Evidence-based practice (EBP) is the integration of these the best research evidence, clinical expertise, and patient values and the act of putting them all into practice using clinical reasoning skills. Each of these components are equally as important in the final decision made in a care plan. Most clinical decisions begin in the Research circle, as they should. PT's would not be licensed clinicians without an education built on hard evidence. Honestly, if "Patient Values" is skipped, there is a serious disconnect in the relationship.
Physical therapists graduate as generalists and learn the research. Then they use the rest of their skills learned and experience to help in making the best decision....but the best decision is not made without considering everything about the patient in front of them.
The definitions of the 3 circles:
Best Evidence: the best research available from expert opinion (the lowest valued) to systematic reviews and meta-analyses (highest valued). This is where clinicians start.
Clinical Expertise: physical therapist's experience, education, continuing education, opinion, and judgment in clinical practice. These are things learned with experience and pulled from education. The skills range from communication to the credentials by their name.
Patient Values: the patient's personal wants and needs, motivational factors, expectations, cultural concerns, personal values. This is "all aspects of the patient." What do they need? what are they willing to do or not do? How do they learn? What do they expect? What is their story?
Without patient values, the clinical decision is made with just what the PT knows and what the research says.
Without research, the clinical decision is made off whatever the PT learned and has seen and patient preference.
Without clinical expertise, the clinical decision is made with whatever the majority of research has found, and what the patient wants.
This diagram is adapted from Scatterfield et al. (2009) and is what is taught in school.
I always start with evidence, but I never forget to consider clinical expertise, and I make it a point to learn patient values FIRST. Once you've experienced a session properly set up for you, I promise you will experience what it means to have a PT that is COMMITTED to you, your goals, and your experience.
Start today with a consult!
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