What is change? Why is it difficult to either become a part of the change or to introduce the change? The abhorrent situations were faced with the introduction of Evidence Based Practice (EBP) in the emerging field of Rehabilitation. Globally, EB physical therapy practice (EBPTP) has brought innovation and revolution in the current practices of Physical Therapist (PT) and has become a challenge for them. Worldwide these challenges have already been popularized for more than twenty years but we might need another decade to practice it in Pakistan.
Internationally, EBPT practice emerged as a new paradigm within the health care and health education in the 1990s with the growing concerns to fill the gap between research and practice. It was essentially focused that practice knowledge, patient preference and most importantly high-quality clinical research to be inculcated among the practicing PT. Although the practitioners were already utilizing practice knowledge and patient preference but high-quality clinical research was neglected as the element of research was evolving in Pakistan. Interestingly, the conceptual origin of EBP extends back more than 150 years but was never realized. However, it was notified by the researchers that PT practice is belief based rather than utilizing and availing the sound information. Currently, a good practice is making the most use of the other source of information such as peers and practice guidelines yet high-quality clinical research remains ignored.
A question may arise among the practitioners especially the senior therapist; why to practice EBP? As their evaluation, diagnoses and patient satisfaction levels are extremely high. The simple and straight answer is the cost effectiveness of physiotherapeutic intervention. Furthermore, it is claimed to be one of the best strategies utilized to cope with potential chaos and uncertainty of modern clinical practice and to meet the ethical imperative of providing the best possible care for the patients. In addition, the aim of emphasizing on EBP as a core element of the current practice is to ensure that decision making is in cooperated with the best available evidence. Moreover, to administer an improved treatment plan, provide essential patient information; analyze research studies and for the better measurement and interpretation of outcomes. The main focus is to accurately gauge the relationship between patient and PT and the effects on health-related outcomes.
Universally, different database are the key sources for collecting evidences such as Cochrane review, Database of Abstracts of Reviews of Effectiveness (DARE), Central Register of Controlled Trials (CENTRAL), PubMed, PEDro (Physiotherapy Evidence Database), Google Scholar and many more. The evidences collected from these databases are considered as of high-quality clinical research. Although evidences are also collected from Wikipedia and are referenced in a few articles but the purpose of high-quality research becomes ambiguous. EBP follows five different steps starting from assessing the client, asking the question, acquiring and appraising the evidence; and then applying it on the patients. The most essential part of EBP remains in self- evaluating the performance.
American Physical Therapy Association (APTA) and Chartered Society of Physical Therapy (CSP) have emphasized and claimed EBP as crucial to the professional survival of Physical Therapy in the current climate of competitive health care funding where relevant and high-quality research is implemented to the optimum level. Also, introducing patient preference as well as practice knowledge; APTA has given a vision of 2020 by claiming PT as an autonomous practitioner using evidences in their practice. This became one of the reasons of a paradigm shift in the degree courses from Bachelors of Physical Therapy (BPT) to Doctor of Physical Therapy (DPT) by introducing EBP and research among the upcoming students. Despite of the usefulness of EBP, a few barriers are at present being faced by PT, in utilizing high quality clinical research in their practices. This involves the attitude of the question and inquiry, the lack of experience in finding the correct evidence, appraising and applying evidence in their current practices, the information resources available on the tap and most importantly lack of time.
Currently, EBP is being practiced in the field of Physical Therapy in Pakistan both in the clinical as well as academia. A number of tertiary care hospitals as well as reputed institutions have introduced research-based practice as an essential part of the Physical Therapy. Ziauddin College of Physical Therapy is one of the few Physical Therapy colleges in Pakistan to introduce EBP and other research courses in their curriculum by upgrading their degree programs. Similarly, the department of Physical Therapy has been implementing EBP in their clinics and is keen in promoting research. The aim of the editorial is to spread the message of EBP Worldwide so that the health care professionals including therapist use the best evidence in clinical decision making on the individual basis. Eventually, the health care professionals are expected to inculcate EBP by involving complex and conscientious decision-making and considering patient characteristics, situations, and preferences.
Amna Aamir Khan
Assistant Editor, Pakistan Journal of Rehabilitation
Assistant Professor, Ziauddin College of Physical Therapy