 General Characteristics of Desirable evidence

 Forms of evidence
 Hierarchies of evidence
 The 1st content criterion pertain to the type of
question a therapist wants to answer
 The 2nd criterion pertains to the subjects studied.
(Similarity)
 Peer review
 Time of Publication
 According to Guyatt & Rennie: “any empirical observation
about the apparent relation between events constitutes
potential evidence”

 Evidence in its broadest sense includes anything that is used

to determine or demonstrate the truth of an assertion.
 Research based evidence
 Expert opinions
 Patient feed back
 Clinical experience
 Clinical records
Not all evidence is judged to be of equal value, that is, there are hierarchies
of research design that are evaluated to have different strengths, different
levels of value in the decision making process.   
 Category I: 
Evidence from at least one properly randomized controlled
trial. (RCT)

Examples: Systematic Review of RCTs

 Category II;

II-1: Evidence from well-designed controlled trials without

randomization.

II-2: Evidence from well-designed cohort or case-control

analytic studies, preferably from more than one center or
research group.

II-3: Evidence from multiple times series with or without

intervention or dramatic results in uncontrolled experiments
such as the results of the introduction of penicillin treatment
in the 1940s.
 Category III:

Opinions of respected authorities, based on clinical experience,

descriptive studies and case reports, or reports of expert
committees.
EBP is a five-step process:
Step 1
Conversion of patient problem in to an answerable question.
 One method for formulating the question is referred to as
PICO.

P = Patient or population of interest

I = Intervention
C = Comparison of intervention
O = Outcome.
 Step 2 :
Efficiently find the best evidence
 Step 3 :
Critically appraise the evidence.
 Step 4 :
Applying critically appraised evidence to clinical practice

 Step 5:
Evaluate the effects of EBP on clinical outcomes.
 Convert the patient problem in to a specific question, which
will make the search easy.

 Search the literature for evidence related to the question or

problem

 Critically appraise the relevant literature.

 Integrate the appraisal of the literature with the clinician’s
expertise and the patient circumstances and values.

 Incorporate the information and discussion into clinical

practice.

 Re-evaluate the outcome and ask an other question if needed.

 Internet access in the facility
 Subscription to the relevant databases
 Special training for literature search and review
 Save the search work for future use.
 Create a list of authentic databases and post it near the
computer that will save time.
 Create a format, which guides the clinician, how to search
and what to search for?