Evidence based Physical Therapy: a new perspective

LETTER TO THE EDITOR

Evidence based Physical Therapy: a new perspective

Filippin LI^I; Wagner MB^II

^IMedical Sciences Graduate Program, Universidade Federal do Rio Grande do Sul (UFRGS) – Porto Alegre (RS), Brazil

^IIMedicine Department, UFRGS

Correspondence to

The demand for the highest quality in healthcare, combined with the need for a rational use of both public and private resources, has added pressure on healthcare professionals to guarantee the implementation of practices based on scientific evidence. The movement for Evidence-Based Medicine (EBM) began in the 1980s with David L. Sackett as one of its main architects¹.

The practice of EBM consists in integrating each specialty with the best available clinical evidence derived from systematic investigation¹. This movement represented a radical departure from a paradigm of knowledge based on autonomy and clinical experience.

Evidence-Based Practice (EBP) began in the mid-1990s, and there are currently many centers where research in this area is carried out. That is the case of the Centre for Evidence Based Physiotherapy (CEBP), an online center where professionals can access guidelines, articles, and important research links².

EBP comprises the same concepts and principles of EBM and is used by various professionals in several health contexts. EBP has been defined as the conscious, explicit, and well thought-out use of the best and latest research evidence on clinical decisions involving patient care.

Meticulously developed research provides grounds for clinical decisions, but will never replace the rationale behind the most appropriate intervention in a given clinical situation.

EBP involves overcoming certain challenges, such as keeping up-to-date with the growing availability of information in the health field, searching the literature efficiently by means of optimal databases, and selecting studies which are relevant and adequate from a methodological perspective.

By definition, scientific evidence is a group of elements used to confirm or disprove a given theory or scientific hypothesis. In order to produce scientific evidence, research must be carried out according to scientific principles, and this research must be subject to replication by other scientists in settings other than those where the research was originally carried out³.

The analysis of research evidence requires knowledge and skills that enable professionals to gain autonomy in the critical evaluation of the scientific information which will be used to reduce uncertainties that involve clinical decisions. Nevertheless, not all studies are well developed; thus, it is necessary to evaluate their validity and the clinical applicability of their results.

Evidence levels are now used as guidelines to classify the quality of the studies developed in the area of health. The quality of the evidence may be categorized into three levels (level I – strong evidence of at least one randomized, controlled study with appropriate design and size; level II – evidence of well-designed studies without randomization, cohort, or case-control; level III – opinions of reputable authorities)^4-6.

Unlike medicine, Physical Therapy is still lacking in research to form the scientific body of knowledge needed to sustain EBP, particularly studies with level I evidence. Therefore, it is imperative to foster the development of research in physical therapy as it will contribute to the creation of a body of knowledge pertaining to this specific area. This will improve Physical Therapy care by making it more grounded in scientific knowledge, and it will enrich professionals and their practice as well as help them solve day-to-day problems.

EBP has been discussed in the literature and, as previously mentioned, there are several obstacles to its implementation. However, this approach to practice may help shift physical therapy from a practice based on tradition, rituals, and tasks, to a well though-out practice based on scientific principles which will enhance the quality of care. In this context, it can be concluded that EBP is an approach that encourages the physical therapist to search for scientific knowledge by developing research or by applying the results found in the literature to their professional practice.

References

• 1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71-2.
• ²
  Centre for Evidence Based Physiotherapy. [cited 2008 Jan]. Available from: https://www.cebp.nl/
  » link
• 3. Stetler CB, Brunell M, Giuliano KK, Morsi D, Prince L, Newell-Stokes V. Evidence-based practice and the role of nursing leadership. J Nurs Adm. 1998;28(7-8):45-53.
• 4. Chambers LW. Evidence based healthcare: how to make health policy and management decision. Can Mad Assoc J. 1997;157(11):1598-9.
• 5. Medeiros LR, Stein A. Níveis de evidência e graus de recomendação da medicina baseada em evidências. Revista AMRIGS. 2002;46(1,2):43-6.
• 6. Grimes DA, Schulz KF. An overview of clinical research: the lay of the land. Lancet. 2002;359(9300):57-61.

Publication Dates

• Publication in this collection
  11 Dec 2008
• Date of issue
  Oct 2008