Definition Of Evidence-based Practice Research Articles

Navigating complexities: clinicians’ experiences and systemic challenges in the implementation of evidence-based practice for chronic low back pain – a qualitative study

Purpose Implementation of evidence-based practice (EBP) for chronic low back pain (CLBP) is poor. This study aimed to investigate the factors that influence exercise-based clinicians’ implementation of EBP for people with CLBP. Materials and Methods Semi-structured interviews were conducted with 40 clinicians (20 physiotherapists and 20 accredited exercise physiologists). Interviews explored clinicians’ definition of EBP, understanding of EBP in CLBP management, barriers and enablers to EBP, and the impact of these factors on EBP implementation. Interviews were analysed using reflexive thematic analysis. Results A complex interplay among clinician factors, systemic factors, and patient interactions was identified. Clinicians encountered challenges stemming from their misconceptions about EBP, which influenced their perspective(s) on its implementation. Clinicians expressed the challenges of implementing EBP when navigating patient expectations and beliefs, experiencing external pressures from funders and business models, and the subsequent impacts on their well-being. Continuing professional development, support from community, and workplaces that prioritised EBP enhanced clinicians’ ability to make decisions that accommodate for the complexities of CLBP and better align with EBP. Conclusion A variety of factors impact exercise-based clinicians’ implementation of EBP. The interaction between these factors greatly influences clinicians’ ability to engage in and implement EBP in clinical practice.

Co-Design of an Evidence-Based Practice Continuing Education Course for Canadian Naturopathic Doctors.

Objectives: Evidence-based practice (EBP) is a clinical decision-making process combining the best available scientific evidence with clinician expertise and patient preference. While EBP has been associated with a range of benefits, it is recognized that EBP is used suboptimally by a range of health professionals, including naturopathic doctors (NDs). Canadian NDs have expressed a high level of interest in opportunities to improve their EBP skills; however, barriers exist, including those that apply broadly to health professionals, and those that are unique to the naturopathic profession. The objective of the present project was to co-design an EBP continuing education (CE) course tailored to the needs and preferences of Canadian NDs. Design: These needs were solicited through the use of focus groups. Groups were stratified based on participants' use of evidence at baseline. The focus groups asked NDs about their definition of EBP, and their interest in an EBP course, including preferred content, and method of delivery. The focus group discussions were transcribed, and thematic analysis was completed. Subjects: Twenty-two Canadian NDs participated. Results: Participants reported a high level of understanding of EBP, a high level of interest in participating in an EBP course and provided actionable recommendations about course content and delivery. Some of the themes that emerged were consistent across the groups while others differed by stratification. Conclusions: The findings of this project will inform the development and evaluation of a future CE course.

A Survey of Speech-Language Pathologists' Understanding and Reported Use of Evidence-Based Practice

PurposeThe purpose of this study was to assess speech-language pathologists' (SLPs) understanding and self-reported use of evidence-based practice (EBP). The study also investigated SLPs' opinions toward and barriers to EBP.MethodSLPs (n= 176) from across the United States participated in an online survey designed to assess their understanding and self-reported use of EBP. Participants were recruited via each state's speech-language-hearing association.ResultsA majority of participants were able to identify part of the American Speech-Language-Hearing Association's definition of EBP, but only a small percentage was able to accurately identify the complete, three-part definition. Similarly, most participants could discern between high and low levels of evidence but could not accurately rank all levels. Of a variety of listed sources, participants self-reported the least amount of knowledge for accessing college, university, public, and medical libraries, including online databases through these libraries. American Speech-Language-Hearing Association resources were reported as the most frequently accessed source. Participants self-reported that EBP is beneficial and important but that engaging in EBP can be difficult. The largest barrier to engaging in EBP was lack of time during the workday to stay up-to-date on research. Finally, although participants self-reported a lack of employer-led training in EBP, a majority also self-reported that employers value EBP in the workplace.ConclusionResults suggest SLPs may benefit from increased training on EBP and more time during the workday to engage in EBP. Employers, administrators, and supervisors should consider providing increased training on how to access and utilize peer-reviewed databases. The use of EBP will allow SLPs to improve their clinical practices and provide higher quality treatment to their clients.

