Welcome to iCAHE's Learning Hub
The iCAHE learning hub is the starting point for a range of self-directed, open access learning resources aimed to introduce you to, or expand your knowledge of, evidence-based practice (EBP). This section of the iCAHE website provides you with tutorials, podcasts, examples and booklets that you can work through at your own pace and in a manner best suited to your learning style.
Current learning hub resources:
MS Excel short course in data handling & statistical function (pdf 5Mb)
Example dataset for the statistical booklet activities
A short course in searching the literature (pdf 2Mb)
Podcast presentations - a collection of research presentations
Links to external free learning resources:
Evidence Informed Practice - Foundations of EIP - From the University of Minnesota
OnlineCourses.com - Free online courses from a range of US Colleges and Universities, covers multiple topics
EBP e-learning resource
This online resource provides an innovative and flexible means for self-directed training at a pace appropriate to your own style of learning. It offers health students, clinicians and academics access to resources and tutorial modules.
Acknowledgement: This project was jointly funded by Experience Plus and the School of Health Sciences. The contents of the module were developed by the staff of the International Centre for Allied Health Evidence (iCAHE).
About EBP
Introduction to EBP
Definition of Evidence Based Practice (EBP)
Evidence-based practice (EBP) is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients (Sackett et al 1996). It involves combining information from four sources: knowledge arising from one’s clinical expertise, the consumers values & preferences, research evidence and the local context. All four areas are considered equal in the decision making process (Satterfield et al 2009).
Consumer values and preferences: refer to individual person's predicaments, values, beliefs, rights, and preferences regarding the care they receive.
Clinical expertise: refers to the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice (Sackett et al 1996). More recent work calls this circle ‘Resources’ and considers the clinicians expertise to be one of a battery of resources that can be used to answer the clinical question (Satterfield et al 2009).
Research evidence: refers to the best available research evidence relating to the type of question and the specific practice or policy the question is about. This may involve quantitative data (numerical results of a study) or qualitative data (non-numerical observations and patient/consumer input into a study). The most appropriate study design is the one that adequately addresses your clinical question (Satterfield et al 2009).
Local context: it has been acknowledged in recent times that in order to fully apply the principles of EBP in practice, the local context needs to be taken into consideration (McCormack et al 2002). Local context includes both the environment that the consumer, clinician and clinic are existing in, and the organisational structures that are in place. These may include; the health care system, nature of local practice, available resources and any other concerns regarding the localization or contextualization of the evidence (Satterfield et al 2009).
To be able to underpin EBP components with the local context, it is essential to have a clear understanding of the issues that challenge the application of EBP in practice.
References
Sackett D, Rosenberg W, Muir Gray J, Haynes RB, Richardson W. Evidence-based medicine: what it is, and what it isn’t. BMJ 1996; 312:71.
History of EBP
The roots of EBP date back to the reign of the Chinese emperor Quianlong (1688-1766) from the Qing dynasty where the method of “Kaozheng” (practicing evidential research) was used to dispel dogmatic traditional teachings and to reinterpret ancient Confucian texts based on documented facts (Leung 2001; van Driel 2007). Variations of EBP have appeared throughout history as interest in empirical evidences strengthened and waned.
References
Leung GM. Evidence-based practice revisited. Asia Pac J Public Health 2001; 13(2):116-121.
Van Driel ML. The implementation of evidence in clinical care: exploring the gap between knowledge and practice. 2007 Dissertation; Faculty of Medicine and Health Science, Ghent University, Netherlands.
Rajashekhar HB, Kodkany BS, Naik VA, Kotur PF, Goudar SS. Evidence-based medicine and its impact on medical education.Indian J Anaesth 2002; 46(2):96-103.
Purpose of EBP
- To improve quality, effectiveness and appropriateness of clinical practice (Cormack 2002)
- To reduce variations in practice patterns which can be a result of geographical differences or gaps between current knowledge and its application to care (Cormack 2002)
- To substantiate the care provided to patients (Cormack 2002)
- To share decision making with the patients (Cormack 2002)
- To provide a framework for lifelong, self-directed learning crucial for continued provision of quality care
Reference
Cormack JC. Evidence-based practice…What is it and how do I do it? JOSPT 2002; 32(10):484-487.
Misconceptions about EBP
- That EBP is a cookbook approach
- That EBP is a cost-cutting tool
- That EBP is unrealistic
- That EBP is impossible and impractical
Further reading
Sackett D, Rosenberg W, Muir Gray J, Haynes RB, Richardson W. Evidence-based medicine: what it is, and what it isn’t. BMJ 1996; 312:71.
Common barriers to EBP in allied health
There are two components related to the successful implementation and uptake of evidence in allied health: the practical components and knowledge components (Metcalfe 2001; Jette 2003; Iles & Davidson 2006).
Practical components: refer to the time and resources to search for, access, analyse and interpret the evidence as well as the organisational support to implement evidence into practice.
Knowledge components: relate to allied health practitioners’ understanding of research concepts (e.g. research designs, methods, analysis) which allow them to become proficient consumers of research.
References
Metcalfe C, Lewin R, Wisher S, Perry S, Bannigan K, Moffett JK. Barriers to implementing the evidence based in four NHS therapies: dieticians, occupational therapists, physiotherapists, speech and language therapists’. Physiotherapy 2001; 87(8):433-441
Harding KE, Porter J, Horne-Thompson A, Donley E, Taylor NF. Not enough time or a low priority? Barriers to evidence-based practice for allied health clinicians. J Contin Educ Health Prof 2014; 34(4): 224-231.
Further reading
Steps of EBP
There are five steps in applying an evidence-based approach to clinical practice.
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Step 1 |
Formulating a question A problem or uncertainty arises from the care of a patient, how do you then translate that uncertainty or problem into an answerable clinical question? |
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Step 2 |
Systematic searching and retrieval of the best available evidence Finding and acquiring the right evidence to address the clinical question |
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Step 3 |
Critical appraisal of evidence Examining the evidence for its validity, relevance and applicability to clinical practice |
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Step 4 |
Implementation of evidence into practice Making an informed decision, based on the integration of evidence, clinical expertise and patient’s preferences, and applying it to clinical practice |
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Step 5 |
Evaluation of practice Evaluation of clinical performance and determining whether the implementation of evidence into practice achieved the desired outcomes |
