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Reflecting back on when I partook in my first EIP class in physical therapy school, I remembered going over the different research designs and methods that reduce bias in research. I learned that EIP is defined by its clinical expertise, and patient values and is accessible to the public. Also, I was educated on the many types of literature reviews that I may see when I do research, such as meta-analysis, systematic review, narrative review, and meta-synthesis. During the course, I learned that meta-analysis and systematic reviews come from quantitative studies and meta-synthesis reviews come from qualitative studies because it uses open-ended questions. 1 Narrative review is a broad overview of the topic and does not have the same rigor as a systematic review. 1 Systematic review is rigorous due to having a clear method to perform a thorough search on a research topic. 1 The literature reviews have their own unique way of presenting information. Moreover, EIP goes a long way in expanding ones knowledge of clinical expertise and shows work that has been done by researchers. EIP also can elaborate on peoples beliefs and opinions about concepts dealing with the work field, such as physical therapy.1 Furthermore, in the course I was taught three types of designs. The designs were qualitative, quantitative, and mixed methods. The qualitative design uses words and has open-ended questions.1 This data creates an outlet for exploring the meaning people associate with a social or human problem. 1 Quantitative design is called true experiments because of the use of numbers and presenting with closed-ended questions. 1 This type of data uses the scientific method and is a structural written report with variables that can be measured. 1 The last design is mixed methods that incorporate both approaches and overall strength is greater than the other two. 1 I am yearning to obtain more from this course, so I can apply myself as a future physical therapist.
My CI clinical practice was based on the principles of EIP. He believed strongly in the research on clinical prediction rules, such as Ottawa ankle rules and the Wells score to determine the pretest probability of deep vein thrombosis. He utilized the orthopedic clinical practice guidelines during new evaluations for certain physical therapy diagnoses and considered interventions that were done in the studies for patients. For instance, a patient came in with plantar fasciitis, and looking at the clinical guidelines that were made it stated the participant may have decreased dorsiflexion range of motion and pain typically occurring at the common insertion point of the plantar fascia.2 During the examination, the patient had decreased dorsiflexion and felt pain at the sole of her foot. Also, there was strong evidence reported about discussing shoe wear with the patient, applying manual therapy, and stretching to reduce pain. 2 This evidence was strong because it received an A grade by using the A-D grading scale, which receives a D is considered of having weaker evidence.2 Therefore, the interventions were implemented in the treatment plan to reduce and improve the dorsiflexion range of motion. This demonstrates that my CI believed heavily in EIP and that it is imperative for physical therapists to remain up-to-date with research. With research, one can see what may work with a certain diagnosis and possibly create interventions from research.
Moreover, my CI recently became an orthopedic clinical specialist (OCS) certified. He read all the different types of research and even introduced me to a website to further enhance my studies. With my CI receiving this certification, he was introduced to ICF classifications of low back pain and the McKenzie method. He also did the cupping technique in the clinic for many patients. I had the opportunity to observe and ask questions about the technique. He likes using the cupping technique on his patients for myofascial release and to increase blood flow to the area. EIP played a role in his participation in using the cupping technique because of the research and the results he received from using the technique on his patients.
Another way my CI used the principles of EIP is by sharing ideas and his clinical expertise with his co-workers. His co-workers and himself work diligently together as a team. For instance, we had a patient who had Cerebral Palsy (CP) and presented with weak abductors, weak core muscles, and could not sustain standing for more than 30 minutes. The patient needed two people to assist her during her treatment session. Before the treatment session, I shared my ideas with my CI, and we both collaborated on her treatment session for that day. With the knowledge that each one of us possessed we were able to come up with a favorable intervention for the patient.
