Van Sant, Ann F. PT, PhD, FAPTA
We are very familiar with the term evidence-based practice (EBP) and understand the emphasis our profession is putting on incorporating research findings into our clinical practice.
I know we still have a long way to go in getting the majority of practitioners up to speed with respect to practicing based on evidence. In a past editorial, I highlighted the barriers that clinicians face, not the least of which is access to the information that can guide their efforts. However, I am convinced that it is critically important that we double our efforts to provide the best care to our young patients that evidence can support.
I teach 2 courses for the Doctor of Physical Therapy program at Temple University that prepare physical therapy students for EBP. The second course requires students to complete a critically appraised topic (CAT). As fledgling consumers of the research literature, I am very aware of the level of analysis and synthesis that is needed for students to undertake these critical reviews. Good CATs are based on well-stated, cogent questions arising from a clinical case, effective and efficient literature searches to identify research reports related to their questions, and understanding the validity of various research designs and statistical procedures that allows rating of the rigor of the studies identified.
Whereas a CAT is typically prepared to answer a specific clinical question, systematic reviews that are seen in increasing numbers in this journal are broader in scope, involving a more extensive and comprehensive literature search. The efforts that so many of our authors have put into preparing systematic reviews are to be applauded. Those reviews provide clinically meaningful guidelines for treatment of our patients and should be read and analyzed with care by each of us.
The importance of incorporating evidence into practice came home to me in a very personal way earlier this year when I was diagnosed with breast cancer. To keep a short story even shorter, the clinical bottom line is that there are well-defined guidelines for the treatment of breast cancer that have been developed based on research evidence. These guidelines are updated on a regular basis. Lucky for me, my medical team was not only familiar with the evidence, but also practices in accordance with that evidence. After all, why would one do otherwise when someone’s life is at risk? I was comforted to know that the cancer with which I was diagnosed was a common form, for which there are numerous studies of surgical, radiological, hormonal, and chemotherapies. Guidelines for treatment are based on the likelihood of successful outcomes for a specific type of cancer and its many defining characteristics. I was able to choose the treatments that were optimal while minimizing risks of unwanted side effects.
Of course, many women have faced breast cancer and comparing notes with friends, including other physical therapists who have experienced breast cancer treatment, was both enlightening and encouraging. That cohort represents a formidable group, which was supportive in ways that one might never expect. What was most remarkable to me, however, was how much things have changed over the past 5 to 10 years. Each arm of treatment is more effective now, and this culminates in outcomes that are redefining breast cancer and who survives this disease and the quality of life that they experience. A member of my treatment team stated “this is not your mother’s breast cancer.” She was helping me understand that things have changed so much in the past 20 years, that treatments available to women today are totally different, and more advanced that the treatments my mother’s generation received. I learned along the way that my treatment was similar to that offered to other women being treated in Los Angeles; Washington, DC; Memphis; Vancouver; and smaller cities and towns throughout the United States. Cancer care is practiced according to evidence-based guidelines, not just in big cities at large medical centers but in small hospitals and clinics as well.
Breast cancer is life threatening, and one might ask how this short story even relates to the majority of care that we provide children. Does the fact that many of our treatments are not necessarily aimed at keeping our young patients alive release us from an obligation to provide the best care evidence can support? I think not.
I continue to be concerned about how invasive ongoing care can be for children with developmental disabilities and their families. We should not forget that, and we should, to the best of our abilities, find the best types and patterns of treatment for the children who need our care. We should be thinking about the specific timing and dose of our therapies and how our interventions affect the quality of life of the children whom we serve and their families.
Furthermore, I think, that it is time for us to take the evidence one step further and to work to prepare guidelines for treatment for the most common impairments and disorders that we treat as pediatric physical therapists. Such guidelines are typically anchored in evidence, as well as expert opinion, and updated on a regular basis to ensure that we are using the most current information to guide our practice. These guidelines should be published, not just in this journal, but prepared to meet the standards of the National Guideline Clearinghouse1 and submitted to the Clearinghouse, where they will be publicly available not to just a national but also an international audience that is as eager as we are for guidance in this world of EBP. Such publicly available guidelines may go far in eliminating the barriers that pediatric therapists face in trying to practice according to the principles of EBP.
Ann F. Van Sant, PT, PhD, FAPTA
© 2009 Lippincott Williams & Wilkins, Inc.