Evidence Based Practice

As healthcare providers, it is imperative to stay up-to-date on current research and best practices; and update our clinical approaches and interventions accordingly. This requires the consistent reading of journal articles related to one’s area of practice, reflective thought regarding the findings, and incorporation of the findings as appropriate into clinical practice, referred to as Evidence-Based Practice (EBP).

Healthcare agencies are increasingly demanding the utilization of EBP to strengthen outcomes and improve services. Insurance companies are also beginning to request literature that supports the efficacy of interventions and tying this to reimbursement.

Systematic reviews and meta-analyses are the most sought after literature to justify the efficacy of interventions. In a systematic review, all of the studies on a particular intervention are synthesized to determine the current state-of-the-art regarding the intervention (e.g., common outcomes and themes found throughout the studies). A meta-analysis also synthesizes findings from all of the studies on a particular intervention, but it utilizes  statistical methods to combine the results from all of the studies to determine the state-of-the-art regarding the intervention.

The Knowledge Translation Action Cycle

To identify the best available evidence and apply it to practice, the therapist follows the “Knowledge Translation Action Cycle” (see graphic below).

STEP 1 – Identify the Problem: Clearly identify the specific topic to be explored.

STEP 2 – Knowledge Inquiry: Search the literature to find the best available evidence on the topic. Click here to learn more about the hierarchy of research design

STEP 3 – Knowledge Synthesis: Synthesize the finding from the identified studies.  Click here to learn how to conduct a synthesis of the literature

Note: Prior to synthesizing the knowledge, find out if a systematic review or meta-analysis has already been conducted on the topic of interest. In addition to searching for systematic reviews and meta-analyses on this site (RT Wise Owls), you can also explore other open-access websites. Here are a few:

Agency for Healthcare Research and Quality

ASHA Systematic Reviews

Bandolier

Campbell Systemic Reviews

Center for Evidence Based Practices at Case Western Reserve University

Centre for Reviews and Dissemination at the University of York

Child Development & Rehabilitation Evidence Centre

Child Life Council

Clinical Evidence

Cochrane Summaries

Early Childhood Technical Assistance Center

Evidence Alerts from BMJ

Evidence for Policy & Practice Information (EPPI Centre)

Essential Evidence Plus

Evidence Based Medicine

Evidence-Based Review of Moderate to Severe Acquired Brain Injury

Evidence Based Review of Stroke Rehabilitation

National Center for Post Traumatic Stress Disorder

National Guideline Clearinghouse

National Institute of Corrections

National Institute for Health & Care Excellence (NICE)

National Rehabilitation Information Center

Natural Medicines Comprehensive Database (Complementary, Alternative & Integrative Therapies)

NeuroCognitive Communication Lab

Nursing Plus

Rehab Plus

OT Seeker

PEDRO

PsychBITE

PubMed Clinical Queries

Spinal Cord Injury Rehabilitation Evidence (SCIRE)

Substance Abuse and Mental Health Services Administration

SUMSearch 2

The National Professional Development Center on Autism Spectrum Disorders

The University of York Centre for Reviews and Dissemination

TRIP Database

What Works Clearinghouse

World Health Organization Institutional Repository for Information Sharing (WHO IRIS)

STEP 4 – Adapt Knowledge to Local Context: Assess the values, usefulness, and appropriateness of the knowledge to the particular setting and circumstances, and customize accordingly.

STEP 5 – Assess Barriers and Knowledge Use: Assess for barriers that may limit the application of the knowledge so that these barriers may be targeted by intervention strategies (e.g., need for increased direct treatment time with clients).

STEP 6 – Select, Tailor, and Implement Interventions: Select, tailor, and execute interventions to implement the knowledge (develop a “Knowledge Translation Plan” – see the “Home” tab to view Knowledge Translation Plans developed by students), as well as promote awareness of the knowledge to others.

STEP 7 – Monitor Knowledge Use: Measure for desired changes in level of knowledge, understanding, attitudes, and/or changes in behavior or practice of the clinicians.

STEP 8 – Evaluate Outcomes: Measure whether application of the knowledge has improved the identified outcomes (e.g., decreased depressive symptoms).

STEP 9 – Sustain Knowledge Use: Plan and manage changes to the implementation strategies (the “Knowledge Translation Plan”) in response to the ever-evolving environment, context, and barriers by cycling back through the action cycle.

KT cycle

Webinars on Evidence Based Practice

The Center on Knowledge Translation for Disability and Rehabilitation Research (KTDRR) created a FREE Webinar Series titled “Systematic Review: From Evidence to Recommendations”. Click here to access the webinars.