Evidence-based physical therapy is an emerging and increasing theme in rehabilitation and physical therapy. Evidence-based practice (EBP) refers to the systematic process whereby decisions are made and actions or activities are undertaken using the best evidence available. The aim of evidence-based practice is to remove as far as possible, subjective opinions, unfounded beliefs, and/or biases from decisions and actions in clinical practice.
Sports Rehab supports and applies EBP as a way to guarantee the best and safest care for his patients and athletes. It does this promoting, supporting, and getting involved in different projects and actively involving patients in the EBP culture during the decision-making process to establish the most appropriate care plan for each of them.
The importance of EBP is worldwide recognized. There are four sources of evidence for EBP:
In short, EBP is imperniated on multiple sources of evidence and data.
EBP starts with the customer, client or patient and questioning what research evidence will assist in achieving the best outcome for them. The goal with EBP isn't just to solve a particular problem but to find out what we can learn to obtain the best outcome for the final user (our patients).
These components lead to the evidence-based decision-making and shared decision-making processes, therefore the broad EBP vision embodies the commitment to include patient and society from the very beginning in the clinical decision-making process. The incorporation of the patients’ values, beliefs, and preferences in clinical decisions is a challenge, but must be assured.
Since we consider evidence-based physical therapy as an area of study, research, growth, and practice in which clinical decisions are based on the best available evidence, integrating the clinicians’ expertise with ethical principles, and patients’ values, we constantly maintain active different research groups within our staff with the aim to deepen and update the scientific foundation for the shared clinical practice offered by our staff to the patients and athletes we take care of.
The purpose behind the internal research groups is devoting time to deepen the knowledge about multiple areas of clinical knowledge. The main goal is to then obtain results that are useful for the everyday practice with our patients and that are then spread through our staff via internal courses and/or guidelines.
It is important to highlight that sports physical therapy, post-operative rehabilitation, pediatric and geriatric rehabilitation, rehabilitation in rheumatology, cancer rehabilitation, respiratory rehabilitation, physical reconditioning (& many more) are the fields in which our internal research groups comprised by our physical therapists collect relevant information and use a variety of research methods to collect the most recent scientific evidence on topics related to patients’ evaluation and physical therapy interventions.
This approach reflects our goals to pursue an actual evidence-based practice, which is indeed essential in enhancing our patients’ care experience.
Clinical reasoning is a key skill underpinning clinical decision-making processes and eventually clinicians’ expertise. Clinical reasoning in practice is an essential skill for our physical therapists/clinicians and a crucial step mandatory to enhance the reasoning skills to help our patients.
Four components identify a properly structured clinical reasoning: cue acquisition, hypothesis generation, cue interpretation, and hypothesis evaluation.
The aim with the clinical reasoning is to apply the acquired skills in a critical fashion, avoiding or at least being aware of the assumptions being made, then doing the best for our patients and our community/society through a shared decision-making process in an evidence-based environment.
That means that our physical therapists/clinicians promote a process based on communicating information about treatment options to patients/athletes. At the same, our patients/athletes communicate their involved expectations/beliefs/ideas/etc. so that an agreement on the best treatment strategy in the best interest of the patient can be reached.
Clinical reasoning and evidence-based decision making combined generate a process in which care decisions are optimized by bringing all of these perspectives together, in an ethical environment.
This was feasible in our physical therapy centers because we are consistently recording objective patients' outcomes to track and validate our interventions results. All the information is analyzed and then the best possible evidence-based rehabilitation program is tailored on each patient. This is also relevant from a financial standpoint, since we practice in an insurance-based healthcare system in which there are no free state-provided health services, but mandatory private health insurances. Justifying the need for further intervention providing the objective proof of the achievement of previous goals is mandatory.
A properly structured clinical reasoning makes easier for physical therapists and clinicians to do the “right thing” to the “right patient” at the “right moment”. It can also help in assembling specialized and skilled teams around certain major health issues/diseases in need of the attention of a whole team and not just one physical therapist, creating a “squad” in support of a single patient.
In Sports Rehab we consistently record patients' reported objective outcomes to validate our interventions.
We follow the following 5 steps on a daily routine, that are also known as the 5 A's of evidence-based practice:
Prior to provide whatever intervention, we measure and objectivate the baseline data. The initial data may help determine the course of treatment intervention. Once treatment has commenced, the same measurements are usually performed in serial and periodical assessments to determine whether the patient has demonstrated changes. Objectivating outcomes is an essential component of assessment, planning and monitoring physical therapy treatment. Various things can help clinicians in taking such measurements:
These evidence-based tools are used to facilitate clinicians' communication about treatment options and patients sharing their personal values. Choosing the appropriate outcome measures for your patients is critical to track their status and progresses over time.
` The goal is to reach agreement on the best plan with the patients when there are two or more reasonable interventions options.
Considering sports teams (not single patients), our goal is always to have a baseline screening / testing / measurement in order to collect data and have the chance to design the best injury prevention plan for the season. Our physical therapists are trained in top-notch and worldwide renowned facilities in the injury prevention field.
That drastically reduces the numbers of injuries among the players/athletes.
At the end of the day, it means a lot of saved money for the team! And more safe and healthy athletes.