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Evidence-Based Practice for Rehabilitation Professionals: Concepts and Controversies

      Abstract

      Dijkers MP, Murphy SL, Krellman J. Evidence-based practice for rehabilitation professionals: concepts and controversies.
      This article describes evidence-based practice (EBP) in the health professions and sciences in general and in the rehabilitation disciplines specifically. It discusses the following: what counts as evidence and how that has changed over the last 4 decades, trends in the short history of evidence-based medicine and EBP, the fallacious nature of most criticisms of EBP, (perceived) shortcomings of clinical research and the resulting evidence in rehabilitation, resources available to clinicians who want their practice to be evidence-based, and the barriers these clinicians face in keeping up with the evidence and applying it in practice. Lastly, it describes how the development of a new art and science, knowledge translation, may play a role in truly making EBP feasible in rehabilitation services.

      Key Words

      List of Abbreviations:

      AJOT (American Journal of Occupational Therapy), AOTA (American Occupational Therapy Association), APTA (American Physical Therapy Association), CAT (critically appraised topic), CI (confidence interval), CPG (clinical practice guideline), EBM (evidence-based medicine), EBP (evidence-based practice), GRADE (Grading of Recommendations Assessment Development and Evaluation), NNT (number needed to treat), OT (occupational therapy), PBE (practice-based evidence), PEDro (Physiotherapy Evidence Database), PLUS (Premium LiteratUre Service), PT (physical therapy), RCT (randomized controlled trial), SMD (standardized mean difference), SLP (speech and language pathology), SR (systematic review), SSD (single subject design)
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      References