Physical therapy is complex, and it possesses the opportunity of direct access, treatment by referral, different practice requirements in public and private practice, and different opportunities for continuing professional education.3According to Evidence-Based Medicine/Practice in Sports Physical Therapy, 30-40% of patients do not receive care according to current scientific evidence and approximately 20-25% of care provided is not needed or is potentially harmful.4 This matter needs to change of physical therapists not utilizing scientific evidence for their patients and making sure to comprehend the evidence properly to treat patients. The importance of EIP is the characteristics that it embodies to aid in the growth of physical therapy as a whole. Physical therapists are able to broaden their expertise and share ideas with the world. This encourages therapists to be involved with evidence that they can use on a daily basis. I believe it is important to have EIP so physical therapists will be informed. This will help to prevent poor decision-making and becoming a mediocre therapist. EIP allows us in our career field to grow and learn outside of school. It was stated in the article, Evidence-Based Medicine/Practice in Sports Physical Therapy that colleagues agree it is important, but professionals do not make time to practice due to a lack of time and skills.4 More than ever, evidence that is used to guide and inform clinical practice is accessible now, and professionals can get their hands on information without having to wait. 4 This way we can share the work of others and spread the word to our patients and counterparts. In this manner, professionals are properly treating and diagnosing their patients. There are many ways EIP is helping, but three come to mind keeping physical therapy current, creating effective treatment plans for patients, and making it suitable to educate patients on their impairments.
EIP is keeping physical therapy current by allowing physical therapists who are out of school the opportunity to continue to grow. This permits them to flourish as therapists for reasons that things may have changed, such as techniques or other practices from the time they were in school. There are resources to help therapists with techniques in the clinic to improve patients impairments. As it is important to remain up to date with new evidence, it is just as important to correlate this evidence with real-world techniques. As mentioned in Advancing Evidence-Based Practice in Physical Therapy Settings: Multinational Perspectives on Implementation Strategies and Interventions, the exponential growth in physical therapy clinical research in recent years calls for effective and efficient methods to translate research findings into practice.3 One specific case that will require constant updates and proper execution of effective methods is the deliverance of Clinical Practice Guidelines (CPGs) to improve stroke rehabilitation for patients in the Philippines. The Philippine Academy of Rehabilitation Medicine (PARM) underwent strenuous testing in numerous hospitals to produce these CPGs and ensured sustained use of these guidelines by diligently providing access to the guidelines through workshops, public access via the website, and sending revisions to the Health Insurance Corporation. Utilizing these methods as well as keeping them up to date leads to their patients seeing rapid improvements.3 By encompassing the knowledge from up-to-date evidence and research, therapists are given the ability to gain insight on topics and become more comprehensive towards patients feelings and situations. EIP is paving the way for physical therapists.
EIP is encouraging physical therapists to create effective treatment plans. For instance, physical therapists are able to assess research on pathologies that they may come in contact with in the clinic. They can look at the results of the study and see if the interventions showed any significant improvements in the condition of the participants. In this way, physical therapists can adapt those interventions or get ideas of what interventions they should be doing by following a protocol depending on the patient’s presentation. Moreover, EIP is favorable to physical therapy as a whole because patients are able to get effective treatments, so they will be able to get stronger.
Furthermore, EIP is making it suitable for physical therapists to educate patients on their impairments. Physical therapists are able to supply the evidence and better educate their patients. Patient education is imperative because patients are more adherent to the treatment plan when they are educated. Educating the patient will help with the further progression of the treatment plan and prevent any injuries. The patient will be compliant with the treatment service and appreciates the physical therapist.
The article, Advancing Evidence-Based Medicine/ Practice in Sports Physical Therapy challenges practitioners to integrate current worthy evidence into their clinical practice.4 And I do as well. Many clinicians should be involved and utilize research for educating patients and creating effective treatment plans. EIP is just another step that professionals should be willing to take for continuing education. One can conclude that EIP is a major necessity in the field of physical therapy.
References
- Creswell J. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 4th ed. Thousand Oaks, CA: Sage Publications; 2014.
- Martin RL, Davenport TE, Reischl SF, et al. Heel pain- plantar fasciitis: revision 2014. J Orthop Sports Phys Ther. 2014; 44(11): A1-A33. doi:10.2519/jospt.2014.0303
- Bernhardsson S, Lynch E, Dizon JM, et al. Advancing evidence-based practice in physical therapy settings: multinational perspectives on implementation strategies and interventions. Phys Ther. 2017; 97(10): 51-60.doi:10.2522/ptj.20160141
- Manske RC, Lehecka BJ. Evidence-based medicine/practice in sports physical therapy. Int J Sports Phys Ther. 2012; (7)5: 461-473.
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