Introduction to Scientific Evidence.pptx

Introduction to Scientific Evidence

1. Introduction to Scientific Evidence Rajesh K. Yadav Assistant Professor School of Health and Allied Sciences, Pokhara University 27/08/2025 BPT-251:Part:B-rky 1

2. Course Objectives Understand scientific evidence, its importance and access of the evidence; Search evidence from the reliable sources; Understand parts of an article and information to be included within an article; and Understand need and ways of result dissemination. 27/08/2025 BPT-251:Part:B-rky 2

3. Introduction Scientific evidence is  evidence that serves to either support or counter a scientific theory or hypothesis. Scientific evidence is made up of data and observations carefully collected in a lab or in the field. It is important because it provides the basis for objective and unbiased explanations of the natural world. 27/08/2025 BPT-251:Part:B-rky 3

4. Contd.. Two kinds of data is collected- qualitative and quantitative. Qualitative data involves making observations and then writing and sometimes drawing descriptions of those observations. Quantitative data involves numerical information obtained by counting or measuring and doing calculations. 27/08/2025 BPT-251:Part:B-rky 4

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6. Hierarchy of Scientific Evidence 27/08/2025 BPT-251:Part:B-rky 6

7. Importance of Evidence in Physiotherapy Patients are increasingly demanding information about their disease or clinical problem and the options available for treatment. Evidence helps to e nsures patients receive treatments that are scientifically proven and effective. Promotes faster recovery and better health outcomes. 3 . Reduces the risk of ineffective or outdated therapies. Enhances patient confidence in the quality of care. 27/08/2025 BPT-251:Part:B-rky 7

8. Contd.. 4. Provides personalized treatment by considering individual needs and preferences. 5. Many patients have access to a wide range of information sources, but not all of these sources provide reliable information. It i mproves overall patient satisfaction and safety. 27/08/2025 BPT-251:Part:B-rky 8

9. In short, scientific evidence is important to Enhance treatment efficacy Scientific evidence allows physiotherapists to choose interventions that have been rigorously tested and proven effective, leading to better patient recovery and optimized outcomes. 2. Improves patient safety By relying on validated research, physiotherapists minimize the risk of harm caused by outdated or ineffective techniques, ensuring safer treatment practices. 27/08/2025 BPT-251:Part:B-rky 9

10. 3. Support professional growth Engaging with scientific research promotes continuous learning and critical thinking, equipping physiotherapists to adapt to advancements in the field. 4. Build professional credibility Evidence-based practice builds trust among patients and other healthcare providers, reinforcing the physiotherapist's role as a knowledgeable and reliable member of the healthcare team. 27/08/2025 BPT-251:Part:B-rky 10

11. Need of Scientific Evidence To maintain standardization and consistency in service delivery – Scientific evidence provides a standardized framework, ensuring consistency in care delivery across different practitioners and settings. 2. Support in informed decision making – It also need for the informed decision making of treatment choices. Evidence-based practice offers a robust foundation for explaining and supporting clinical decisions. Physiotherapists need to justify their treatment choices to patients, insurers, and healthcare teams. 27/08/2025 BPT-251:Part:B-rky 11

12. 3. Provide patient centered care – Evidence-based practice empowers physiotherapists to educate patients on the benefits and rationale of their interventions, fostering trust and collaboration. Patients today expect transparent and effective treatment plans. 4. Optimizing resources – In resource-constrained healthcare systems, evidence-based physiotherapy ensures efficient use of time, equipment, and effort by focusing on interventions with the highest success rates. 27/08/2025 BPT-251:Part:B-rky 12

13. 5. Adaption of innovation/advancement: Advances in medical technology, rehabilitation science, and biomechanics require physiotherapists to stay updated. Scientific evidence helps integrate these advancements into clinical practice. 27/08/2025 BPT-251:Part:B-rky 13

14. Evidence Evidence is the results of research used to support decision making and can be broadly categorized into two main categories in evidence based practice.: 1. Filtered information (Secondary) 2. Unfiltered information (Primary) 27/08/2025 BPT-251:Part:B-rky 14

15. Sources of scientific evidence Generally, there are two types of sources in the science or while generating the evidence : Primary sources Secondary sources 27/08/2025 BPT-251:Part:B-rky 15

16. Primary sources Primary sources are documents that provide full description of the original research. For example, a primary source would be a journal article where scientists describe their research on the human immune system. No external appraisal or interpretation provided 27/08/2025 BPT-251:Part:B-rky 16

17. Secondary sources A secondary source would be an article commenting or analyzing the scientists' research on the human immune system. O ften make recommendations for practice. These are considered the highest quality of evidence 27/08/2025 BPT-251:Part:B-rky 17

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19. Example of Primary sources Conference Papers Correspondence Dissertations Diaries Interviews Lab Notebooks Notes Studies or Surveys Technical Reports Theses 27/08/2025 BPT-251:Part:B-rky 19

