PT as a critical inquirer new edited.pptx

PT as a critical inquirer new edited.pptx

1. Physical Therapist as Critical Inquirer 1 SYED ZAIN UL ABIDIN DPT,MSPT,CHR(IPMR,KMU)

2. What's meant by critical inquiry? History of critical inquiry Foundation for physical therapy Evidence based practice Steps in evidence based practice Some idea about the data sources Diagrammatic flow chart showing how EBP is implemented?? Objectives of this presentation 2

3. S cientific methods to read and interpret professional literature ; P articipate in, plan, and conduct research; evaluate outcomes data ; A ssess new concepts and technologies .(on experimental basis) What’s meant by critical Inquiry?? 3

4. Since day 1, physical therapy has recognized the importance of critical inquiry . In 1921 AWPA stated the importance of scientific investigation. 3 rd Edition of Therapeutic Exercise and Massage,( 1932 ) was introduced, because of clinical research in pathology. THE HISTORY OF CRITICAL INQUIRY 4

5. In 1975 Helen Hislop lamented that physical therapy is still infant. According to him a gap exist between Physical therapy and clinical research. In 1993 Gary Soderberg addressed that there is dire need for implementation of science in physical therapy. 5

6. In a review of articles in the professional journal Physical Therapy , Robertson noted a lack of evidence and coherence among the articles in three topic areas— knee , back, and electrical stimulation 6

7. According to Robertson the issues are…. Lack of agreement on what physical therapy is and what PTs do Lack of understanding of why physical therapy is necessary Lack of agreement on terms and concepts Lack of clinical literature in the discipline Lack of development of relevant theory Issues in unique body of knowledge!!! 7

8. In 2003 , using the Hedges Project Criteria, it was concluded that 56% of the 179 articles reviewed were original research and the rest were general discussion. only 11% of the articles met the Hedges criteria for high-quality evidence suitable for direct application to patient care. 8

9. Just as with other health care professionals, PTs cannot expect patients and third party payers to accept on blind faith that PTs do good things and people get better. As Wolf asks, “Do our patients improve because of the physical interventions we provide, thus affecting their state of well-being, or do our caring and interaction favorably affect patient behaviors, which subsequently motivates them to improve physically?” 9

10. Over the past 30 years, the American Physical Therapy Association (APTA) has taken major steps to advance the science of the profession, including formation of the Foundation for Physical Therapy , publication of a clinical research agenda , to develop a database for evidence in physical therapy . 10 PEDRO

11. The Foundation for Physical Therapy was established in 1979 to support the research needs of the physical therapy profession in three areas: ● Scientific research , to create a solid platform for future clinical research ● Clinical research , to assess the efficacy of physical therapy interventions and to help define best practice ● Health services research , to assess the effectiveness of physical therapy practice in the emerging health care delivery models THE FOUNDATION FOR PHYSICAL THERAPY: 11

12. The following are some of the foundation’s activities, designed to advance these objectives: ● Assisting clinicians, researchers, and academicians in doctoral programs ● Expanding funding for new researchers ● Supporting clinically relevant research 12

13. is the integration of the best research evidence with clinical expertise and patient values. Best research evidence as clinically relevant research from the basic sciences that leads to accurate and precise diagnosis and prognostic markers, as well as therapeutic Clinical expertise is clinical skills and past experiences Patient values are preferences and concerns Evidence based practice 13

14. 14

15. The popularity of EBP has emerged from clinicians’ realization of the following: ● They need new information on a daily basis. ● They lack the time to find new information. ● Traditional information resources often are out of date, wrong etc ● A disparity exists between clinical judgment, which increases with experience, and “current, relevant” information, which decreases with experience. POPULARITY OF EBP: 15

16. Step 1 : Formulating a well-built question Step 2 : Identifying articles and other evidence-based resources that answer the question Step 3 : Critically appraising the evidence to assess its validity Step 4 : Applying the evidence Step 5 : Re-evaluating the application of evidence and areas for improvement STEPS IN APPLYING EVIDENCE-BASED MEDICINE 16

17. 17

18. 18

19. Remains a matter of controversy Certain physical therapy faculties assume a great deal of responsibility for new knowledge through the academic triad— teaching, scholarship, and service Individual research agendas are more often driven by personal interest and available funding than by the needs of the profession WHOSE RESPONSIBILITY IS RESEARCH?

