Department of Physical Therapy and Rehabilitation Sciences.

FHMS 1
 INDUS UNIVERSITY

Department of PhysicalTherapy and Rehabilitation

Sciences , FHMS

Department of Physical Therapy and Rehabilitation Sciences. FHMS 2

 Topic : Informational Needs
GROUP MEMBERS:

• Fareeha rehman
• Ayesha rafiq
• Areej Tariq
• Dua
• Binish anwar
• Farman ali

Department of Physical Therapy and Rehabilitation Sciences. FHMS 3

Contents to be covered
 Relevant clinical questions
 Effects of intervention
 Experience
 Prognosis
 Diagnosis
 Activity

Department of Physical Therapy and Rehabilitation Sciences. FHMS 4

 fareeha

Relevant Clinical Questions

• The first step in evidence-based practice
is to formulate a specific question to find
a scientific answer to the question.

• Posing specific questions relevant to a

patient’s problem provides a focus to
thinking, and it helps in the formulation
of search strategies and in the process of
critical appraisal of evidence.

Department of Physical Therapy and Rehabilitation Sciences. FHMS 5

 fareeha

The most important clinical questions are those concerning:

• Effects of intervention.
• Patients experiences.
• The course of a condition (prognosis).
• The accuracy of diagnostic tests.

Department of Physical Therapy and Rehabilitation Sciences. FHMS 6

 fareeha

Importance Of Relevant Clinical

Questions
• Patient Care
• Efficiency
• Diagnostic Accuracy
• Patient Safety
• Patient Communication
• Evidence Based Practice
• Documentation

Department of Physical Therapy and Rehabilitation Sciences. FHMS 7

 fareeha

Refining The Question

• Before begin the hunt for evidence that relates to the
clinical questions, it is needed to spend some time
making the questions specific.

• Structuring and refining the question makes it easier to

find an answer.

Department of Physical Therapy and Rehabilitation Sciences. FHMS 8

 Ayesha
Effects Of Intervention
Intervention is all about learning what treatments or strategies work
best to improve outcomes and making a difference in what matters
most to you.
Questions about the effects of intervention can be break into
four parts.
MNEMONIC PICO

• Patient or problem
• Intervention or management
strategy
• Comparative intervention
• Outcome

Department of Physical Therapy and Rehabilitation Sciences. FHMS 9

 Example 1
In patients with frozen shoulder, does soft tissue
mobilization result in a greater increase in range of
motion compared to a home exercise program alone?

10
 MAKE PICO

 P- Patients with frozen shoulder

 I- Soft tissue mobilization
 C- Home exercise program
 O- Increase in range of motion

11
 Ayesha

Example 2
Is manual therapy more effective than exercise therapy in
reducing pain and improving range of motion in patients
with chronic low back pain?

Department of Physical Therapy and Rehabilitation Sciences. FHMS 12

 Ayesha
MAKE PICO
P - Patients with chronic low back pain
I - Manual therapy
C - Exercise therapy
O - Pain reduction + Improvement in range of
motion

Department of Physical Therapy and Rehabilitation Sciences. FHMS 13

 Dua
EXPERIENCES
Questions about experiences can relate to any aspect
of clinical practice.
Such questions are potentially very diverse so they
must be relatively open.
E.g. ‘What are the principal concerns of adults with
acute low back pain?’

Returning to our example, you may be interested in

your patient’s attitudes to his condition.

Department of Physical Therapy and Rehabilitation Sciences. FHMS 14

 Dua
In a similar scenario in your own practice you recently heard a
patient expressing concern about whether his complaint might
become chronic, or whether he might have a serious illness.

You become interested in knowing more about the concerns of

patients with acute low back pain. Consequently your two-part
question is:

‘What are the principal concerns of adults with acute low back
pain?’

Department of Physical Therapy and Rehabilitation Sciences. FHMS 15

 Dua

Patient Phenomenon
Adult with low back pain Patient’s concern

Department of Physical Therapy and Rehabilitation Sciences. FHMS 16

 farman

Prognosis:
• Question may be about the expected amount of
outcome or about probability of the outcome.

• Questions about the probable cause of a patient's

disease or the likelihood that he or she will develop
an illness.

