EvidenceBased Decisions NATA Journals Reviewer Workshop 2018 New Orleans LA June 26 2018 EvidenceBased Practice Progress and Failures Craig R Denegar PhD PT ATC FNATA 2 A Model for ID: 1036094
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1. “Writing So That Clinicians Can Make Appropriate,Evidence‐Based Decisions”NATA Journals Reviewer Workshop 2018New Orleans, LAJune 26, 2018
2. Evidence‐Based Practice: Progress and FailuresCraig R. Denegar, PhD, PT, ATC, FNATA2
3. A Model for Evidence-Based Clinical Decision MakingRELEVANTRESEARCHEVIDENCEPATIENT’SPREFERENCES& ACTIONSCLINICALEXPERTISEPATIENT’S CLINICAL PRESENTATION & CIRCUMSTANCESHanynes RB, et al: Clinical expertise in the era of evidence-based medicine and patient choice. EBM. 2002;7:30-38.Evidence-Based Practice: Progress & Failures3
4. What is evidence-based medicine?“It's about integrating individual clinical expertise and the best external evidence”“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”Evidence based medicine: what it is and what it isn't. Sackett DL, Rosenberg WMC, Muir Gray JA, Haynes RB, Richardson, WS. BMJ 1996;312:71 Evidence-Based Practice: Progress & Failures4
5. Editorial: Clinical Education Reform and Evidence-Based Clinical Practice Guidelines“The athletic training profession is in the midst of substantial educational reform. Changes in the structure of clinical education are an important component of that reform.”“Demonstrating that what is done in clinical practice truly makes a difference in the outcome of patients' health care is a daunting challenge to researchers and clinicians alike. This challenge is being addressed across medical and allied medical disciplines through the development of evidence-based clinical practice guidelines.”Denegar CR, Hertel J. Editorial: Clinical Education Reform and Evidence-Based Clinical Practice Guidelines. J Athl Train. 2002 Apr-Jun; 37(2): 127–128. Evidence-Based Practice: Progress & Failures5
6. ProgressThe paradigm of evidence-based practice has infiltrated athletic training education, continuing education and athletic training language Evidence-Based Practice: Progress & Failures6
7. FailureParaphrasing an introductory comment from an attendee of an EATA workshop“ I often read the literature (Journal of Athletic Training) but it really hasn’t changed how I practice”Evidence-Based Practice: Progress & Failures7
8. Missing connectionResearch reports in the medical literature (including JAT) report sample differences. The training of most athletic training scholars is grounded in “frequentist” (hypothesis testing) teaching. We treat individuals!The responses of individuals vary despite receiving the same treatment for the same diagnosis.We often interpret “significant” and being equal to “clinically important” Evidence-Based Practice: Progress & Failures8
9. Connecting the evidence to the practiceAsk – are the outcomes reported meaningful to the patient and provider?How much change in the outcome measured would be considered meaningful?What is the shift in probability or odds of achieving a change that is meaningful when comparing one intervention to another?Evidence-Based Practice: Progress & Failures9
10. The goal – communicating with a patient in a meaningful manner - examplesThe probability of sustaining another ankle sprain is reduced from 1 in 4 to 1 in 12 patients when they complete the recommended plan of care The odds of achieving a ≥ 6° increase in dorsiflexion range of motion are 5.3:1 when posterior talar mobilization is provided following an acute lateral ankle sprain. Evidence-Based Practice: Progress & Failures10
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13. RealityCertainty in achieving a health outcome is rare.Probability and odds convey likelihood of success (or failure) for the individualEvidence-Based Practice: Progress & Failures13
14. SuccessSuccess in focusing on the individual (patient) rather than the sample of patients is needed if the clinical research is truly going to help the clinician integrate the best-available evidence into patient-care recommendations and decisions The promise of the evidence-based practice paradigm for improving the outcomes of healthcare is dependent on this shift in focus. Reviewers and editors are keys in guiding (forcing) the focus of authors on what their mean for each individual patientEvidence-Based Practice: Progress & Failures14
15. Thank you!!!Evidence-Based Practice: Progress & Failures15