EVIDENCE BASED PHYSIOTHERAPY PERTEMUAN 1 ABDUL CHALIK MEIDIAN

EVIDENCE BASED PHYSIOTHERAPY PERTEMUAN 1 ABDUL CHALIK MEIDIAN S 1 FISIOTERAPI – FAKULTAS FISIOTERAPI

VISI DAN MISI UNIVERSITAS ESA UNGGUL

VISI DAN MISI PRODI S 1 FISIOTERAPI VISI Menjadi Program Studi Fisioterapi yang unggul dan terbaik di tingkat nasional serta bersaing di tingkat international dalam pengembangan ilmu, khususnya Manual Terapi, Fisioterapi Olahraga dan Latihan Fungsi tahun 2019. MISI 1. Menyelenggarakan pendidikan fisioterapi yang memiliki kekhususan dalam bidang Manual Terapi, Fisioterapi Olahraga dan Latihan Fungsi yang memenuhi standar pendidikan nasional maupun international. 2. Menyelenggarakan kegiatan penelitian yang sesuai dengan perkembangan keilmuan dan kebutuhan masyarakat 3. Menyelenggarakan kegiatan pengabdian pada masyarakat yang sesuai dengan perkembangan keilmuan dan kebutuhan masyarakat 4. Mengembangkan kerjasama dengan institusi pendidikan, pelayanan, industri dan organisasi dari dalam negeri maupun luar negeri. 3

Materi Sebelum UTS 01. Introduksi EBP and categories 02. PICO Framework and Level of Sci Evidence 03. Clinical Practice Guidlines 04. Cross Cultural Research 05. Guidelines for selection of test 06. Research proses and publication 07. Anatomy of research paper

Materi Setelah UTS 08. Systematic Review & Meta analysis 1 09. Systematic Review & Meta analysis 2 10. Systematic Review & Meta analysis 3 11. Plagiarisme 1 12. Plagiarisme 2 13. Academic Integrity & research misconduct 14. Good Clinical Research Practice

KEMAMPUAN AKHIR YANG DIHARAPKAN • Mahasiswa mampu mengenal konsep EBP dan kategori pertanyaannya

INTRODUCTION : Evidence-based practice • Evidence-based practice is every physiotherapist’s professional responsibility. • Physiotherapist have to know how: – to explain what is meant by evidence-based practice – to provide suggestions about how to ask the right questions – to find and rate evidence and use it to help you make the best decision about patient care

What is evidence-based practice? • Evidence-based practice (EBP) is a systematic process for finding, appraising and applying current best evidence to inform clinical practice.

Current best evidence • Current best evidence is : – ‘up-to-date information from relevant, – valid research about : • the effects of different forms of health care, • the potential for harm from exposure to particular agents, • the accuracy of diagnostic tests, and • the predictive power of prognostic factors’ (NIPH, Oslo, 1996)

The aim of evidence-based practice • The aim of evidence-based practice is : to enable practitioners to make well formed decisions about clinical practice based on the ‘conscientious, explicit, and judicious use of current best evidence’ (Sackett et al 1996). • The practice of evidence-based physiotherapy means : integrating current best research evidence with clinical expertise and patient values (Haynes et al 2002).

Why should we care about EBP? • There are important reasons why clinicians need to be evidence-based practitioners. • These may vary from health system to health system. • However, the concept of ‘evidence-based purchasing’ (Long & Harrison 1996) is now common, even in countries with health systems that are predominantly government funded.

EVIDENCE-BASED PHYSIOTHERAPY • Questions and doubts about treatment decisions or usual practices are a normal part of clinical practice. • Having the confidence and ability to ask and answer these types of questions moves you towards improving the efficiency and effectiveness of clinical practice.

You can begin the process of using evidence to guide practice by asking the following types of questions: 1. 2. 3. 4. 5. 6. 7. 8. What is the best way to assess this problem? What is the best way to treat this problem? What is the rationale for this practice? Could the treatment I deliver be done better, more efficiently, or more cost-effectively? Can I deliver the best treatment with the resources I have (e. g. facilities, expertise)? What evidence supports my decision? What are the clinical implications of delivering this treatment? Have I overlooked an important treatment?

Getting started • The practice of evidence-based health care is usually triggered when a healthcare professional is faced with a patient. • There are six distinct sequential stages of EBP (Table 1. 1)

Formulating a clear question • As a physiotherapist’s time is limited, searching for the best available evidence needs to be efficient and this requires learning the art of building the well structured question. • Physiotherapists’ clinical questions are likely to fall into one of the following categories (see Table 1. 2).