Evidence-Based Practice in Mission: A Method for Establishing Best Practices and Achieving Desired Goals

Decision making and strategy in missions can be elusive tasks. The presence of experts and careful planning may not assure the establishment of best practices. The purpose of this article is to introduce evidence-based practice (EBP) as a proven method for establishing best practices in the mission enterprise. I will provide (1) a definition of EBP, (2) the process for establishing an EBP, (3) the value of EBP and its contribution to the mission enterprise and the fulfillment of mission goals, and (4) the problem of bias and barriers, which challenges the implementation of EBP.

Guideline orthodoxy and resulting limitations of the American Psychological Association's Clinical Practice Guideline for the Treatment of PTSD in Adults.

This article introduces the special issue in which we explore problems and limitations inherent both in the development and implementation of the American Psychological Association's (APA) Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults. As Chair (Christine A. Courtois) and member (Laura S. Brown) of the guideline development panel, we were in a unique position to observe how certain decisions made by the APA regarding how this guideline should be produced led to flaws in the final product. In this special issue, we address problems that may be inherent in many clinical practice guidelines for psychotherapists. Our authors explore the importance of a more ecologically-informed model for such guidelines, one that would take into account the body of research on the psychotherapy relationship, psychotherapy process, and a broad range of psychotherapy outcomes. We end with recommendations APA might take to generate future clinical practice guidelines that are well-founded in APA's own definitions of evidence-based practice, and more attuned to APA's increasing attention to the specialized concerns of clients who come from socially marginalized groups. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

What's the Task Value? Understanding Doctor of Physical Therapy Students' Perceptions of the Value and Relevance of Evidence-Based Practice

Background and Purpose. The profession of physical therapy requires clinicians to value and use evidence-based practice (EBP) in their decision-making process with patients. Although EBP has been incorporated into doctor of physical therapy (DPT) curricula for 2 decades, a gap between knowledge and practice persists. As a first step to addressing this gap, academic programs can focus on fostering students' valuing of EBP and research methods. The current method/model set out to achieve this with task value (TV) as the theoretical basis. Task value is a theory of motivation based on four constructs: intrinsic value (IV), cost, attainment, and utility. Based on the TV theory, the purposes of this method/model were to (1) clarify students' definition of EBP in clinical practice; (2) explicitly link “EBP/Research Methods” and their future role as a clinical practitioner; and (3) further students' understanding of EBP and research methods by providing an opportunity for them to practice these skills. Method/Model Description and Evaluation. Eighty-one, third-year DPT students enrolled in a 6-year, entry-level DPT program participated in the “EBP/Research Methods” course. The educational intervention incorporated a course advanced organizer to illustrate assignment linkages, a graphic that provided an overview that illustrated the EBP process in the clinic, EBP assignments, an interactive student response system to uncover students' knowledge and understanding in real time, and article critiques, which underscored the value and importance of EBP. Evaluation consisted of a 10-question online survey, with 7 questions designed to measure the four constructs of TV. Two reflective papers were used to identify students' definition of EBP; perceived costs to use in a clinical setting; and course activities that impacted students' understanding of EBP. The survey and reflective papers were administered before and after course intervention. Outcomes. Paired t tests were conducted on the seven questions related to the TV scale. Overall, mean values of IV of EBP reported on the presurvey were high and did not change significantly postsurvey. However, the cost measure decreased significantly from pre- to postsurvey P < .00, as did the measures of attainment (P = .001) and utility (P = .002). Qualitative data revealed that the contributors to perceived costs of learning about EBP included the following: lack of clinical experience, fear of challenging authority, lack of access to medical literature, and lack of time. Discussion and Conclusion. Although students generally reported a high level of IV for EBP that did not change significantly after the course, their perception of cost, attainment value, and utility value decreased significantly. These changes may have been due to students' increased understanding of EBP/Research Methods, which resulted in their perceiving greater cost. Educators may expect this response as students discover that EBP is complex and has an ongoing learning process. More positive perceptions may occur once students gain clinical experience. Pedagogical models must systematically and longitudinally target improvement of student value and motivation for using EBP. Recognition that EBP is a continuous process is critical to its development in students and practicing clinicians.

