Melnyk & Fineout-Overholt (2015, p. 10), Step 4 = "Integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change". Show
Once you have found the evidence from various sources* to help with your clinical question (assignment or thesis topic), you need to decide if you can apply that evidence, and in what ways *like the library databases, of course! And don't forget to cite all the sources you use according to a specific citation style. Scientific WritingOne of the most brilliant quotes I have ever read can be found in an article by Hotaling. It seems to say it all and is only part of the reason you should read the article. “I am writing a longer letter than usual because there is not enough time to write a short one.” by Blaise Pascal, Lettres Provinciales (ca. 1657) French Philosopher & Mathematician. Another useful article if you need help with scientific writing. Hyatt, J. P. K., Bienenstock, E. J., & Tilan, J. U. (2017). A student guide to proofreading and writing in science. Advances in Physiology Education, 41(3), 324-331. https://doi.org/10.1152/advan.00004.2017 Need Help with Statistics?
Applying the Evidence - Optional ReadingThe kind of questions you should be asking yourself at this stage deal with:
Follow the link below to read a very useful article that provides a, easy-to-read overview of Evidence Based Practice. Guyatt, G.H., Haynes, R.B., Jaeschke, R.Z., Cook, D.J., Green, L., Naylor, C.D,...Richardson, W.S. (2000). Users' guides to the medical literature XXV. Evidence-based medicine: Principles for applying the users' guides to patient care. JAMA, 284(10), 1290–1296. https://doi.org/10.1001/jama.284.10.1290 Click the "Download PDF" option, and login via OpenAthens using your SIT user name and password. Evidence-based practice includes the integration of best available evidence, clinical expertise, and patient values and circumstances related to patient and client management, practice management, and health policy decision making. All three elements are equally important. Although evidence-based practice encompasses more than just applying the best available evidence, many of the concerns and barriers to using
evidence-based practice revolve around finding and applying research. APTA helps PTs and PTAs discover and use evidence-based resources. The physical therapist and physical therapist assistant's knowledge and skills are a key part of the evidence-based process. This personal scope of practice consists of activities
undertaken by an individual physical therapist that are situated within a physical therapist's unique body of knowledge where the individual is educated, trained, and competent to perform that activity. Using clinical decision making and judgment are key. The patient's wants and needs are a key part of evidence-based care. Incorporating a patient's
cultural considerations, needs, and values is a necessary skill to provide best practice services. What is Evidence-Based Practice?The classic definition of Evidence-Based Practice (EBP) is from Dr David Sackett. EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research”.2 EBP has developed over time to now integrate the best research evidence, clinical expertise, the patient's individual values and circumstances, and the characteristics of the practice in which the health professional works.3  So, EBP is not only about applying the best research evidence to your decision-making, but also using the experience, skills and training that you have as a health professional and taking into account the patient's situation and values (e.g. social support, financial situation), as well as the practice context (e.g. limited funding) in which you are working. The process of integrating all of this information is known as clinical reasoning. When you consider all of these four elements in a way that allows you to make decisions about the care of a patient, you are engaging in EBP.4 Why is Evidence-Based Practice Important?EBP is important because it aims to provide the most effective care that is available, with the aim of improving patient outcomes. Patients expect to receive the most effective care based on the best available evidence. EBP promotes an attitude of inquiry in health professionals and starts us thinking about: Why am I doing this in this way? Is there evidence that can guide me to do this in a more effective way? As health professionals, part of providing a professional service is ensuring that our practice is informed by the best available evidence. EBP also plays a role in ensuring that finite health resources are used wisely and that relevant evidence is considered when decisions are made about funding health services.4 What happened before Evidence-Based Practice?Before EBP health professionals relied on the advice of more experienced colleagues, often taken at face value, their intuition, and on what they were taught as students. Experience is subject to flaws of bias and what we learn as students can quickly become outdated. Relying on older, more knowledgeable colleagues as a sole information source can provide dated, biased and incorrect information. This is not to say that clinical experience is not important - it is in fact part of the definition of EBP. However, rather than relying on clinical experience alone for decision making, health professionals need to use clinical experience together with other types of evidence-based information.5 Is not all Published Research of Good Quality?Not all research is of sufficient quality to inform clinical decision making. Therefore you need to critically appraise evidence before using it to inform your clinical decision making. The three major aspects of evidence that you need to critically appraise are:
Why is the integration of research with clinical expertise and patient preference necessary?Using the best-available scientific evidence by itself is not enough to care for our patients in an evidence-based environment. We must also incorporate our clinical expertise and patient preferences and values to include the art with the science to see patient outcomes improve.
Is the integration of best research evidence with clinical expertise and patient values?Evidence-Based Practice (EBP) is the integration of best research evidence with clinical expertise and patient values.
How does clinical expertise informs evidenceClinical expertise must encompass and balance the patient's clinical state and circumstances, relevant research evidence, and the patient's preferences and actions if a successful and satisfying result is to occur. Accomplishing this goal often involves sorting through tradeoffs.
Why is patient values important in evidenceOne important prudential value of patient values is their wellbeing – applying best evidence to individual patients requires attention to their specific values. Concordance with care and treatment can mean cost effective care and treatment, 'quality cost' or 'high value care'.
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