Department of Physical Therapy and Rehabilitation Sciences. FHMS 17

 farman

Prognosis factor:
• Prognostic factors should be clearly distinguished from
risk factors, which are exposures that are associated with
creating a condition or new cases (like smoking for lung
cancer.
• On the other hand, are characteristics of the clinical
course that influence outcomes Of condition that already
exist or intervention to treat those conditions

Department of Physical Therapy and Rehabilitation Sciences. FHMS 18

 farman

Example 1
A 45-year-old male patient, Mr. Smith, presents to his primary
care physician with a history of chronic obstructive pulmonary
disease (COPD) and a recent exacerbation of symptoms. He has
a long history of smoking and is currently on bronchodilator
therapy. Mr. Smith reports increased shortness of breath,
frequent coughing with sputum production, and fatigue. His
oxygen saturation is 88% on room air.
PICO:
P: 45-y old male
I: Current bronchodilator therapy
C: no treatment
O: Improved management of COPD symptoms

Department of Physical Therapy and Rehabilitation Sciences. FHMS 19

 farman
Example 2
Your pt, who owns a bakery, recently participated in their
employer’s wellness program. Their BMI is with in a normal
range, but they have a family history of obesity, and are
concerned about the impact carbs may have on maintain a healthy
weight.
PICO:
P: Pt family history obesity
I: Card intake, specific diet
C: Obese pts
O: Keeping BMI below 25.healthy weight management

Department of Physical Therapy and Rehabilitation Sciences. FHMS 20

 binish

Diagnosis
• In evidence-based physiotherapy (EBP),
the process of diagnosis involves using a
combination of clinical examination,
patient history, and diagnostic tests to
accurately identify the underlying
condition or causes of a patient's
symptoms.
• Misclassification and misdiagnosis are an
unavoidable part of professional practice
even the best diagnostic tests occasionally
misclassify patients.

Department of Physical Therapy and Rehabilitation Sciences. FHMS 21

 binish

Example
A 55-year-old individual presents to the physiotherapy
clinic with complaints of progressively worsening pain and
stiffness in the right shoulder over the past several months.
The patient reports difficulty reaching behind their back and
performing overhead activities such as combing hair or
reaching into a cabinet. There is no history of recent trauma
or injury to the shoulder.

Department of Physical Therapy and Rehabilitation Sciences. FHMS 22

 binish

Perhaps using Codman's drop arm test, amongst others,

to find out whether there is an inflammation of capsule.

In patients presenting with progressive shoulder pain

and stiffness suggestive of adhesive capsulitis, what is
the diagnostic accuracy of range of motion testing and
special tests (e.g., Codman's drop arm test)

Department of Physical Therapy and Rehabilitation Sciences. FHMS 23

 binish

Population/Problem (P): Patients presenting with

progressive shoulder pain and stiffness suggestive of
adhesive capsulitis.
Intervention (I): Clinical assessment including range of
motion testing, special tests (e.g., Codman's drop arm test).
Comparison (C): Diagnostic accuracy of clinical assessment
compared to imaging (e.g., MRI, ultrasound) in confirming
adhesive capsulitis.
Outcome (O): Sensitivity and specificity of clinical
assessment methods in diagnosing adhesive capsulitis.

Department of Physical Therapy and Rehabilitation Sciences. FHMS 24

 areej
Miscellaneous
 For patients 65 years and older , how does the use of an influenza
vaccine compared to not received the vaccine influence the risk of
developing pneumonia during flu season ?
 What are the biomarkers associated with the progression of Alzheimer's
disease?
 What is the probability of treatment outcomes for patients with
Parkinson's disease based on the age of onset and the presence of motor
complications?
 What is the sensitivity and specificity of a new imaging technique (e.g.,
MRI, CT scan) compared to the current gold standard for detecting brain
tumors?
 What is the impact of comorbid conditions (e.g., diabetes, hypertension)
on the prognosis and treatment outcomes of patients with heart failure?
 Is there prolonged exposure to vibrations from using hand tools or
power tools most likely the cause of carpal tunnel syndrome?

Department of Physical Therapy and Rehabilitation Sciences. FHMS 25

 areej
Miscellaneous
 Does telemonitoring blood pressure in urban African Americans
with hypertension improve blood pressure control within the six
months of initiation of the medication ?
 In African female adolescents with hepatitis B , how does
acetoaminophen compared to ibuprofen affect liver function?
 Among athletes with ACL injury, does neuromuscular training
reduce the rate of ACL re-injury compared to standard rehabilitation
protocols?
 What are principal concerns of patient with hypertension ?
 How does the extent of coronary artery disease and left ventricular
function impact the treatment outcomes of patients with heart
failure?

Department of Physical Therapy and Rehabilitation Sciences. FHMS 26

 REFERENCES
(Rob Herbert, Rob Herbert, G. J. (2005). Practical Evidence
Based Physiotherapy. London: Elsevier Limited.

Department of Physical Therapy and Rehabilitation Sciences. FHMS 27

 Thank You

17

Department of Physical Therapy and Rehabilitation Sciences. FHMS 28