PowerPoint Presentation

What about when there is no evidence? Clinicians Creating Evidence to Drive Practice Improved patient outcomes

Evidence Based Medicinehttp://www.cebm.net/resources/cebm-presentations/Practicing EBM the 5 AsAsk a clinical questionAcquire the best evidenceAppraise the evidenceApply the evidenceStep 1Assess your performanceStep 2Step 3Step 4Step 5http://www.cebm.net/resources/cebm-presentations/Levels of evidence

Qualityhttp://www.cebm.net/resources/cebm-presentations/What are the barriers to quality research?Study designIRB Sufficient numbersSubject recruitmentSubject retentionControl vs treatment groupRandom allocationEquality of groupsData collectionNormalizing dataRelevance of the dataClinical significanceDONT forget

Statisticshttp://www.cebm.net/resources/cebm-presentations/Measurement - outcomesWhat were the outcomes?PrimarySecondaryWere they appropriate?How were the results reported?Were they significant?

Methods: Outcomes and Resultshttp://www.cebm.net/resources/cebm-presentations/Which outcome measures do you use?http://www.rehabmeasures.org/rehabweb/allmeasures.aspx?PageView=Shared

How often are you seeking out research?PICOCATLit reviewClinical Queries

BMJ VOLUME 311 23-30 DECEMBER 1995JASPA*(Journal associated score of personal angst)J: Are you ambivalent about renewing your JOURNAL subscriptions?A: Do you feel ANGER towards prolific authors?S: Do you ever use journals to help you SLEEP?P: Are you surrounded by PILES of PERIODICALS?A: Do you feel ANXIOUS when journals arrive?

YOUR SCORE? (0 TO 5)* Modified from: BMJ 1995;311:1666-16680 (?liar) 1-3 (normal range) >3 (sick; at risk for polythenia gravis and related conditions) http://www.cebm.net/resources/cebm-presentations/10The story of the continuing education course

What about anecdotal evidence?

Why dont you find out for yourself?Action research- clinicians answering their questions

Action research- BackgroundBegan in EducationA method for teachers to investigate ways to enhance their teachingCyclical process of Developing a planImplementing proceduresCollecting dataAnalyzing resultsModifying the planAction research vs. clinical practiceAction ResearchRecognize a needDeveloping a planImplementing proceduresCollecting dataAnalyzing resultsModifying the plan

Clinical practiceEvaluateDevelop and plan of careImplement interventionsCollect dataAnalyze results of careModify the treatment care plan

Please discuss- At your table, discuss with others:1. A clinical question you have or have had2. A method of answering that question3. a method of assessing the outcome4. What you will do with the information once you have it

I feel like an active warm-up may be better than heat and ESIm going to try warming my knee patients up on a bike instead of heat/ESPatients are excited that they could possibly reduce pain at home with their own recumbent bikePatients like it. Are there improved outcomes?Let me check my outcome questionaires and visits/patientI do seem to be getting better results in fewer visits. Maybe I should market that!

CliniciansPatients and clientsHealth Care FacilitiesHealthAdapted from Action Research. A Guide for the Teacher Researcher25Components of action researchKey ConceptExampleAction research is participatoryYou find an area in your practice that you feel could be better.Action research is socially responsive and takes place in contextPeople start asking you more about a new fad (crossfit). You want to figure out if it is beneficial to your patients.Action research helps clinicians examine the everyday, taken-for-granted ways in which they carry out professional practiceYou commonly use handouts for home exercises. You wonder if compliance would be better with videosKnowledge gained can liberate clinicians, patients, and systems and enhance treatment, practice and policy making.It turns out that your efforts in preventing injuries at the local high school has produced increased referrals to your clinic.A Practical (recent) ExampleObservationDr. K volunteers his time at the local high school coaching soccer. The girls coach came to him yesterday worried about her team because she has had 5 girls on her varsity team next year who have torn their ACL. They may not be able to play next school season.ActDr. K collects some dataThe girls season starts with games prior to the first day of schoolSchools cannot hold tryouts until the last week of July providing only a week of practice before games beginHe surveys the girls about their summer activity levels and training schedules, outside of soccerHe investigates which positions these girls play, with the suspicion that they are forwards and defenders, making their running more sporadic and high velocityHe investigates what type of warm up is utilized and what conditioning/training is implementedPlan changeDr. K finds various injury prevention programs that have had good success in reducing ACL injury ratesFIFA- PEPJUMPSPORTSMETRICSImplementationDr. K teaches the team and coach to implement the FIFA 11+ programHe also collaborates with the high school athletic trainer to check in on proper form and implementation of the program at each practice and gameCollect dataDr. K tracks injuries that season to see if there are fewer ACL injuriesDr. K performs pre-season testing of drop jump performance of both the JV and Varsity teamsHe again performs post-season Drop jump assessment to observe quality of movement in each girlHe develops a rating scale (or finds one) to determine who is at greater risk due to landing mechanics.He advises those at greater risk to come into the clinic for further training to decrease their riskAssessDr. K assesses if the program implementation has improved the health of his clients with fewer ACL injuries as well as reduced risk of ACL tear. He modifies the program as neededHe now approaches the various club teams that these girls play on in the spring to continue the program in the off season.Why should I do Action Research?Youre already doing it

The goal is to improve how you are doing things

You patients will appreciate you for advancing their care

You will be more productive

You will stand out in your field

You may be the new guru of the latest technique