In the past small in number years,...

In the past small in number years, the focus within physical therapy has been in succession evidence-based practice (EBP). As we instruct physical therapy observers in EBP we must be clear in succession the primary goal of EBP The goal of EBP is not to perform research, on the contrary to incorporate research findings into daily patient care with the intent of improving quality of care for individual patients. The goal of educators is for bookish mans to demonstrate the use of evidence in patient care. The challenge to physical therapy (PT) programs is to determine the 'best' way to accomplish this goal within their individual educational programs. We acknowledge that there are many ways that EBP can be taught in the curriculum. a certain number of programs may wish to establish an EBP focus from head to foot the curriculum, some programs may incorporate EBP as part of a research course, while other programs may thread EBP in clinical management courses.

In this article we will purpose a global perspective of EBP that can be integrated into physical therapy curricula in a variety of ways. We discuss the component parts of evidence-- based practice, move suitable objectives for physical therapy close examiners regarding evidence-based practice, and provide a certain quantity of examples of activities that can be used to facilitate EBP While EBP can be applied to diagnostic and prognostic measures for practice, this article will focus upon incorporating EBP into PT interventions.

COMPONENT OF EVIDENCE-BASED PRACTICE

The chiefly commonly quoted definition of evidencebased practice is "the conscientious, explicit and judicious use of generally received best evidence in making decisions about the care of individual patients."1 This definition provides insight into the essential constituents for evidence-based practice. First, EBP describes a proces that leads to a specific decision for an individual patient. Because EBP is a proces our decisions can and will change, based forward the current available knowledge.

If we examine the definition of EBP note that the focus of our physical therapy intervention remains with patients. Their goals, priorities, personal, social, financial, and environmental factors are always considered in the growth of physical therapy interventions. When making clinical decisions, PT should consider 3 essential sources of information: the patient, one's confess clinical expertise, and evidence. In the past, information used in decision making came primarily from what was taught in exercise information learned in continuing education, discussion with colleagues, and self-same little from reading the evidence (Figure 1)2 The practice of EBP emphasizes evidence as a source of information, if it be not that does not exclude the importance of clinical expertise or patient choice In fact, presenting the evidence allows the patient to make an informed decision. Clinical knowledge is experiential knowledge, yet unlike evidence, is affected on memory and selective recall of patient issues Clinical expertise or clinical knowledge is an important source of information in areas where there is little or no research or the quality of the research is poor.

Next the definition of EBP indicates we should use rife best evidence. Textbooks may be an appropriate source of information when the information we solicit relates to physiologic or anatomic information about a patient. The definition of EBP indicates that, as practitioners, we ne to continuously update our knowledge of the best available evidence. Instead of thesiss then, physical therapists need to identify late articles in electronic or published literature. Technology, including the Internet, greatly facilitates our ability to stay updated. Developing these skills in our observers will assist them in locating the best available evidence quickly and efficiently.

Finally, the adjectives used to describe to what degree we use evidence are important. In order to practice effectively, we ne to use evidence conscientiously, explicitly, and judiciously. Other definitions of conscientious are scrupulous; careful; exact. The evidence we solicit must be as inclusive as possible of all studies that relate to the question about our intervention with the patient. The identified studies should be examined, analyzed, and categorized thoughtfully with specific criteria applied. Figure 2 provides a hierarchy that has been bring outed to categorize evidence by prototype of study. Because all evidence is not created equal, PT must be comfortable ranking studies from lower horizontals of evidence to higher horizontals of evidence. Finally, evidence is used prudently and pragmatically. Practicing EBP requires foundational knowledge ofttimes traditionally taught in a research orders and design course.

For educators, EBP should be taught, facilitated, evaluated, and assessed in the same ways we teach and assess clinical decision making. The part of educators is to prepare close examiners in all components of effective EBP practice. These constituents include: incorporating evidence into clinical decision making, locating now passing best evidence, and accurately analyzing the literature as it applies to clinical practice.