Physiotherapists’ Perception of Evidence-Based Practice

Introduction: Evidence-Based Practice (EBP) and Research Utilization (RU) were introduced to physiotherapy more than two decades ago. Physiotherapists with their professional responsibility to provide the best care, will find practical evidence-based physiotherapy a veritable goldmine of useful information. Recently, evidence-based physiotherapy, as a means to improve the quality of physical therapy intervention, has become an interesting topic for the researchers all over the world. However, few studies have researched EBP in Iranian community of physiotherapists. This study was conducted to investigate the perceptions and experiences of EBP among Iranian physiotherapists and the resources of evidence for a duration of 8 months, from 2015 to 2016. Material and Methods: In this qualitative study, 15 physiotherapists holding at least a BSc. degree and with two years of relevant work experience, participated. Purposeful sampling method was used to recruit the samples. The data were collected via semi-organized in-depth interviews. Content analysis was used to analyze the data according to Cheevakumjorn’s method. Results: The collected data were divided into two groups containing the definition of EBP and evidence resources for physiotherapists. The participants were divided into two groups. The first group contained the physiotherapists who became familiar with EBP at university. The contributors who had not passed this course at university were included in the second group. The first group provided more detailed definitions and implemented evidence into their clinical work with greater certainty. The data related to the nature of evidence were put into 4 subgroups; experiences of colleagues, acquired knowledge, therapist’s experience, and obtained knowledge through the patients. Conclusion: Most physiotherapists participating in this study were somewhat familiar with EBP. Since there are some impediments such as poor clinical training, lack of role models during university education, weak research skills and critical evaluation of research, as well as ignoring the importance of life-long learning, most physiotherapists are not able to fully apply evidence in their clinical practice. A comprehensive program for educating the physiotherapists can be an effective method to improve the physiotherapists’ overall level of knowledge as well as the quality of the health care services they provide.

Use of online training modules for professional development with school-based therapists: Outcome project

ABSTRACTThis evidence-based project provided a professional development opportunity for school-based therapists to gain knowledge about evidence-based practice and learn strategies to integrate newly learned knowledge for the purpose of becoming an evidence-based practitioner. The purpose of the project was to determine whether a six-module online course about evidence-based practice would increase school-based occupational therapists’ knowledge of evidence-based practice. Current literature reveals that teaching allied health professionals about evidence-based practice increases their knowledge about this topic. Literature also supports the use of online teaching as an effective tool for learning about evidence-based practice. Through web-based delivery, participants viewed six narrated PowerPoint presentations at individually convenient times. Results, measured by discussion forum responses and pre- and postsurveys, indicated that six lessons of contextually based, online learning was an effective means to teach 15 postgraduate school-based OTs about evidence-based practice. After the training, all participants’ knowledge of evidence-based practice increased. All participants reported an increase in using evidence-based practice to make decisions about student goals and benchmarks. Knowledge of research findings and knowledge of professional literature was considered more useful in day-to day-work. Participants’ knowledge and preparedness to incorporate evidence-based practice into their work settings increased. Perceptions of 10 out of 13 barriers to evidence-based practice were reduced after the intervention. After training, 13 out of 15 participants modified their definition of evidence-based practice to include consideration of their clients’ motivations and desires. This reflected a more holistic understanding of evidence-based practice.

Advancing the Scientific Foundation for Evidence-Based Practice in Clinical Child and Adolescent Psychology

Evidence-based practice (EBP) has become a central focus in clinical child and adolescent psychology. As originally defined, EBP in psychology is the integration of the best available research evidence, patient characteristics, and clinical expertise. Although evidence-based perspectives have garnered widespread acceptance in recent years, there has also been some confusion and disagreement about the 3-part definition of EBP, particularly the role of research. In this article, we first provide a brief review of the development of EBP in clinical child and adolescent psychology. Next, we outline the following 4 points to help clarify the understanding of EBP: (a) knowledge should not be confused with epistemic processes, (b) research on clinician and client factors is needed for EBP, (c) research on assessment is needed for EBP, and (d) the 3-part conceptualization of EBP can serve as a useful framework to guide research. Based on these principles, we put forth a slightly revised conceptualization of EBP, in which the role of research is expanded and more clearly operationalized. Finally, based on our review of the literature, we offer illustrative examples of specific directions for future research to advance the evidence base for EBP in clinical child and adolescent psychology.

Clinical errors that can occur in the treatment decision-making process in psychotherapy.

Clinical errors occur in the psychotherapy decision-making process whenever a less-than-optimal treatment or approach is chosen when working with clients. A less-than-optimal approach may be one that a client is unwilling to try or fully invest in based on his/her expectations and preferences, or one that may have little chance of success based on contraindications and/or limited research support. The doctor knows best and the independent choice models are two decision-making models that are frequently used within psychology, but both are associated with an increased likelihood of errors in the treatment decision-making process. In particular, these models fail to integrate all three components of the definition of evidence-based practice in psychology (American Psychological Association, 2006). In this article we describe both models and provide examples of clinical errors that can occur in each. We then introduce the shared decision-making model as an alternative that is less prone to clinical errors.

