EVIDENCE-BASED PHYSICAL THERAPY · CHAPTER 1 · EVIDENCE-BASED DECISIONS
Before you search PubMed, what are you asking?
It’s easy to find a paper. The harder part is knowing whether it answers the question you actually have about your patient. Your EBP notes start with a clinical decision, not a citation count.
1. Turn a vague concern into a searchable question
Suppose a person with symptomatic knee osteoarthritis wants to rise from a dining chair with less difficulty. ‘What’s the best exercise for knees?’ is too broad. A more useful question might compare a supervised lower-extremity strengthening program with an appropriate alternative for improving chair-rise performance in adults with knee OA.
The later class chapter introduces PICO: Patient/Problem, Intervention or Exposure, Comparison, and Outcome. PICO is a question-building tool, not a guarantee of a perfect search. Here the outcome should relate to what the person actually wants to do.
Your course separates background questions (e.g. what happens in knee OA?) from foreground questions about specific diagnostic, prognostic or treatment decisions.
Quick check: is ‘Does exercise help people?’ a useful foreground question?
Reasoning: Not yet. Specify the relevant population, the type of intervention or comparison and a meaningful outcome, while keeping the question answerable.
2. Does this study answer that kind of question?
The lecture distinguishes diagnosis, prognosis, intervention and outcomes questions because each may require a different study design. For treatment effects, a well-conducted randomized comparison may be especially useful. For prognosis, appropriately followed cohorts often answer a different question.
Even a systematic review can be a poor fit if it summarizes a very different population, treatment or endpoint. Start with what was actually studied. Then check the methods, possible bias, size and uncertainty of the result.
The class warns against reasoning errors such as confirmation bias: finding the paper that supports the answer you already wanted. A good search also looks for evidence that challenges your initial belief.
The five A’s from class
Assess, Ask, Acquire, Appraise, Apply. The order helps you organize the decision; it doesn’t replace clinical judgment or research methods.
3. Research results are not the whole plan
Evidence-based practice brings together research evidence, clinical expertise, patient values and circumstances. A patient with limited time, particular equipment access, symptoms or a strong preference may not be well served by copying a study protocol verbatim.
For the chair-rise example, consider what the program changed, what it cost in time and effort, and whether the outcome matches the patient’s goal. Explain reasonable options and reassess what matters to the person. Don’t claim any single paper proves a universal plan.
The free lesson is meant to sharpen the question. The full companion notes cover study designs, bias, statistics, diagnostic accuracy and critical appraisal in more detail.
Quick check: a high-quality trial shows an average benefit, but the patient cannot access the studied program. Is the trial useless?
Reasoning: No. It can inform the choice, but feasibility, preferences, available alternatives and the patient’s circumstances belong in the decision. Avoid presenting the trial as a one-size-fits-all prescription.
Sources & learning scope
Based on the user’s Evidence-Based PT class lecture notes, particularly Chapters 1–3 (EBP foundations, types of evidence and finding evidence) and the PICO chapter. The knee-OA example is a newly written teaching illustration, not a claim about one particular trial. The full companion is still under final review. Next lesson: choosing a study design to match a clinical question.
Put it into practice
Scenario: A patient with knee osteoarthritis says they mainly want to rise from a low chair without pushing with both hands. Your initial search phrase is simply ‘best knee exercises.’
What should you conclude?
Reasoning: Turn the real decision into a focused foreground question: population (adults with symptomatic knee OA), intervention (a defined exercise approach), comparison (another approach/usual care) and outcome (chair-rise performance). Search terms should describe the question, not the answer you hope to find.
Common trap: Picking the most positive-looking article before defining the outcome. Remember: Start with the functional decision; then find the evidence.
From My PT School Notes · Companion learning content. Examples are for study, not individualized medical advice or a substitute for supervised lab instruction.
