With the shift to CMS values-based model, attention to quality care can be maximized by implementing evidence based knowledge for continual improvements toward patient outcomes with occupational therapy, physical therapy, and speech therapy treatments.
We recently discussed the basics and barriers of evidence based practice for therapists. In this article, we will expand on the basics and describe how you can take evidence to action through a 5 step process.
A paper by Bennet and Bennet provides a clear process in implementation for therapists, which is outlined briefly below.
Below you will see a practical 5-step process for evidence based practice.
Featured Image Credit: Department of Health Library Service
At the center of the circle lies the patient context, which encompasses the individual person, their preferences and values, along with the environment the therapy is conducted in.
With this in mind, the process begins with asking appropriate questions.
STEP 1: Asking Clinical Questions
As therapists dealing with a diverse range of situations, there could be many instances where new information is required to help resolve patient problems.
Bennet and Bennet suggest that questions predominantly land in three areas of concern:
- Treatment/ Prevention
Some of the basic questions to ask in each area may include:
- What performance issues does my patient have?
- Which test can be used to measure and how should data be interpreted?
Many questions regarding diagnosis can be answered through conversation with the patient and from patient history, assessments, observation, experience and reasoning.
- What choice of therapy treatment is most effective?
- How can my choice of treatment be implemented for higher outcomes?
- Are there difficulties associated with my choice of treatment?
- How can risk factors be addressed?
- How can I inform the patient to minimize risk factors in future?
- What are the likely outcomes of selective treatments?
- What is the expected timeline for this clinical course of action?
- What are the consequences or complications with the patient’s situation and how can they be managed?
Expanding Questions for Search
When a gap in knowledge arises, the need for additional information can be turned into a clinical question to help focus your search for answers.
Focused questions usually fall in four broad areas:
- Around the patient or problem
- About a selective treatment or indicator
- Regarding an outcome measurement
- Regarding comparison of treatments/ outcomes
Bennet and Bennet provide an expanded list of questions you might consider.
STEP 2: Search
Your next step is to search peer-reviewed journals to identify appropriate information – see our list of the best journal resources over here.
STEP 3: Critical Appraisal
The ability to think critically about the quality, validity and significance of the evidence is a skill that can be learned.
Here are some free resources for learning critical appraisal skills:
- Critical appraisal skills program
- Critical appraisal tools and worksheets
- Printable checklist for appraising reviews
- Understanding different study designs
STEP 4: From Evidence to Action
The main question that arises once you have more information is: What does all this mean for the patient?
Always keeping the patient context and context of therapy in mind, further questions may include:
- Do these results apply to my patient?
- Or how could they apply?
- Do the outcome measures suit my objectives?
- Can this be implemented into treatment?
- How can I build this into my treatment process?
Your task is to assimilate the information and implement your new knowledge into clinical practice.
STEP 5: Evaluation
Implementing a process for evaluation is also important as it helps you identify gaps in skills and implementation in practice. And more than that, the process of evaluation usually leads to more questions, which promotes the cycle of evidence based practice for continuous improvements.
Being informed with evidence based knowledge that answers a wide range of questions, not only improves your skills as a therapist, but helps you communicate and inform patients so they can understand, plan, cope and engage more effectively with their own treatment plan.
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