Finding the Best Evidence

I. Understanding Evidence-Based Practice (EBP)

• Evidence-Based Practice (EBP) combines:

  • Best available research evidence

  • Patient values and characteristics

  • Clinical expertise

II. Types of Evidence

• Evidence: Data from clinical research performed on patients

• Theory: Data from basic science research or observation

III. Evidence Hierarchy (Guyatt et al., 2002)

1. Systematic Review of Randomized Trials (Highest quality)

2. Single Randomized Trial

3. Systematic Review of Observational Studies

4. Single Observational Study

5. Physiologic Studies

6. Unsystematic Clinical Observations

IV. Study Types and Their Characteristics

• Randomized Clinical Trials (RCTs)

  • Combines data from multiple studies for precision

  • Advantage: Provides consensus and improved reliability

  • Disadvantage: Requires high-quality individual studies

• Systematic Reviews

  • Ensures minimal bias and clear conclusions

  • Advantage: Strong evidence for cause-and-effect

  • Disadvantage: May not account for all patient variability

• Observational Studies

  • Tracks outcomes over time without intervention

  • Advantage: Cost-effective; identifies rare occurrences

  • Disadvantage: Prone to confounding variables

• Physiologic Studies

  • Examines biological mechanisms

  • Advantage: Provides insights on bodily processes

  • Disadvantage: May lack clinical relevance

• Unsystematic Clinical Observations

  • Involves case studies or anecdotal evidence

  • Advantage: Good starting point for hypotheses

  • Disadvantage: Limited scope and reliability

V. Critical Appraisal of Evidence

Key questions to evaluate research:

1. Is the study valid?

2. Are the results important? (Significance, magnitude)

3. Are the results applicable to my patient?

VI. PICO Framework for Formulating Research Questions

PICO is a tool for developing clinical questions:

• P = Patient/Problem/Population

• I = Intervention (Treatment, test, etc.)

• C = Comparison (Alternative treatment or standard)

• O = Outcome (Desired result or improvement)

Example Question: "In Parkinson’s patients (P), does trunk rotation (I) improve rigidity (O) better than general aerobic training (C)?"

VII. Database Search Strategies

• Search Terms: Combine synonyms with "AND" or "OR"

• Databases:

  • PubMed/Medline

  • CINAHL (Nursing and Allied Health)

  • Embase (Drug and device monitoring)

  • Cochrane Library (Systematic reviews)

  • PEDro (Physiotherapy evidence)

  • OTseeker (Occupational therapy research)

VIII. Tips for Finding the Best Evidence

• Formulate focused questions using PICO

• Use Boolean operators (AND, OR) to refine searches

• Utilize MeSH terms for precise searching

• Choose high-quality evidence such as Systematic Reviews and RCTs

IX. Fundamental Principles

1. Evidence is never enough – Patient preferences and clinician judgment are vital.

2. Not all evidence is equal – Higher levels of evidence provide stronger conclusions.