Searching the Literature

SEARCHING THE LITERATURE LECTURE 3

OBJECTIVES

  • Use the PICO framework to draft research questions

  • Consider levels of evidence when selecting research

  • Learn which databases are common for rehabilitation literature

  • Use a research question to search databases and discover applicable literature

INTRODUCTION

  • Time Consideration for Researchers vs. Clinicians
      - Researchers spend a significant amount of time searching literature.
      - Clinicians have limited time to address clinical questions efficiently.

  • Goal of Efficient Literature Search
      - Efficient literature search promotes Evidence-Based Practice (EBP).

PATIENT CASE EXAMPLE

  • Patient: J.T.
      - Reported Symptoms:
        - Difficulty accelerating.
        - Reduced confidence when cutting.
        - Early fatigue during practice drills.
      - Denial of Symptoms: Current knee pain, but feels right leg is "less powerful" than left.

  • Initial Questions
      - What muscle or muscle group may be affected to cause these symptoms?

  • Action Required
      - Begin developing a hypothesis regarding J.T.'s problem.
      - Develop a searchable question to assist in physical therapy intervention.

PATH FROM CLINICAL QUESTION TO EBP

  1. Identify the need for information and develop a focused, searchable clinical question.

  2. Conduct a search to find the best possible research evidence to answer your question.

  3. Critically appraise the research evidence for applicability and quality.

  4. Integrate the critically appraised research evidence with clinical expertise and patient values.

  5. Evaluate the effectiveness and efficacy of your efforts in Steps 1-4, and identify improvement areas for the future.

CREATING A SEARCHABLE CLINICAL QUESTION

  • Step 1:
      - Two Parts:
        1. Identify the need for information, which can stem from evaluation, treatment, outcome measure results, etc.
        2. Construct a searchable clinical question aimed at diagnosis, prognosis, or interventions.

ELEMENTS OF SEARCHABLE QUESTIONS

  1. Patient Characteristics: Include significant patient characteristics relevant to health conditions.

  2. Patient Management: Define the component of interest, focusing on specific types of research studies.

  3. Outcome of Interest:
       - Patient functional goals which could include outcome measure results.

PICO QUESTION

  • Components to define the research question:
      - Population: Define the target population or the specific problem of interest.
      - Intervention: Identify the intervention being studied, including therapeutic interventions or diagnostic tests.
      - Comparison: Specify comparison variables to define levels of the independent variable.
      - Outcomes: State outcomes to study, specifying primary and secondary outcomes.

CASE EXAMPLE FOR PICO

  • J.T.'s Details:
      - Age: 17
      - Sport: High school varsity football (running back)
      - Injury History: Mild right knee strain during preseason training
      - Primary Complaint: Persistent quadriceps weakness limiting sprint speed and power
      - Time Since Injury: 6 weeks

PHYSICAL EXAMINATION FINDINGS

  • Visible quadriceps atrophy on the right thigh.

  • Isometric Quadriceps Strength: 22% weaker on the right compared to the left (measured using handheld dynamometry).

  • Reduced single-leg squat endurance on the right.

  • Decreased vertical jump height on the right leg.

  • Mild asymmetry in sprint mechanics.

POSSIBLE CLINICAL QUESTIONS

  • P: Population?

  • I: Possible intervention?

  • C: Comparison intervention?

  • O: Outcome of interest?

CONDUCTING A SEARCH OF THE LITERATURE - STEP 2

  • Research Steps:

  1. Use Computer-Based Decision-Support Systems for literature search.

  2. Utilize Search Engines and Databases, including evidence retrieval methods:
       - Search for Clinical Practice Guidelines, Synopses of Studies, Individual Studies.
       - Time management for searches: Most efficient to least efficient.

EVIDENCE SELECTION

  • Types of Published Evidence:
      - Systematic reviews and meta-analyses of Randomized Controlled Trials (RCTs) are high-quality evidence.
      - Decreasing quality of evidence includes:
        - Randomized Controlled Trials
        - Cohort studies
        - Case-control studies
        - Cross-sectional studies and surveys
        - Case reports and case studies
        - Mechanistic studies, editorials, expert opinions, all lower quality.

COMMON DATABASES AND SEARCH ENGINES

  • Databases for Rehabilitation Literature:
      - PubMed (contains MEDLINE)
      - Google Scholar
      - PEDro: Physiotherapy Evidence Database
      - SPORTDiscus
      - CINAHL
      - Cochrane Library
      - Embase
      - PTNow: APTA database with Clinical Practice Guidelines, systematic reviews, etc.

DATABASE USAGE - PUBMED

  • Important Features:
      - Considered the gold standard for search results.
      - All articles are peer-reviewed.
      - Not all journals, especially lesser-known/predatory journals, are indexed.
      - Limited flexibility in search techniques.

  • Searching Techniques:
      - Use Medical Subject Headings (MeSH) for standardized wording in articles.
      - MeSH assist in creating search strings.

GOOGLE SCHOLAR

  • Access:
      - Free to use and often links to free full-text articles.
      - It may be less trustworthy for searching clinical questions.

  • Searching Method:
      - Slight variations in search terms help find more relevant results.

PEDRO

  • Overview:
      - A free database of over 67,000 trials, reviews, and guidelines evaluating physiotherapy interventions.
      - Users can search to answer questions, browse latest research, and access valuable resources.

SCITE.AI

  • Usage:
      - Subscription-based access through UK.
      - Facilitates advanced searching capabilities for research articles.

STRATEGIC SEARCH EXAMPLES

  • Example Query: For a 55-year-old truck driver with low back pain, are stabilization exercises or strength training more effective for improving sitting tolerance?

  • In-depth Query Examples:
      - ("quadriceps weakness" OR "quadriceps strength" OR "quad strength") AND ("progressive resistance exercise" OR "PRE" OR "resistance training") AND (rehabilitation OR rehabilitation outcome OR return to play OR return to sport OR RTP) AND (athlete* OR athlete OR sport* OR highschool OR "high school")

CONCLUSION AND TIPS

  • Remember, the search for quality evidence is challenging.

  • It is often necessary to settle for the best available evidence, even if it does not perfectly fit your clinical question.

  • Critical appraisal of articles and ongoing modifications of search strategies can improve search results.

  • Practice, patience, and flexibility in search methods will yield the best outcomes in literature searches.