Evidence-Based Practice Essentials

Bias & Bayes

  • Multiple perspectives → risk of bias; must be minimized

  • Bayes’ Theorem: start with prior belief P(A)P(A), obtain new data BB, update to posterior P(A∣B)P(A\mid B)

Why Evidence-Based Practice (EBP)?

  • Integrates best research, clinical expertise, patient values

  • Info overload; resource waste ≈ 85%85\% of health research

  • Reduces mistakes (e.g., hormone-replacement case)

  • Addresses practice variation & knowledge–practice gap

Decision-Making Models

  • Traditional: experience + circumstances + preferences

  • EBP: adds scientific evidence to the above

Barriers to EBP

  • Time to read, search, interpret

  • Limited access or relevant research

  • Skill/confidence gaps, esp. older clinicians

  • Organizational limits: time, mandate, resources

Principles of Evidence

  • Evidence alone insufficient; weigh benefits, risks, cost, inconvenience, patient values

Hierarchy / Levels of Evidence

  • 1a Systematic Review of RCTs → strongest

  • 1b Individual RCT

  • 2a SR of Cohort; 2b Cohort; 2c Outcomes

  • 3a SR Case-Control; 3b Case-Control

  • 4 Case Series / Report

  • 5 Expert opinion

  • GRADE rates quality: High (RCT) → Very Low (expert/animal)

Key Study Designs

  • RCT: random allocation; strong internal validity; costly, may not reveal causation

  • Cohort: prospective groups; cheaper; no randomization; confounding risk

  • Case-Control: retrospective; good for rare outcomes; recall bias

  • Case Report: novel single case; generates hypotheses

  • Systematic Review: exhaustive, structured synthesis; time-intensive

  • Meta-Analysis: pooled quantitative SR; ↑ power; needs homogenous data

  • Practice Guideline: expert panel, literature-based recommendations; slow to update

EBP Process (5 A’s)

  1. Ask – identify need & craft answerable question

  2. Acquire – locate best evidence

  3. Appraise – assess validity, impact, applicability

  4. Apply – integrate with expertise & patient values

  5. Assess – evaluate outcome & process

Question Types

  • Background: general info ("What is ACL mechanism?")

  • Foreground: specific to patient/population ("In 35−5035{-}50 yo post-ACL repair, does CPM speed return to sport?")

PICO Framework

  • P Patient/Problem

  • I Intervention

  • C Comparison

  • O Outcome

Reading Load Guidance

  • Approx. 2020 key articles/year (≈1−2%1{-}2\% of total literature) per specialty