20. In 1996 , 93.4% of PTs surveyed reported no work-related research activity. In 2001 PTs reported spending an average of 1% of their time each week on research or critical inquiry. ROLES OF THE STAFF PHYSICAL THERAPIST IN CRITICAL INQUIRY

21. The following sections explore five remaining aspects of critical inquiry that do not overlap with the PTs’ other roles (1) Application and Critique of Research (2) Publisher of case reports (3) Collaborator in clinical research studies (4) An assessor of new concepts and technology (5) Research subject Continue….

22. Application and Critique of Research: PTs’ education gives them the skills to practice evidence-based physical therapy . Critique of the literature also is done in journal clubs , which are small groups of practitioners who meet regularly to explore research on a selected topic.

23. Publication of Case Reports: 1. Think . What is the focus of your case? 2. Search the literature. 3. Write : a. introduction (rationale) b. case description c. outcomes d. Reflect on what happened (discussion) 4. Submit the case report for publication in a peer-reviewed publication.

24. Collaboration in Clinical Research: According to Fitzgerald and Delitto , research must be done on patients in clinical settings if the physical therapy profession is to: 1. D ocument the effectiveness of interventions accurately 2. Validate patient classification systems 3. Identify prognostic indicators of functional limitations & disability.

25. Factors which are crucial for clinicians conducting clinical research Research related injuries Maintenance of support Availability of target population Patient management issues Resources Ethical consideration FACTORS

26. Assessment of New Concepts and Technology: The PT should determine whether: 1.The theories underlying the intervention or instrument are supported by valid anatomical and physiological evidence 2. The intervention or instrument is designed for a specific type of patient population 3. Potential side effects are presented

27. 4. Studies from peer-reviewed journals that support the intervention’s or instrument’s efficacy are provided 5. The supportive peer-reviewed studies include well-designed, randomized, controlled clinical trials or well-designed single-subject experimental studies 6. The proponents of the intervention or instrument are open and willing in discussing its limitations

28. Serving as a Research Subject: SERVING AS A RESEARCH SUBJECT Interest Completion of study Participation Research design Value of study

29. APTA Code of Ethics and Guide for Professional Conduct Principle 5 of the code places a duty on the PT to “maintain and promote high standards for physical therapy practice, education, and research .” Section (6.5A) states that a PT “participating in research shall abide by ethical standards governing protection of human subjects and dissemination of results.” ETHICAL AND LEGAL ISSUES IN CRITICAL INQUIRY

30. Section (6.5B) states that PTs to “support research activities that contribute knowledge for improved patient care,” Section (6.5C) directs PTs to report unethical acts “in the conduct or presentation of research.”

31. Other sections of the Guide for Professional Conduct (GPC) and the Code of Ethics (COE) specifically address the issues of truthfulness, autonomy and consent, and compliance with laws and regulations. Using and providing accurate, relevant information are also responsibilities of the researcher.

32. Protection of Human Subjects ( Nuremberg Code) PROTECTION OF HUMAN SUBJECTS Rights of subjects Prohibition of studies Avoidance of injury Disclosure of risks to subjects Voluntary participation Balancing of risks

33. Institutional Review Boards(IRB) Over the past half century, federal regulations to ensure protection of human subjects have developed continually, culminating in the Common Rule of 1991 . IRBs are the mechanism by which institutions determine whether the benefit to society from a research study warrant the risk to individual subjects in the study. An important feature of this process is the use of IRBs to review research before it is implemented.

34. Subjects vs. Patients A patient should reasonably expect that health care providers will attempt to place the individual’s interests first respect confidentiality be truthful disclose relevant information respect individual and cultural differences collaborate with the patient in achieving goals

35. Responsibilities of Clinical Researchers Besides protecting human subjects, PTs who participate in clinical research have a responsibility to report results honestly and accurately to report both positive and negative results to comment constructively on research literature.

36. Ethics and Evidence-Based Practice Investigation of the effectiveness of physical therapy interventions is undeniably necessary and potentially stands to benefit patients, clients, and society. For this reason, most PTs have embraced the concept of evidence-based practice.

37. Critical Inquiry Role in the Ethics Literature Although it has not been explored as extensively as the PT’s role in patient/client management, the critical inquiry role has been the subject of a handful of peer-reviewed articles; from 1970 to 2000, 9.9% of peer-reviewed publications dealt with critical inquiry . Informed consent and protection of human subjects also were frequent topics.

38. Thank you