Table 1. 2 Categories of evidence-based practice (EBP) questions with examples (adapted from Sackett DL et al 1997, with permission). Categories of EBP Description question Example What information should I gather, what is the best way to collect that Diagnosis/assessment information and how should I interpret the findings? What is the best way to assess arm function in stroke patients?

Table 1. 2 Categories of evidence-based practice (EBP) questions with examples (adapted from Sackett DL et al 1997, with permission). Categories of EBP question Aetiology Description Example How do I identify the possible causes of a problem? What is the cause of pain in a patient with post stroke shoulder pain?

Table 1. 2 Categories of evidence-based practice (EBP) questions with examples (adapted from Sackett DL et al 1997, with permission). Categories of EBP question Differential diagnosis Description Example When symptoms indicate several potential diagnoses, how do I decide which diagnosis is the most likely? In a young woman presenting with knee swelling, stiffness, pain, crepitus, quadriceps atrophy on examination, pain on compression and resisted extension, what is the most likely cause – chondromalacia patella or osteoarthritis of the patellofemoral joint?

Table 1. 2 Categories of evidence-based practice (EBP) questions with examples (adapted from Sackett DL et al 1997, with permission). Categories of EBP question Description What is the pattern of recovery over Prognosis time and are complications likely? Example My patient had a stroke six days ago. When will they be able to walk?

Table 1. 2 Categories of evidence-based practice (EBP) questions with examples (adapted from Sackett DL et al 1997, with permission). Categories Description of EBP question Therapy What intervention is going to produce the best result for my patient? And is it worth the cost and effort involved? Example What are the effects of physiotherapy based on the Bobath concept for post stroke patients compared to other physiotherapy treatment approaches across a range of outcomes?

Table 1. 2 Categories of evidence-based practice (EBP) questions with examples (adapted from Sackett DL et al 1997, with permission). Categories Description of EBP question Example How can I prevent new problems or secondary Prevention conditions occurring? How can I improve my patient’s health? What is the best method to prevent shoulder pain in patients after stroke?

Table 1. 2 Categories of evidence-based practice (EBP) questions with examples (adapted from Sackett DL et al 1997, with permission). Categories of EBP question Description How can I continue to be an efficient and Self-improvement effective physiotherapist /manager? Example What are the effects of different activities to improve my own knowledge, attitude or skills?

Table 1. 2 Categories of evidence-based practice (EBP) questions with examples (adapted from Sackett DL et al 1997, with permission). Categories of EBP question Description Example What factors motivate or deter The patient’s How can I better individuals from experience/ understand my using outpatient perceptions patient? physiotherapy services?

Other resources • Clinical guidelines See National Guidelines for the Therapeutic Management of Disease States (http: //www. ukmicentral. nhs. uk ) • Critical appraisal questions for different types of research www. cebm. net/critical_appraisal. asp. • Effective health care bulletins Implementation of evidence discussions http: //www. york. ac. uk/inst/crd/ehcb. htm

Other resources • Evaluating quality of primary research of systematic reviews http: //www. phru. nhs. uk/casp/critical_appraisal_tool s. htm#s/reviews • Evidence-based texts http: //www. clinicalevidence. com http: //www. Effective. Stroke. Care. org • How to find the evidence – the basics in a 90 -minute tutorial http: //www. shef. ac. uk/scharr/reswce 3. htm

Other resources • Nursing and allied health tutorial – what is evidence-based practice? http: //www. mdx. ac. uk/www/rctsh/ebp/main. htm • Levels of evidence Centre for Evidence Based Medicine: www. cebm. net/levels_of_evidence. asp Scottish Intercollegiate Guidelines Network (SIGN): www. sign. ac. uk/guidelines/fulltext/50/index. html • OVID – How to search using OVID – an online tutorial http: //www. mclibrary. duke. edu/training/ovid

Other resources • Synopses See Centre for Review and Dissemination (www. crd. york. ac. uk/crdweb) , including: DARE (Database of abstracts of reviews of effects) NHS Economic evaluation database (NHS EED) Health technology assessment (HTA) database American College of Physicians (ACP) Journal Club • Synthesis of primary studies (systematic reviews) See The Cochrane Library: http: //www. cochrane. org/reviews Physiotherapy evidence database (PEDro). (http: //www. pedro. fhs. usyd. edu. au/

Referensi • Lennon, S. Stokes, M. (Ed). 2009. Pocketbook of Neurological Physiotherapy. UK: Churchill Livingstone Elsevier