3 Pillars of Evidence-Based Practice
1. EVIDENCE derived from rigorous scientific research found in literature.
2. EXPERTISE derived from clinical experience and skill.
3. PATIENT PREFERENCE concerning personal health decisions.
Steps in the EBP Process
Asking for and locating evidence depends upon asking an effective clinical question.
Use the PICO mnemonic to build that question.
P = Patient Population Problem (includes demographic information)
I = Intervention Treatment Therapy Prognostic Factor Exposure
C = Comparison (could be placebo or no treatment)
O = Outcome (what you hope to accomplish; measurable)
P I C O
P -- patient, population, participant, problem (diagnosis)
I -- intervention, therapy, treatment
C -- comparison (not always required)
O -- outcome
P I C O T
P -- patient, population, participant, problem (diagnosis)
I -- intervention, therapy, treatment
C -- comparison (not always required)
O -- outcome
T -- time
P I C O (T)
P -- patient, population, participant, problem (diagnosis)
I -- intervention, therapy, treatment
C -- comparison (not always required)
O -- outcome
T -- type of studies or questions
P I C O T T
P -- patient, population, participant, problem (diagnosis)
I -- intervention, therapy, treatment
C -- comparison (not always required)
O -- outcome
T -- type of question
(therapy/treatment, diagnosis, prognosis, harm/etiology)
T -- type of study
(research method/design)
5 Types of PICO Questions
1. Diagnosis
2. Therapy (treatment / intervention)
3. Etiology (cause)
4. Prognosis (future / forecast)
5. Prevention
Diagnosis PICO:
In children with respiratory infection, is the respiratory rate as effective as chest x-ray in detecting pneumonia?
Prognosis PICO:
In premature infants (compared to full-term infants), what is the lifetime prevalence of hearing deficit?
Therapy PICO:
In patients with recurrent infection, do antibiotics, compared to no treatment, reduce recurrence rate?
Etiology PICO:
In post-menopausal women, does hormone replacement therapy increase the risk of breast cancer?
EVIDENCE derived through rigorous scientific research.
EXPERTISE from the healthcare practitioner's clinical experience.
PATIENT preferences concerning personal healthcare decisions.
“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett et al, 1996)
EBP as a Speech-Language Pathologist Using the acronym PICO which stands for:
1. Definition of the problem/formulate a clinical question
Population
Intervention & Comparison
Outcome
2. Literature search by evaluating and assessing the evidence.
3. Assessing the Evidence
The table below is one example of a hierarchy of levels of evidence.
Level | Description |
---|---|
Ia | Well-designed meta-analysis of >1 randomized controlled trial |
Ib | Well-designed randomized controlled study |
IIa | Well-designed controlled study without randomization |
IIb | Well-designed quasi-experimental study |
III | Well-designed non-experimental studies, i.e., correlational and case studies |
IV | Expert committee report, consensus conference, clinical experience of respected authorities |
Adapted from the Scottish Intercollegiate Guidelines Network
4. Making the Decision
References:
1. http://speechbite.com/ebp/what-is-it/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839740/
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