Evidence Based

Practice
Contents
 Introduction to Evidence based practice

 Aims of EBP

 EBP triad

 Databases to use

 Levels of Evidence
What is Evidence?

“Anything that provides material or

information on which a conclusion or
proof may be based; used to arrive at
the truth , used to prove or disprove a
point”.
Introduction to EBP
 Definition:

“Evidence based practice is a problem solving approach

that incorporates the best available scientific evidence ,
clinicians’ expertise and patient’s values and preferences”.

 The conscientious , explicit and judicious use of current

best evidence in making decision about the care of
individual patient.
Aim of EBP

 Todo right thing , at the right time , for

the right person , ensure quality care for
the individual client.
Goals of EBP
 The goal of EBP is the integration of:

(a) clinical expertise/expert opinion,

(b) external scientific evidence, and
(c) client/patient/caregiver values to provide high-
quality services reflecting the interests, values, needs,
and choices of the individuals we serve.
Importance of EBP for Speech and Language
Pathologists
 They recognize the needs, abilities, values, preferences and
interests of individuals and families to whom they provide clinical
services and integrate those factors along with best current
research evidence and their clinical expertise in making clinical
decisions.
 Acquire and maintain the knowledge and skills that are necessary

to provide high quality professional services, including knowledge

and skills related to based practice.
 Evaluate prevention, screening and diagnostic procedures,

protocols, measures to identify maximally informative and cost

effective diagnostic and screening tools, using recognized
appraisal criteria described in evidence based practice literature.2
 Steps in EBP
Assess the patient 1. Start with the patient ; a clinical problem or question arises from
the care of patient.

Ask the Question 2. Construct a well built clinical question derived from the case.

Acquire the evidence 3. Select an appropriate resource and conduct a search.

Appraise the evidence 4. Appraise the evidence for its validity (closeness to the truth) and
applicability (usefulness in clinical practice).

Apply : talk with the 5. Return to the patient ---integrate that evidence with clinical
patient expertise , patient preferences and apply it to the practice

Self-Evaluation 6. Evaluate your performance with this patient.

Sources of Information
 Colleagues
 Textbooks
 The internet
 Educational events
 Reading the Journal articles
 What you learned in school.
Databases to use
 Important databases are :

 PubMed/Medline
 CINAHL
 APA PsycNet/PsychInfo
 TRIP database
 National Guidelines Clearing House
 PubMed Health
 Medline Plus
Levels of Evidence
Levels of Evidence
 Meta-analysis ---- uses a statistical approach

 Systematic Review ---- brings together and appraise

all research findings.

 Randomized Controlled Trial (RCT)---- one group

receives an intervention , one group does not ;
participants are randomly assigned.
Levels of Evidence
 Case control studies ---- one group does not have the
condition , the other group has the condition.

 Cohort studies----participants are studied over a

period of time ; prospective or retrospective.

 Descriptive studies with analyses of outcomes for a

particular individual,,, e.g. case series.
Contents

 Steps involved in EBP

 PICO model of EBP

 Categories of EBP questions

 Steps involved in EBP
Evidence-based practice involves the following steps (Sackett et al 2000):

 Step 1: Convert information needs into answerable questions

 Step 2: Track down the best evidence with which to answer those questions

 Step 3: Critically appraise the evidence for its validity, impact and applicability

 Step 4: Integrate the evidence with clinical expertise and with patients’ unique biologies,

values and circumstances.

 Step 5: Evaluate the effectiveness and efficiency in executing steps 1–4 and seek ways to

improve them both for next time.

Categories / Types of Evidence Based
Medicine/Practice Questions
 Recognizing your clinical question's domain is an important part of
the Evidence-Based Practice (EBP) process. Establishing the question
type allows you to:
 Identify the research methodology that provides the best evidence

to answer the question.  Note that the hierarchy of evidence will

differ according to question type.
 Select the best EBP Tools to search for the evidence. The Cochrane

Database of Systematic Reviews, for example, only addresses

treatment and prevention questions.  Other databases address
questions of treatment and prevention, diagnosis, prognosis,
etiology, quality improvement, and health economics, among others.
 Select evidence filters in PubMed / CINAHL and other
databases that will help narrow your search to papers
using appropriate research methods.

 Identifying your question type will also assist you in

critically appraising the evidence based on the
appropriateness and rigor of the research methods
described in a paper.
Types of Clinical Questions
 Clinical questions can be categorized as either background or
foreground.  Determining the type of question will help you to
select the best resource to consult for your answer.

Background questions ask for general knowledge about a

condition, test or treatment.  These types of questions
typically ask who, what, where, when, how & why about
things like a disorder, test, or treatment, or other aspect of
healthcare.  For example;
 How overweight is a woman to be considered slightly obese?
 What causes migraines?
Types of Clinical questions
 Foreground questions ask for specific knowledge to inform
clinical decisions. These questions typically concern a specific
patient or particular population.
 Foreground questions tend to be more specific and complex
compared to background questions. Quite often, foreground
questions investigate comparisons, such as two drugs, two
treatments, two diagnostic tests, etc.

 Foreground questions may be further categorized into one of

4 major types: treatment/therapy, diagnosis, prognosis, or
etiology/harm.
 For example
 In pediatric patients with Allergic Rhinitis, are

Intranasal steroids more effective than

antihistamines in the management of Allergic Rhinitis
symptoms?
 In patients with osteoarthritis of the hip, is water

therapy more effective than land-based exercise in

restoring range-of-motion?
Formulating a Well Built Clinical question

 According to the Centre for Evidence Based Medicine

(CEBM), "one of the fundamental skills required for
practicing EBM is the asking of well-built clinical
questions. To benefit patients and clinicians, such
questions need to be both directly relevant to
patients' problems and phrased in ways that direct
your search to relevant and precise answers."
PICO Model of EBP
 The PICO is the format provides a consistent ,
systematic way to identify the components of an
issue.

 Structuring a clinical question With PICO helps to

clarify the components which will guide the
search for evidence.
 A well-built clinical foreground question should have 4
components. The PICO model is a helpful tool that assists you
in organizing and focusing your foreground question into a
searchable query. Dividing into the PICO elements helps
identify search terms/concepts to use in your search of the
literature.

 P = Patient, Problem, Population 

 I = Intervention, Prognostic Factor, Exposure 
 C = Comparison
 O= Outcome 
 Foreground questions can be further divided into questions
that relate to therapy, diagnosis, prognosis, etiology/harm
 Therapy: Questions of treatment in order to achieve some
outcome. May include drugs, surgical intervention, change
in diet, counseling, etc.
 Diagnosis: Questions of identification of a disorder in a
patient presenting with specific symptoms.
 Prognosis: Questions of progression of a disease or
likelihood of a disease occurring.
 Etiology/Harm: Questions of negative impact from an
intervention or other exposure.