Finding Evidence to Support Physical Therapy Clinical Practice: DPT

Min-Lin E. Fang, MLISEducation and Information Consultant for Nursing and Social and Behavioral Sciences

415-476-3397Fang@library.ucsf.edu

2

ObjectivesAfter completing this lecture, you should be able to:

Identify the sources of evidence for primary questions Develop a good search strategy and conduct an

efficient PubMed search using MeSH database Find the highest levels of evidence using PubMed

Clinical Queries and Evidence-Based filters Find evidence using Cochrane, PEDro, CINAHL, TRIP Find evidence-based practice guideline (National

Guideline Clearinghouse)

3

Evidence-Based Medicine The process of systematically finding, appraising, and

using contemporaneous research findings as the basis for clinical decision.

Formulate a clinical question Literature search Evaluate the evidence Implement findings in clinical practice

Rosenberg, William and Anna Donald. Evidence based medicine: an approach to clinical problem-solving. BMJ 1995; 310:1122-1126.

4

Hierarchy of Evidence (Evidence Pyramid) Source: Med Research Library Brooklyn

5

Key Databases for Evidence-Based Physical Therapy Practice

PubMed@UCSF CoChrane Library PEDro TRIP (Turing Research into Practice) CINAHL Hooked on Evidence (APTA)

6

Developing Search Strategies Formulate a well-built clinical question (PICO). Break your question into multiple concepts. Locate the appropriate MeSH (indexed term) for

each concept. Run the search using AND, OR, NOT Apply limit options (date, language, age,

publication type, gender), major headings and subheadings

Modify your search strategies and rerun your search.

7

Boolean Operators (upper case)

ANDCombine different concepts to narrow your search. aged AND women aged women

ORBroaden your search to include similar concepts.HIV OR AIDS AIDS patients

NOTExclude a concept from your search.AIDS NOT hearing aids AIDS patients

8

Searching PubMed: MeSH Terms

Using the MeSH Database to locate MeSH terms; using MeSH terms to increase the precision of your search results

9

When to use Keyword search? New studies not yet indexed

e.g. PubMed – in process PubMed – as supplied by publisher

Do a keyword search and limit search results for the past few months.

search sample: (ACL OR anterior crucial ligament) reconstruction

10

PubMed: Clinical Queries Finding the highest levels of evidence:

systematic reviews and meta-analyses faster and easier

Providing further analysis of randomized controlled trials

Graft choice in ACL reconstruction

11

Setting up Evidence-Based Filters Using my NCBI

Filters help sort search results faster Set up EB filters for systematic reviews,

meta-analyses, RCTs, practice guidelines

12

Set Up EB Filters Using My NCBI Register My NCBI.

Setting up filters for systematic reviews, RCT, meta-analysis, practice guideline and outcomes assessment

Select ‘Filters’ in the far left menu, and then select PubMed.

Select ‘Browse’ to choose specific filters or select ‘Search’ to enter a specific filter.

For example: Select “Search” to look up ‘systematic reviews’. Select Systematic reviews under the matchingfilters list and then check the ‘Add’ box to automatically add systematic reviews as one of your filters.

Go back to ‘Search’ and repeat this with ‘meta-analysis”, “randomized controlled trial”, “practice guideline” and “outcomes assessment.”

13

MyNCBI (Save Search, Updates)

Save search strategies and set up email updates Set up user preferences – highlight search words in your retrieval. Setting up “User Preferences” for color highlighting:

Click “User Preferences” in the far left menu and choose a color for highlighting.

14

Cochrane Cochrane Database of Systematic Reviews Database of Abstracts of Reviews of Effects

(DARE) Cochrane Central Register of Controlled Trials

15

PEDro Physiotherapy evidence-based database,

produced by the Centre for Evidence-Based Phsiotherapy in Australia

Covers RCTs, systematic reviews, clinical practice guidelines in physiotherapy

Trials rated for quality

16

TRIP Searches over 75 sites of high quality

medical information Provides you direct, hyperlinked access to

the evidence-based material on the web as well as articles from premier online journals such as BMJ, JAMA, NEJM and the Lancet

17

CINAHL 55% of overlap with MEDLINE Indexes journal articles, books, book chapters,

dissertations, AV materials, conference proceedings

Controlled vocabulary/thesaurus:Nursing headings

Special Interest: Evidence-Based Practice

18

Evidence-Based Practice Guidelines

National Guidelines Clearinghousehttp://www.guideline.gov/

19

Literature Search Online Tutorials

PubMed Quick Tours

CINAHL, Basic Searching, Advanced Searching

20

Exercises Formulate a clinical question.

Effectiveness of strength training for stroke patients

Graft choice in ACL reconstruction Effectiveness of education in school

children with low back pain Heat or cold for low back pain

Literature SearchPubMed, NGC, Cochrane, PEDro, TRIP, CINAHL

21

Managing Citations

Endnote vs. RefWorks

RefWorks a FREE web-Based citation management

tool Check the class schedule

http://www.library.ucsf.edu/edtech/class/and reserve a space for the RefWorks class.