The Consistencies and Vagaries of the Washington State Inventory of Evidence-Based Practice: The Definition of "Evidence-Based" in a Policy Context.

As states increasingly establish the importance of evidence-based practice through policy and funding mandates, the definition of evidence-based practice can have a significant impact on investment decisions. Not meeting established criteria can mean a loss of funding for established programs and the implementation disruption of programs without a strong research base. Whether the definition of "evidence-based" is influenced by these high stakes contexts is an interesting question that can inform the larger field about the value and utility of evidence-based practice lists/inventories for disseminating knowledge. In this paper we review the development of the Washington State Inventory of Evidence-Based, Research-Based and Promising Practices as a case study for the process of defining evidence-based practice in a policy context. As part of this study we also present a comparison of other well-known evidence-based practice inventories and examine consistencies and differences in the process of identifying and developing program ratings.

On Research-Minded Practitioners

McBeath and Austin define the concept of research-minded practitioners, describe the organizational contexts, structures, and strategies for supporting this type of practitioner. Further, the authors propose a research agenda to establish effective organizational development strategies to support research-minded practitioners, align their efforts with organizational improvement processes, and culminate in new directions for practice research. This response to McBeath and Austin disagrees with their characterization of evidence-based practice, their definition of practice research, and their conceptualization of the research-minded practitioner as something different from an evidence-based practitioner. While McBeath and Austin are commended on their analysis of organizational barriers to research-minded practice, the redundancy of the concept of research-minded practice is questioned by reiterating commonly held definitions of evidence-based practice.

The Art of Practicing with Evidence

This article reviews the definition of evidence-based practice and promotes an expansive view of the kinds of evidence available to the practitioner. It suggests that art and science are intertwined in practice, and describes the process of balancing and incorporating evidence derived from multiple sources, including the findings of research, the cumulative experience and wisdom of the practitioner, and the values and preferences of clients.

Evidence-Based Practice and Research: The Challenge for Transplant Nursing

Despite the initiative for nurses to engage in evidence-based practice and research, little is known about transplant nurses and the role they play in research and evidence-based practice in nursing care. The definition of evidence-based practice and research and how it relates to the role of the transplant nurse, the facilitators and barriers to research and evidence-based practice, and the implications for the future of research and evidence-based practice in transplant nursing are addressed.

Evidence-based practice and research: the challenge for transplant nursing

Despite the initiative for nurses to engage in evidence-based practice and research, little is known about transplant nurses and the role they play in research and evidence-based practice in nursing care. The definition of evidence-based practice and research and how it relates to the role of the transplant nurse, the facilitators and barriers to research and evidence-based practice, and the implications for the future of research and evidence-based practice in transplant nursing are addressed.

Athletic Training Educators' Knowledge, Comfort, and Perceived Importance of Evidence-Based Practice

Context: Before new strategies and effective techniques for implementation of evidence-based practice (EBP) into athletic training curricula can occur, it is crucial to recognize the current knowledge and understanding of EBP concepts among athletic training educators. Objective: To assess athletic training educators' current knowledge, comfort, and perceived importance of evidence-based concepts. Design: Cross-sectional survey design. Setting: Online survey instrument. Patients or Other Participants: 141 respondents (28.3% response rate) from a convenience sample of 498 athletic training educators. Main Outcome Measure(s): Demographic information and knowledge, comfort, and perceived importance of 11 EBP concepts (definition of EBP, steps of EBP, reliability, validity, intra-class correlation coefficient, kappa coefficient, specificity, sensitivity, likelihood ratio, positive predictive value, negative predictive value) were obtained. Results: Participants' overall EBP knowledge score was 64.4%. Characteristics associated with higher knowledge scores were terminal degree (69.92% ± 10.36, P < .001), hours of research per week (66.96% ± 12.61, P = .029), and hours of teaching-related tasks conducted per week (67.47% ± 12.48, P = .002). Overall EBP comfort was 2.37/4.0 (“uncomfortable”). Characteristics associated with higher comfort scores were terminal degree (2.51 ± 0.67, P = .017), hours of research per week (2.52 ± 0.69, P = .025), and EBP workshops previously attended (2.56 ± 0.66, P = .002). Overall EBP perceived importance was 3.34/4.0 (“important”). The characteristic associated with higher importance scores was hours of research per week (3.44 ± 0.45, P = .009). Conclusions: Athletic training educators' current knowledge of EBP concepts needs to be improved. This study indicates that athletic training educators are uncomfortable with evidence-based concepts, yet believe it is important for curricular implementation. The future development of workshops and teaching models should focus on the varying levels of EBP concepts. Distinguishing modes for curricula implementation might also be an effective way to increase knowledge, comfort, and perceived importance levels.

