Guide To Evidence-Based Physical Therapist Practice / Edition 2

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Guide to Evidence-Based Physical Therapist Practice provides readers with the information and tools needed to appreciate the philosophy, history, and value of evidence-based practice, understand what constitutes evidence, search efficiently for applicable evidence in the literature, evaluate the findings in the literature, and integrate the evidence with clinical judgement and individual patient preferences and values. This unique handbook marries the best elements of multiple texts into a single accessible guide.

The Second Edition has been updated throughout with new references and expanded information on key topics. There are two new chapters: Appraising Evidence about Clinical Prediction Rules and Appraising Evidence about Self-report Outcomes Measures. The new edition is divided into four sections that break down the research process, this user-friendly text also includes key terms, learning objectives, exercises, diagrams and worksheets, and useful appendices. This is a comprehensive resource no physical therapist or student should be without.

Updates to the Second Edition:

New chapter on Appraising Evidence About Clinical Prediction Rules
Chapter 10 is expanded to help readers understand the differences in critiquing evidence about diagnostic tests v. evidence about clinical measures
Chapter 13 is split into two chapters – Appraisal of Evidence About Outcomes Research and Appraisal of Evidence About Self-Report Outcomes Measures
Additional patient case examples in Chapter 18: Putting it All Together (Chapter 15 in the 1st edition)
Revised worksheets for easier documentation of findings during evidence appraisal process
Updated information and screen shots for data base search engines

Instructor Resources Include: Sample Syllabus, PowerPoint Slides, Image Bank, and Answers to End of Chapter Questions

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Editorial Reviews

Doody's Review Service
Reviewer: Charles R. Wolfe, III, PT, DPT, DAC. (U.S. HealthWorks Medical Group, Inc.)
Description: This is an extensive update of a book on the fundamental research methods vital to the evidence appraisal process as applied to the patient/client management model in physical therapy practice. It is the only book that integrates fundamental research methods into clinical practice. The previous edition was published in 2010.
Purpose: The author's stated goal is to teach the knowledge and skills necessary to evaluate evidence and apply these to physical therapist practice. With the current emphasis on evidence-based practice throughout healthcare, a book of this scope is relevant and important for novice and experienced clinicians. The author has filled a critical void in the market with this book, and with the extensive revisions and updates to this edition, it continues to remain current and relevant.
Audience: Its format makes this book equally beneficial for students and experienced clinicians. It follows a logical progression, starting with a definition of the principles of evidence-based practice, followed by a description of features that enhance or diminish the qualities of a research study. Readers are then educated on how to determine whether evidence is useful to them and guided through the process of applying evidence to their own practice patterns. Experienced clinicians who may be less conversant with evidence-based practice can easily learn the material. The author has spent her 25-year career as a clinician, educator, and administrator. More recently she founded a company helping rehabilitation practices to demonstrate their value to consumers, referral sources, and payers by leveraging their patient and practice data. She also is a program director for a university-based health policy certificate program.
Features: The 19 chapters are grouped into four separate sections on principles of evidence-based physical therapist practice; elements of evidence; appraising evidence; and evidence in practice. Each chapter begins with clearly stated learning objectives, essential terminology, and with 6-10 concluding questions strongly correlated to the learning objectives. Tables and figures in a two-color format highlight important concepts. Chapters 9 and 10 exemplify the author's ability to simplify confusing and complex concepts, giving readers an appreciation of statistical significance balanced against clinical relevance. The book also includes an access code to an accompanying website with additional learning/review resources including flashcards, an interactive glossary, practice quizzes, web links, and screenshots of electronic databases from chapters 3 and 19. All are excellent supplements to the book.
Assessment: This excellent book has particular relevance to the evolving profession of physical therapy and is a timely update of the previous edition. It is an excellent adjunct to other established books, such as Evidence-Based Medicine: How to Practice and Teach It, 4th edition, Straus et al. (Elsevier, 2011), Critical Evaluation of Research in Physical Rehabilitation: Towards Evidence-Based Practice, Helewa and Walker (Saunders, 2000), and Foundations of Clinical Research: Applications to Practice, Portney and Watkins (Prentice Hall, 2008).
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Product Details

  • ISBN-13: 9780763777654
  • Publisher: Jones & Bartlett Learning
  • Publication date: 8/23/2010
  • Edition description: 2
  • Edition number: 2
  • Pages: 468
  • Sales rank: 1,405,531
  • Product dimensions: 7.00 (w) x 8.90 (h) x 1.00 (d)

