Evidence-based search

The development of knowledge in the health sector is strong, which makes great demands on all health professionals to keep abreast of new findings. Evidence-based medicine (EBM) and evidence-based health care (EBV) means you are intentionally using the best available scientific information, along with clinical experience and patient preference, when you treat and care for your patients.

Evidence-based healthcare follows four steps:

1. Formulate a question – a patient-related question that can be answered.
2. Information Search – search literature that answers the question.
3. Critical review – is the literature relevant and valid?
4. Apply the result – treat your patients based on current evidence.

1. Formulate a question

A clear question gets a clear answer. PICO is a model that you can use to structure and clarify your question:
Population
Intervention
Comparison
Outcome

Population

Which patient category is relevant? Which age groups? Men or women? With what diagnosis, disease severity, risk factors, or other conditions?

Intervention

What treatment method is relevant? Applied by which type of therapist, at what intensity, and for what duration?

Control

Compared to what other method, placebo, or lack of intervention?

Outcome

Mortality? Morbidity? Quality of life? Measured by which method?

Keywords

Once you have broken down the question into smaller components and identified keywords, consider finding synonyms and subject headings for each term. Use Swedish MeSH or SveMed+ to locate medical subject headings.

• Swedish MeSH External link.
  In Swedish MeSH you can find medical subject terms, both in Swedish and English.
• SveMed+ External link.
  You can also use SweMed+ to get suggestions for MeSH terms.

2. Information search

Usually, an evidence-based information search focuses on the first two parts of PICO: population and intervention. These can be broken down further. For example, if the population is 'adolescents with alcohol abuse,' you can separate it into 'adolescents' and 'alcohol abuse.' This approach is called the building block strategy. You combine all synonyms, subject headings, and free text into one block using OR, and then combine your blocks with AND, as shown in the example below:

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])

Suitable databases and search sources:

The choice of databases when searching depends on the type of material you want to find. For evidence-based information searches, the SBU or Cochrane Library is a good place to start. You can then search for original articles in databases such as PubMed.

• SBU, Statens beredning för medicinsk och social utvärdering External link.
  Systematic reviews in Swedish.
  
• Cochrane Library (RN) External link.
  Systematic reviews in medicine and adjoining areas.
  
• PubMed – Clinical Queries (RN) External link.
  Select Clinical Queries below PubMed Tools to restrict the search to include only articles based on clinical studies and certain predefined methods. Here you will find original articles but also systematic overviews.
  
• CINAHL with Full Text (RN) External link.
  Limit to Evidence-based practice or to a particular publication type.
  
• OTseeker External link.
  Systematic reviews in occupational therapy and more.
• PEDro External link.
  Systematic reviews in, for example, physical therapy.
  
• Trip External link.
  Searching for evidence-based resources available on the Internet, including material from SBU, Cochrane Library, HTA and PubMed. The search results are sorted and presented in hierarchical categories with a rather small selection of best evidence at the top.
  

3. Critical review

To evaluate relevance, validity, and clinical utility, the scientific quality of the articles must be assessed, as the studies may contain systematic errors or biases. Errors in results can, for example, stem from incorrect data, interpretation mistakes, or assessment errors. Various review templates are often used to assess the material, such as:

• Critical appraisal tools and checklists from SBU External link.
  Different types of review templates for systematic reviews.
• GRADE External link.
  An international grading system often used in evidence grading to assess the reliability of the scientific basis.
• PEDro scale External link.
  The PEDro scale is used in the PEDro database to evaluate the quality of clinical trials.

4. Apply the results

In conjunction with your clinical experience and the patient's needs, you must determine whether the evidence from the scientific results is applicable to your patient. Consider how generalisable the study's findings are. Do the benefits of the chosen intervention outweigh the disadvantages? Is the evidence robust enough to support your decision?

Learn more about evidence-based care:

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