Living and Role Modelling Evidence-Based Practice

Original Editor - Wanda van Niekerk based on the course by Benita Olivier

Top Contributors - Wanda van Niekerk, Jess Bell and Vidya Acharya  

Introduction

Evidence-based practice (EBP) in healthcare plays a pivotal role in clinical training, research and rehabilitation practices. It operates as a problem-solving method where research evidence guides clinical reasoning and decision-making. Every aspect of the evidence-based practice model is significant, and instead of applying each element in isolation, the emphasis lies on the collective application of these aspects to substantiate a clinical decision.

The definition of evidence-based practice has evolved over time. Along with the integration of research, clinical expertise and patient values and circumstances, it is also necessary for the healthcare professional "to consider characteristics of the local and broader practice context.” Thus, it is not only about research. It is also about the skills, education and experience of a clinician, as well as the patient and their values, circumstances, preferences and clinical status. Furthermore, the clinician needs to consider the availability of resources, policies, and cultural and socioeconomic factors in the decision-making process. Hoffman et al. explain this eloquently: “This requires judgment and artistry, as well as science and logic.”

Review of the Evidence-Based Practice Steps

Step 1: Determining the patient’s needs to formulate a clinical question

• You can review this step here: Evidence-Based Practice and Patient Needs
• Make use of the PICOT mnemonic to formulate your clinical question when searching for the best available treatment option.

PICOT mnemonic to use in formulating a clinical question

P (Patient / Population)	I (Intervention)	C (Comparator)	O (Outcome)	T (Type)

• When formulating a clinical question to determine which outcome measure to use, make use of the P, O and T columns of the PICOT mnemonic

Step 2: Locating the knowledge resources

• If you'd like to review this step, you can have a look at Locating the Knowledge Sources in Evidence-Based Practice
• Suggested order for locating knowledge resources:
  1. Look for information on a synthesised, evidence-based platform
  2. Look for a clinical practice guideline
  3. Look for a systematic review
  4. Look for primary studies

Note: Remember to download and save the relevant papers in a safe place so that you can easily find them again.

Step 3: Appraising the quality of the knowledge resources

• If you'd like to review this step in detail, you can have a look at Appraising the Quality of Knowledge Resources.
• Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Table
• For information on how to determine which study type was used, please see this downloadable PDF by Jeremy Howick about study designs
• See here for a list of websites with critical appraisal checklists: Critical appraisal

Step 4: Discussing the options with the patient

• Please see Discussing the options with the patient to review some important points on discussing options with the patient
• Remember that each discussion with a patient will be different as each patient has their own unique context; use this step to build a relationship with your patient and to create a safe space.

Step 5: Formulating the treatment plan

• Plan your treatment, be willing to adapt and always reconsider, reflect and revise

Step 6: Implementing the treatment plan

• Review key considerations when formulating and implementing the treatment plan here: Formulating and Implementing the Treatment Plan

Step 7: Evaluating the effectiveness of the treatment plan and the evidence-based practice process

• If you'd like to review this step, you can have a look at Evaluation

You can review how to use evidence-based practice to decide on an outcome measure here. Please also see the Allied Health Professions (AHP) Outcome Measures UK Working Group's Key questions to ask when selecting outcome measures: a checklist for allied health professionals to help you appraise the quality of an outcome measure.

Making Evidence-Based Practice Part of Your Life

Implementing Evidence-Based Practice

• Work on your evidence-based practice skills – you know best where you lack the necessary skills
• Make time – time is a big barrier to evidence-based practice
  • Try to overcome this barrier in a creative and innovative way that works for you
• Remind yourself of the evidence-based practice process – put it up where you can see it daily, make it a habit
• Live evidence-based practice – find opportunities to share the evidence-based practice model with others

Empowering Others

Share what you have learned with others. Here are some examples of ways to do this:

• Organise journal clubs or case discussions
  • Join in these if they already exist at your specific setting
  • Actively contribute to these sessions
  • If there are no journal clubs – start one – be the change!
  • Journal clubs can be online or in-person
    • Join the Rehabilitation Community by USAID and ReLAB-HS here. The site is free to use, and it only takes a few moments to sign up. Once you are signed up, there is a journal club (as well as other groups) that you can join and have discussions with other rehabilitation professionals.
    • Xia et al. reported that the integration of journal clubs promoted students' confidence in evidence-based practice skills.
• Write blog posts
  • Suggestions for blog posts:
    • Share some valuable websites that you have discovered
    • Share what you have learned from the evidence-based practice process
    • Highlight how you followed the evidence-based practice process with a specific case
    • Share some of the new skills that you gained
• Make videos
  • Find platforms where you can be interviewed, record techniques, share outcome measures, and showcase the brilliant new skills that you have acquired
• Podcasts
  • Contribute to podcasts as an expert or as an interviewer
• Contribute to courses and / or webinars, partner with organisations or associations and share your knowledge
• Publish case studies