Table of Contents



Part I Principles of Evidence-Based Physical Therapist Practice

Chapter 1 Evidence-Based Physical Therapist Practice 3

Introduction 5

Evidence-Based What? 6

Evidence-Based Physical Therapist Practice 7

Evidence-Based Physical Therapist Practice Focus Areas 8

The Process of Evidence-Based Physical Therapist Practice 10

Summary 12

Exercises 12

References 14

Chapter 2 What is Evidence? 17

Introduction 18

General Characteristics of Desirable Evidence 19

Forms of Evidence 20

Research Designs: Overview 20

Research Designs: Timing 24

Research Designs: What is the Question? 25

Hierarchies of Evidence 25

Limitations of Evidence Hierarchies 29

Summary 29

Exercises 30

References 30

Chapter 3 The Quest for Evidence: Getting Started 33

Introduction 34

Formulating Clinical Questions 34

Background Questions 35

Foreground Questions 35

Questions About Diagnostic Tests 36

Questions About Clinical Measures 36

Questions About Prognostic Factors 36

Questions About Interventions 38

Questions About Clinical Prediction Rules 38

Questions About Outcomes and Self-Report Outcomes Measures 39

Searching for Evidence 39

Determine Which Database Will Be Most Useful 39

Identify Search Terms to Enter into the Database 40

Use the Database Features to Streamline the Search 40

Be Prepared to Reformulate the Question 41

Aim for the Highest Quality Evidence Available 42

Electronic Databases for Evidence-Based Physical Therapist Practice 42

U.S. National Library of Medicine: PubMed 42

Search Limits 42

Medical Subject Headings (MeSH) 43

General Keyword Search 47

Search History 48

Clinical Queries 50

Related Articles 52

"My NCBI" 52

PubMed Tutorials 54

Cumulative Index of Nursing and Allied Health Literature (CINAHL) Plus with Full Text 54

Cochrane Library 55

Physiotherapy Evidence Database (PEDro) 60

American Physical Therapy Association's Hooked on Evidence 63

Other Databases and Services 69

Summary 70

Exercises 71

References 72

Part II Elements of Evidence

Chapter 4 Questions, Theories, and Hypotheses 77

Introduction 78

The Research Question 78

Background 79

Literature Review 81

Citations of Epidemiologic Data 82

Theories, Concepts, and Constructs 82

Hypotheses 86

Summary 88

Exercises 88

References 89

Chapter 5 Research Design 91

Introduction 93

General Features of Research Designs 94

Philosophical Approach 94

Design Format 95

Number of Groups 95

Degree of Control 95

Time Elements 96

Research Question 97

Research Designs for Questions About Diagnostic Tests and Clinical Measures 97

Methodological Studies of Clinical Measures 99

Research Designs for Questions About Prognostic Factors 100

Cohort Designs 100

Case-Control Designs 102

Other Designs for Prognostic Indicators 102

Research Designs for Questions About Interventions 102

Experimental Studies 103

Quasi-Experimental Studies 106

Research Designs for Clinical Prediction Rules 108

Research Designs for Outcomes Research 109

Methodological Studies About Self-Report Outcomes Measures 110

Secondary Analyses 112

Systematic Reviews 113

Meta-Analyses 114

Qualitative Studies 114

Summary 115

Exercises 116

References 117

Chapter 6 Research Subjects 121

Introduction 123

Subject Identification 124

Subject Selection 126

Probabilistic Sampling Methods 126

Nonprobabilistic Sampling Methods 128

Subject Management Within the Study 131

Random Assignment Methods 131

Nonrandom Assignment 132

Other Subject Management Issues 133

Sample Size 133

Summary 134

Exercises 134

References 135

Chapter 7 Variables and Their Measurement 137

Introduction 140

Variables 140

Independent Variables 140

Dependent Variables 142

Extraneous Variables 142

Other Terminology Related to Variables 144

Measurement 144

Levels of Measurement 144

References Standards in Measurement 146

Measurement Reliability 148

Instrument Reliability: Reproducibility (or Test-Retest Reliability) 148

Instrument Reliability: Internal Consistency 149

Instrument Reliability: Parallel Forms 150

Instrument Reliability: Split-Half 150

Rater Reliability 150

Measurement Validity 150

Face Validity 151

Content Validity 151

Construct Validity 151

Convergent Validity 152

Discriminant Validity 152

Criterion Validity 153

Concurrent Validity 153

Predictive Validity 153

Responsiveness to Change 154

Floor and Ceiling Effects 154

Interpreting Change 155

Summary 155

Exercises 155

References 156

Chapter 8 Research Validity 159

Introduction 161

Research Validity 162

Threats to Research Validity 162

Threats to Research Validity of Intervention Studies 163

Threat 1 Assignment 163

Threat 2 Attrition 164

Threat 3 Compensatory Equalization of Treatments 165

Threat 4 Compensatory Rivalry or Resentful Demoralization 165

Threat 5 Diffusion or Imitation of Treatment 166

Threat 6 History 166

Threat 7 Instrumentation 167

Threat 8 Maturation 168

Threat 9 Statistical Regression to the Mean 169

Threat 10 Testing 170

Threats to Research Validity in Studies About Other Components of the Patient/Client Management Model 170