Critical care: does profusion of evidence lead to confusion in practice?*

There have been a plethora of articles on evidence-based practice or its many derivative terms (evidence-based nursing, evidence-based medicine, evidence-based health care, etc.). However, the word 'based' implies an almost unquestioning belief in evidence. I will argue that the term 'Evidence Informed Practice' is probably more accurate. This argument will be underpinned by Archie Cochrane's 'road to Damascus' questioning of the value of soft over hard interventions and challenge what is held up as gold-standard evidence. The differences in definitions of evidence-based practice will also be discussed. Carper's identification of ethical, aesthetic and personal knowing will be used to debunk the myth that empirical evidence is always the gold standard for care and treatment. It will be argued that empirical evidence can be ignored when it clashes with other types of evidence. Finally, the tension between certainty and agreement with evidence will be explored.

Black cat, white cat: a pragmatic and collaborative approach to evidence‐based social work in China

Current thinking suggests that evidence‐based practice (EBP) is a key to unlocking the potential for social work development in mainland China. But Chinese social workers may be confronted by the challenges of EBP in using research evidence, exercising expert judgment, as well as considering client characteristics, as social work is a relatively new enterprise in China's unique social–economic–political context. There is little indigenous research evidence for Chinese social workers to refer to. There are few experienced social workers and researchers since social work practice, education and research were reinstated only in the late 1980s. Mainland Chinese may not be aware of what social workers can do and may prefer authority‐based practice. This paper aims to first review the definition of EBP, followed by a discussion of the challenges and opportunities in applying EBP to social work in China. It then highlights the usefulness of collaboration between academics, practitioners, and clients in implementing EBP. A recent research project on ex‐offenders and their family members in Singapore is used to illustrate the feasibility of collaboration between academia and the field. 当前的理论认为， 以证据为本的实践是一个解开中国大陆社会工作重新发展潜能的钥匙。 然而， 中国社会工作者在运用研究证据、行使专业判断及考虑服务使用者的特质时， 或许会遇到实证为本的挑战， 因为在中国独特的社会、经济及政治环境下， 社会工作是一个相对地新兴的专业， 没有太多本土化的研究证据可供中国社会工作者参考。 同时， 因为社会工作实践、教育及研究在1980年代末期才得以复苏， 也没有太多富有经验的社会工作者及研究人员。 中国内地民众或许未曾意识到社会工作者能够做什么， 宁可依据以权威为本的实践。 本文的主要目的首先是检视以证据为本的实践的定义， 然后讨论在中国应用以证据为本的实践的挑战及机遇。 文章突出了在引用以证据为本的实践时， 学术界、前线工作者及服务使用者相互合作的益处。 藉一项在新加坡进行的前刑事犯人及其家人的近期研究成果， 以说明学术界与社会工作界合作的可行性。

Evidence-Based Practice: A Primer for Action

Although evidence-based practice (EBP) began as a challenge to the medical profession in the early 1970s, the concept has since been embraced by nursing and other health care professions. Although it is clear that the process of placing evidence into practice will continue to be refined, the mandate to do so is clear. The purpose of this article is to present a brief history of the definition of EBP, describe some of the more well-known models of knowledge translation, discuss some of the commonly agreed-upon steps in the EBP process, and present some resources that might be useful for readers.

Views of Evidence-Based Practice Among Faculty in Master of Social Work Programs: A National Survey

Objective: A national online survey assessed the views of 973 faculty members in master of social work programs regarding their receptivity toward, definition of, and views of disparate sources of evidence pertinent to evidence-based practice (EBP) and the teaching of EBP. Method: Due to Internet-related technical difficulties, the response rate could not be precisely determined; however, it was at least 33% and conceivably much higher. Results: Although the large majority (73%) of respondents expressed a favorable view toward EBP, disparities are identified among respondents in both the definition of EBP and views regarding the EBP research hierarchy. Conclusion: Efforts appear to be needed to increase agreement regarding the definition and conceptualization of EBP among educators, with special attention to divergent views regarding what constitutes sufficient evidence to guide practice decisions or to convey that an intervention is evidence-based.