20. Example of Secondary sources Criticism and Interpretation Dictionaries Encyclopedias Government Policy Guide to Literature Handbooks Law and Legislation Monographs Moral and Ethical Aspects Political Aspects Public Opinion Reviews Social Policy Tables

21. Level of evidence

22. Filtered evidence: Level I: Evidence from a systematic review of all relevant randomized controlled trials. Level II: Evidence from a meta-analysis of all relevant randomized controlled trials. Level III: Evidence from evidence summaries developed from systematic reviews Level IV: Evidence from guidelines developed from systematic reviews Level V: Evidence from meta-syntheses of a group of descriptive or qualitative studies Level VI: Evidence from evidence summaries of individual studies Level VII: Evidence from one properly designed randomized controlled trial Unfiltered evidence: Level VIII: Evidence from nonrandomized controlled clinical trials, nonrandomized clinical trials, cohort studies, case series, case reports, and individual qualitative studies. Level IX: Evidence from opinion of authorities and/or reports of expert committee

23. Domains that influence EB decision-making Clinical Expertise Research Evidence Patient Preferences Clinically relevant, patient centred, research about: Diagnosis Prognosis Interventions The ability to use our clinical skills and past experience to rapidly identify each patient's unique health state and diagnosis, their individual risks, the benefits of potential interventions, and their personal values and expectations . The unique preferences, concerns and expectations of each patient EBM EBM. Sackett et al 1996

24. Evidence Based Alliance? Clinical Expertise Research Evidence Patient Preferences EBM Are our patients always able to judge what is best for them? Do we always use our clinical experience to improve our patient’s lives? A lot of research is not aimed at improving the lives of patients!

25. 26 Evidence Pyramid From: The Medical Research Library of Brooklyn, http://servers.medlib.hscbklyn.edu/ebm/2100.htm Applicable to toxicology, environmental health, food safety, vaccine development, etc…

26. 27 RCTs Cohort Studies Case-Control Studies Descriptive Studies, Case Series & Reports Ideas, Editorials, Opinions Systematic Reviews & Meta-analyses [Perhaps also Meta-syntheses of qualitative studies?] Evidence Pyramid Adapted from: The Medical Research Library of Brooklyn , http://servers.medlib.hscbklyn.edu/ebm/2100.htm

27. 28 Evidence Matrix Research Question Qualitative Research Survey Cross- Sectional Case-control Studies Cohort Studies Quasi- Experimental Studies Non Experimental Evaluations RCTs Systematic Reviews Effectiveness Process of Service Delivery Salience Safety Acceptability Cost Effectiveness Appropriateness Satisfaction with the Service Petticrew M, Roberts H. Journal of Epidemiology and Community Health, 2003

28. Evidence in Nepalese context The Evidence-Based Policymaking (EBP) process in Nepal is rife with poor practices where often policymakers are portrayed as perpetrators for such practices. N eed to think of the EBP as a two-sided coin where both research pull and research push play equally significant roles.

29. 1 . Systematic Reviews and Meta-Analyses ( Highest Level of Evidence) Limited in Nepal, but some exist, particularly in public health, maternal and child health, and nutrition. Example: Systematic reviews on WASH interventions and their impact on child health outcomes in Nepal. 2. Randomized Controlled Trials (RCTs) Few high-quality RCTs are conducted due to logistical, financial, and ethical challenges. Some RCTs have been done in health interventions, such as maternal nutrition supplementation and sanitation programs. Example: RCTs on community-led total sanitation (CLTS) interventions.

30. 3. Cohort Studies (Longitudinal Studies) Increasing but still relatively rare due to resource constraints. Used in public health, environmental health, and education research. Example: Longitudinal studies on stunting and malnutrition in Nepalese children. 4. Case-Control Studies: More common, especially in epidemiological and health-related research. Example: Studies on risk factors for diarrheal diseases in urban and rural Nepal.

31. 5. Cross-Sectional Studies: Most common type of research in Nepal, especially in WASH, health, and social sciences. Provides valuable but lower-level evidence due to lack of causality. Example: KAP (Knowledge, Attitude, and Practice) studies on menstrual hygiene management. 6. Qualitative Research (Interviews, Focus Groups, Ethnographic Studies) Increasingly recognized for policy and program evaluations. Example: Qualitative assessments of barriers to accessing safe drinking water in remote Nepal.

32. 7. Case Studies and Expert Opinions (Lowest Level of Evidence) Often found in government reports, NGO assessments, and academic commentaries. Example: Case studies on disaster response effectiveness in post-earthquake Nepal. Challenges in Achieving High-Level Evidence in Nep al Limited funding for large-scale RCTs and cohort studies. Lack of national research databases for systematic reviews. Geographical and socio-economic diversity affecting research generalizability. Ethical and logistical constraints in conducting experimental studies.

33. Challenges in Achieving High-Level Evidence in Nepal Limited funding for large-scale RCTs and cohort studies. Lack of national research databases for systematic reviews. Geographical and socio-economic diversity affecting research generalizability. Ethical and logistical constraints in conducting experimental studies.

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