Difficulties using EBP

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_FNG_

PT, DPT, OCS
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So it is obvious why we should have research to help guide our decisions in the clinic but it seems like such a struggle at times. For example, systematic reviews are the highest level of support in the hierarchy of evidence but most of them, at least the ones i've reviewed, come to no definitive answer.

Another thing that I struggle with is external validity when asking if a patient that received the intervention is too heterogenous then the patient that sits in front of me (hypothetically) for the results to hold merit.

What I'm guessing is research needs to be supported with clinical experience in making decisions but since I have little experience (student) i've only got only research and authoritive guidance.

I'd love to hear from other students and clinicians on how they handle this subject. EBP is challenging but is the cost of seperating ourselves from therapeutic touch and such.

EDIT: And how frustrating is it when searching for articles when you can only get the abstract, grrr

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Remembering back in my student days, I certainly recall your frustration. Groups like Cochrane often conclude 'more research is needed' basically providing a regression towards the mean for every review. From the standpoint as a researcher, meta-analysis does provide a nice list references and general framework of completed works which can be handy. There are other benefits, but I don't think they can be applied as easily to everyday practice questions.

As a clinician, I continually use various types of research to guide decision making. Literature can improve your effectivness if used regularly & correctly. If I'm seeing someone I suspect has cervical radiculopathy, I want to use tests which best support or refute the diagnosis. Same goes for treatment, and the rest of the clinical process.

In terms of the art of practice there is still lots of leeway, and there always will be based on experiences, training, psychomotor skills, etc.. PTs out there are still frequently using ultrasound on a variety of injuries. Referring providers still request ultrasound despite abundant research on it being equivalent to placebo. The bottom line is EBP will never make skilled physical therapy like a cookbook. (Only those who are afraid of research and don't understand it will tell you so.)

As for reading only abstracts--doesn't your school library give you acess to full text?!
 
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