary from The International Journal of Sports Physical Therapy in 2012, by Manske, and Lehecka, argues provides an excellent commentary on the value of evidence-based practice in Sports Physical Therapy. This text is a summary of this article.

Research evidence can be used in a number of ways in clinical practice in understanding.

1.The accuracy and precision of diagnostic tests (including clinical examination)

2.Power of prognostic markers

3.Efficacy and safety of therapeutic, rehabilitation and preventative strategies

It is suggested that EBM is used in practice via

1.Producing an answerable, clinically relevant question

2.Tracking down and searching for the best evidence with which to answer a question

3.Critically appraising the evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in our clinical practice).

4.Integrate the critical appraisal with clinical expertise and with your patient’s unique biology, values, and circumstances

5.Evaluated effectiveness and efficiency in executing steps 1 -4 and seeing ways to improve upon them before next time

It suggests that questions can take 2 general forms: background or foreground questions. The background question is used to understand the nature of a problem, test or treatment.  An example of a background question is “what are the common signs and symptoms of a labral tear”. An more ground question helps us make decisions more specific to the clinical situation. For example “will early passive movement result in improved outcomes in college-aged pitchers, with small undersurface cuff tears?”

These are not new concepts and have been promoted by professional and regulatory bodies and academia since the mid-90s, however it is estimated that 30-40%  of patients do not receive care according to current scientific evidence and about 20- 25% of care provided is not needed or is potentially harmful. 

It is emphasised that once useful information has been obtained it needs to be integrated into a particular situation that involves your patient, and stresses that even if we have new information, it may or may not be utilised, depending on the individual patient circumstances.

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