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Five Steps of evidence-based practice in athletic training

This is an excerpt from Evidence-Based Practice in Athletic Training 2nd Edition With HKPropel Access by Scot Raab,Naoko Giblin.

To use evidence-based practice and retain a patient focus, follow these five steps:³

1. Create a clinically relevant and searchable question concerning your patient.
2. Conduct a database search to find the best evidence.
3. Critically appraise the articles or evidence for quality.
4. Critically synthesize the evidence to choose and implement a treatment.
5. Assess the outcomes by monitoring the patient.

Let’s take a closer look at each of these steps.

• Step 1: The first step is to start with the patient, establish the clinical ­concern, and build a clinical question that centers on solving the issue or treating the ­condition. Further details on developing a clinical research question are presented in chapter 2. In the meantime, remember that the clinical question should be focused and searchable. A question that is too narrow in scope will return limited results. One that is too wide will return excessive information, limiting your ability to incorporate the content into a treatment plan. For example, if you are curious about the ability of ultrasound to facilitate increased tissue extensibility and you are treating an athlete with ITB syndrome, searching for treat ITB with ultrasound may result in few or no results. It is too narrow and specific. If you search for ultrasound treatment, the results will most likely be too wide. A more appropriate approach might be to search for ultrasound AND connective tissue. This would return studies related to ultrasound and its effects on connective tissue. This will not be specific to ITB, but because ITB involves connective tissue, the treatment parameters and outcomes may be similar enough to draw upon for clinical use.
• Step 2: This step pertains to conducting the database search and looking for the best evidence related to the patient’s condition or injury. Chapter 2 explains how to conduct the search (including Boolean modifiers, search engines, and databases), format the question, and conduct the first search. With practice, you will become adept at completing this in minimal time.
• Step 3: Appraise the articles for quality and applicability to your patient.² Chapters 3 through 7 will help you learn how to do this. It is helpful to rate the quality and applicability of the studies you find on these two scales. A study may be of high quality but not applicable to your current patient. For example, consider the effect of low-level laser therapy (LLLT) on tissue healing. The use of LLLT to treat wound healing that had no statistically significant effect would not apply to the use of LLLT to treat hip arthritis. In this example, the study might be well designed but have no relevance to a patient with a tight gastrocnemius. Conversely, a study of the effect of counterirritants on athletes with muscle spasms might be very applicable. However, if the article fails to report subjects’ baseline measures, the inclusion or exclusion criteria, or the type of counterirritant used, it would be considered low quality. Without sufficient data presented in the study, it would be impossible to devise a treatment plan.
• Step 4: This step involves critical processing and synthesizing. Integrating the evidence, your clinical expertise and comfort in performing specific skills, and the values of the patient will form the framework for your treatment plan.
• Step 5: This step returns to the patient. You need to critically evaluate the progress and outcomes, reflecting on steps 1 through 4 and continually aiming to improve outcomes.

More Excerpts From Evidence-Based Practice in Athletic Training 2nd Edition With HKPropel Access

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