Evidence-based practice

In healthcare, knowledge develops quickly. This means that all healthcare professionals need to stay up to date with new findings.

Evidence-Based Medicine (EBM) and Evidence-Based Practice (EBP) mean using the best available scientific knowledge together with clinical experience and the patient’s preferences when planning treatment and care.

Four steps in evidence-based practice

1. Formulate a question – a patient-related question that can be answered.
2. Information retrieval – search for literature that can answer the question.
3. Criticall appraisal – assess whether the literature is relevant and reliable.
4. Apply the results – provide care and treatment based on current evidence.
   

1. Formulate a question

A clear question makes it easier to get a clear answer. PICO is a model that helps you structure and refine your research question. PICO stands for:

• Population
• Intervention
• Comparison (control group)
• Outcome

Population

Which patient group does the question concern? For example, age, gender, diagnosis, disease stage, risk factors, or other conditions.

Intervention

Which treatment does the question concern? Who provides the treatment, at what intensity, and for how long?

Comparison (control group)

What is the treatment compared to? For example, another method, placebo, or no intervention.

Outcome

What results are measured? For example, mortality, morbidity, or quality of life. With which method is it measured?

Keywords

After breaking down your research question into smaller parts and identifying the key concepts, you need to find synonyms and subject headings for your terms. Use Swedish MeSH to find medical subject headings.

• Swedish MeSH
  In Swedish MeSH you will find medical subject headings in both Swedish and English.
  

2. Information retrieval

Information retrieval often builds on the first two parts of PICO: population and intervention. These can be broken down into smaller elements.

For example, if the population is youth with alcohol misuse, you can separate it into youth and alcohol misuse.

This method is called block searching. Each block combines all relevant synonyms, subject headings, and free-text terms with OR. The different blocks are then combined with AND. Example of block searching:

Block 1:

("Virtual reality therap*" OR "Virtual reality glasses" OR "virtual reality technolog*" OR "virtual goggles" OR "VR goggles" OR Virtual Reality [Mesh] OR Virtual Reality Exposure Therapy [Mesh])

Block 2:

("panic attack*" OR Phobic Disorders [Mesh] OR Panic Disorder [Mesh] OR Anxiety [Mesh] OR Anxiety Disorders [Mesh])

Block 1 and block 2:

("Virtual reality therap*" OR "Virtual reality glasses" OR "virtual reality technolog*" OR "virtual goggles" OR "VR goggles" OR Virtual Reality [Mesh] OR Virtual Reality Exposure Therapy [Mesh]) AND ("panic attack*" OR Phobic Disorders [Mesh] OR Panic Disorder [Mesh] OR Anxiety [Mesh] OR Anxiety Disorders [Mesh])

Relevant databases and search sources

The databases you choose depend on the type of material you want to find. For evidence-based information retrieval, it may be useful to start in SBU or the Cochrane Library, and then search for original articles in databases such as PubMed.

• SBU – Statens beredning för medicinsk och social utvärdering
  Systematic reviews in Swedish.
  
• Cochrane Library (RN)
  Systematic reviews in medicine and related fields.
  
• PubMed – Clinical Queries (RN)
  Reference database in medicine, nursing, rehabilitation, dentistry, and related fields. Published by the National Library of Medicine. Go to Clinical Queries and search for studies concerning therapy, diagnosis or prevention. You can also find systematic reviews
  
• CINAHL with Full Text (RN)
  A reference database covering nursing, occupational therapy, physiotherapy and health administration. It also includes full-text articles. Limit your search to Evidence-based practice or select a publication type.
  
• OTseeker
  Systematic reviews within the field of occupational therapy.
  
• PEDro
  Randomized controlled trials and systematic literature reviews in physiotherapy.
  
• Trip
  Search for evidence-based resources, including material from SBU, the Cochrane Library, HTA and PubMed. Search results are organised into categories, with a small selection of the best evidence shown first.
  

3. Critical appraisal

To evaluate relevance, reliability, and clinical usefulness, you need to assess the scientific quality of the articles. Studies may contain systematic errors, known as bias. Errors in results can be caused by inaccurate data, misinterpretation, or incorrect effect assessment. Different appraisal tools can be used to evaluate the material, for example:

• Critical appraisal tools and checklists from SBU
  Various tools for assessing systematic reviews.
  
• GRADE
  An international grading system used to evaluate the reliability of the scientific evidence.
  
• PEDro scale
  Used in the PEDro database to assess the quality of clinical trials.
  

4. Apply the results

When planning care, you need to combine your clinical experience with the patient’s needs. Assess whether the results of the scientific evidence are transferable to your patient. Ask yourself:

• How generalisable are the study results?
• Do the benefits of the chosen intervention outweigh the risks?
• Is the evidence strong enough?

Learn more about evidence-based practice:

Bak Andersen, I., Matzen, P., & Vågen, Ö (2015). Evidence-based medicine . Lund: Student literature.

Fisher, AG (2009). Occupational therapy intervention process model: A model for planning and implementing top-down, client-centered, and occupation-based interventions . Fort Collins, Colorado: Three Star Press.

Herbert, R., Jamtvedt, G., Hagen, KB, Mead, JM, & Chalmers, I. (2011; 2012). Practical evidence-based physiotherapy (Second ed.). Edinburgh; Edinburgh: Elsevier, Churchill Livingstone; Elsevier, Churchill Livingstone.

Nordenström, J. Edgren, G. (2019). Evidence-based medicine in the footsteps of Sherlock Holmes (5, [ed.] Ed.). Stockholm: Nordic Medical Publications.

Willman, A. (2016). Evidence-based nursing: A bridge between research and clinical activities (4, [rev] ed). Lund: Student literature