The Role of Investigator Bias 174

Additional Solutions to Research Validity Threats 176

Threats to Construct Validity 177

External Validity 178

Summary 179

Exercises 179

References 180

Chapter 9 Unraveling Statistical Mysteries 181

Introduction 183

Descriptive Statistics 185

Distribution of the Data 185

Subject Characteristics 192

Parametric Statistics 193

Tests of Differences 194

Tests of Relationships 195

Effect Size 200

Nonparametric Statistics 200

Additional Statistics in Evidence-Based Physical Therapy 210

Statistical Importance 210

p Values 210

Confidence Intervals 211

Power 212

Clinical Relevance 212

Summary 213

Exercises 213

References 219

Part III Appraising the Evidence

Chapter 10 Appraising Evidence About Diagnostic Tests and Clinical Measures 223

Introduction 225

Diagnostic Tests 225

Study Credibility 226

Additional Considerations 229

Study Results 229

Reliability 229

Validity 230

Sensitivity 231

Specificity 232

Receiver Operating Characteristic Curves 233

Positive Predictive Value 236

Negative Predictive Value 236

Likelihood Ratios 236

Using Likelihood Ratios in Practice 237

Evaluating a Diagnostic Test: Calculations Based on Study Results 239

Practical Use of Likelihood Ratios 240

The Statistical Importance of Study Results 242

Final Thoughts About Diagnosis in Physical Therapy 243

Clinical Measures 243

Study Credibility 244

Study Results 245

The Statistical Importance of Study Results 245

Evidence and the Patient/Client 245

Summary 252

Exercises 252

References 253

Chapter 11 Appraising Evidence About Prognostic (Risk) Factors 255

Introduction 256

Risk of a Future Adverse Event 257

Ultimate Outcomes 257

Results from Physical Therapy Interventions 258

Elements of Prognosis 258

Study Credibility 259

Additional Considerations 262

Study Results 262

The Statistical Importance of Study Results 265

Evidence and the Patient/Client 266

Summary 269

Exercises 269

References 270

Chapter 12 Appraising Evidence About Interventions 271

Introduction 273

Study Credibility 274

Additional Considerations 278

Issues Related to Research Designs in Intervention Studies 279

Study Results 280

Treatment Magnitude: Continuous Data 280

Treatment Magnitude: Dichotomous Data 281

The Statistical Importance of Study Results 285

Evidence and the Patient/Client 286

Minimal Clinically Important Difference 287

Number Needed to Treat 287

Practical Considerations 288

Summary 290

Exercises 296

References 297

Chapter 13 Appraising Evidence About Clinical Prediction Rules 299

Introduction 301

Study Credibility 302

Clinical Prediction Rule Derivation 303

Clinical Prediction Rule Validation 305

Additional Considerations 306

Study Results 307

The Statistical Importance of Study Results 308

Evidence and the Patient/Client 308

Summary 312

Exercises 312

References 312

Chapter 14 Appraising Outcomes Research 315

Introduction 317

Outcomes Research 317

Study Credibility 320

Additional Considerations 324

Study Results 324

The Statistical Importance of Study Results 325

Evidence and the Patient/Client 325

Summary 326

Exercises 326

References 329

Chapter 15 Appraising Evidence About Self-Report Outcomes Measures 331

Introduction 333

Important Clinimetric Properties 333

Other Circumstances 337

Study Results 337

Initial Survey Development 338

Reliability 338

Validity 339

Responsiveness 339

Interpretability 339

The Statistical Importance of Study Results 340

Evidence and the Patient/Client 340

Evidence Appraisal Tools 340

Summary 344

Exercises 344

References 345

Chapter 16 Appraising Systematic Reviews and Clinical Practice Guidelines 347

Introduction 349

Systematic Reviews 349

Study Credibility 353

Study Results 357

Reporting Formats 358

The Meaning of Study Results 367

Clinical Importance 368

Evidence and the Patient/Client 369

Clinical Practice Guidelines 372

Is the Guideline Valid? 374

Is the Guideline Applicable? 377

Summary 378

Exercises 378

References 379

Part IV Evidence in Practice

Chapter 17 Patient/Client Preferences and Values 385

Introduction 386

Patient-Centered Care 387

Ethical Considerations 388

Informed Consent and Shared Decision Making 391

Preferences, Expectancies, and Values 392

Assessment of Preferences and Values 394

Evidence About Preferences, Expectancies, and Values 396

Summary 398

Exercises 398

References 399

Chapter 18 Putting It All Together 403

Introduction 403

Section One Clinical Case Examples Using Evidence 404

Section Two Using Physiologic Studies as Evidence 439

Article 1 440

Article 2 442

Article 3 443

Therapist's Decision 443

Summary 444

References 444

Appendix A 445

Appendix B 449

Appendix C 451

Appendix D 457

Index 459

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