      1. Evidence based marketing.
        (Accessed April 30, 2011)
        • Dijkers M.
        Rebuttal to Ottomanelli et al. methods of a multisite randomized clinical trial of supported employment among veterans with spinal cord injury.
        J Rehabil Res Dev. 2010; 47: vii-viii
        • Montori V.M.
        • Guyatt G.H.
        Progress in evidence-based medicine.
        JAMA. 2008; 300: 1814-1816
        • Sackett D.L.
        • Rosenberg W.M.
        • Gray J.A.
        • Haynes R.B.
        • Richardson W.S.
        Evidence based medicine: what it is and what it isn't.
        BMJ. 1996; 312: 71-72
        • American Physical Therapy Association
        Vision 2010.
        (Accessed April 22, 2011)
        • Dijkers M.P.
        External validity in research on rehabilitation interventions: issues for knowledge translation.
        National Center for the Dissemination of Disability Research, SEDL, Austin2011
        • O'Brien M.A.
        • Whelan T.J.
        • Villasis-Keever M.
        • et al.
        Are cancer-related decision aids effective?.
        J Clin Oncol. 2009; 27: 974-985
        • Oostendorp R.A.B.
        • Nijhuis-van der Sanden M.W.G.
        • Heerkens Y.F.
        • Hendriks E.J.M.
        • Huijbregts P.A.
        Evidence-based rehabilitation medicine and physiotherapy.
        (Accessed May 9, 2011)
        • Oostendorp R.A.B.
        [Over the horizon of allied health care] [Dutch].
        (Accessed January 18, 2012)
        • Claridge J.A.
        • Fabian T.C.
        History and development of evidence-based medicine.
        World J Surg. 2005; 29: 547-553
        • Maher C.G.
        • Moseley A.M.
        • Sherrington C.
        • Elkins M.R.
        • Herbert R.D.
        A description of the trials, reviews, and practice guidelines indexed in the PEDro database.
        Phys Ther. 2008; 88: 1068-1077
        • Green M.
        Evaluating evidence-based practice performance.
        Evid Based Med. 2006; 11: 99-101
        • Johnson C.J.
        Getting started in evidence-based practice for childhood speech-language disorders.
        Am J Speech Lang Pathol. 2006; 15: 20-35
        • Lin S.H.
        • Murphy S.L.
        • Robinson J.C.
        Facilitating evidence-based practice: process, strategies, and resources.
        Am J Occup Ther. 2010; 64: 164-171
        • Bastian H.
        • Glasziou P.
        • Chalmers I.
        Seventy-five trials and eleven systematic reviews a day: how will we ever keep up?.
        PLoS Med. 2010; 7: e1000326
        • Cochrane A.L.
        Effectiveness and efficiency: random reflections on health services. Nuffield Provincial Hospitals Trust, London1971
        • The Cochrane Collaboration
        Cochrane reviews.
        (Accessed May 11, 2010)
        • Glass G.V.
        Primary, secondary and meta-analysis of research.
        Educ Researcher. 1976; 5: 3-8
        • Glass G.V.
        Integrating findings: the meta-analysis of research.
        Rev Res Educ. 1978; 5: 351-379
        • Schuerman J.
        • Soydan H.
        • Macdonald G.
        • Forslund M.
        • de Moya D.
        • Boruch R.
        The Campbell Collaboration.
        Res Soc Work Pract. 2002; 12: 309-317
        • The Campbell Collaboration
        (Accessed April 1, 2011)
        • Hoppe D.J.
        • Bhandari M.
        Evidence-based orthopaedics: a brief history.
        Indian J Orthop. 2008; 42: 104-110
      2. Guyatt G. Rennie D. Meade M. Cook D. Users' guides to medical literature: a manual for evidence-based clinical practice. 2nd ed. McGraw-Hill Professional, New York2008
        • Nadav D.
        • Dani F.
        Reconstructing data: evidence-based medicine and evidence-based public health in context.
        Dynamis. 2006; 26: 287-306
        • Bailey D.M.
        • Bornstein J.
        • Ryan S.
        A case report of evidence-based practice: from academia to clinic.
        Am J Occup Ther. 2007; 61: 85-91
        • Galen
        Galen on the Usefulness of the Parts of the Body.
        Cornell University Pr, Ithaca, NY1968
        • Whyte J.
        • Barrett A.
        Advancing the evidence base of rehabilitation treatments: a developmental approach.
        Arch Phys Med Rehabil. 2012; 93: S101-S110
        • Seel R.T.
        • Steyerberg E.W.
        • Malec J.
        • Sherer M.
        • Macciocchi S.
        Developing and evaluating prediction models in rehabilitation populations.
        Arch Phys Med Rehabil. 2012; 93: S138-S153
        • Whyte J.
        Traumatic brain injury rehabilitation: are there alternatives to randomized clinical trials?.
        Arch Phys Med Rehabil. 2002; 83: 1320-1322
        • Whyte J.
        • Gordon W.
        • Rothi L.J.
        A phased developmental approach to neurorehabilitation research: the science of knowledge building.
        Arch Phys Med Rehabil. 2009; 90: S3-S10
        • Hart T.
        • Bagiella E.
        Design and implementation of clinical trials in rehabilitation research.
        Arch Phys Med Rehabil. 2012; 93: S117-S126
        • Cicerone K.D.
        Evidence-based practice and the limits of rational rehabilitation.
        Arch Phys Med Rehabil. 2005; 86: 1073-1074
        • Horn S.D.
        • DeJong G.
        • Deutscher D.
        Practice-based evidence research in rehabilitation: an alternative to randomized controlled trials and traditional observational studies.
        Arch Phys Med Rehabil. 2012; 93: S127-S137
        • Graham J.E.
        • Karmarkar A.M.
        • Ottenbacher K.J.
        Small sample research designs for evidence-based rehabilitation: issues and methods.
        Arch Phys Med Rehabil. 2012; 93: S111-S116
        • Kleitman N.
        Keeping promises: translating basic research into new spinal cord injury therapies.
        J Spinal Cord Med. 2004; 27: 311-318
        • Sipski M.L.
        From the bench to the body: key issues associated with research aimed at a cure for SCI.
        J Rehabil Res Dev. 2003; 40: 1-7
        • Turner-Stokes L.
        Evidence for the effectiveness of multi-disciplinary rehabilitation following acquired brain injury: a synthesis of two systematic approaches.
        J Rehabil Med. 2008; 40: 691-701
        • Walsh D.
        • Downe S.
        Appraising the quality of qualitative research.
        Midwifery. 2006; 22: 108-119
        • Pluye P.
        • Gagnon M.P.
        • Griffiths F.
        • Johnson-Lafleur J.
        A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in mixed studies reviews.
        Int J Nurs Stud. 2009; 46: 529-546
        • Evans D.
        Systematic reviews of interpretive research: interpretive data synthesis of processed data.
        Aust J Adv Nurs. 2002; 20: 22-26
        • Flemming K.
        Synthesis of qualitative research and evidence-based nursing.
        Br J Nurs. 2007; 16: 616-620
        • Thorne S.
        • Jensen L.
        • Kearney M.H.
        • Noblit G.
        • Sandelowski M.
        Qualitative metasynthesis: reflections on methodological orientation and ideological agenda.
        Qual Health Res. 2004; 14: 1342-1365
        • Walsh D.
        • Downe S.
        Meta-synthesis method for qualitative research: a literature review.
        J Adv Nurs. 2005; 50: 204-211
        • Flemming K.
        Synthesis of quantitative and qualitative research: an example using critical interpretive synthesis.
        J Adv Nurs. 2010; 66: 201-217
        • Mays N.
        • Pope C.
        • Popay J.
        Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field.
        J Health Serv Res Policy. 2005; 10: 6-20
        • Sandelowski M.
        • Barroso J.
        • Voils C.I.
        Using qualitative metasummary to synthesize qualitative and quantitative descriptive findings.
        Res Nurs Health. 2007; 30: 99-111
        • Albert K.M.
        Open access: implications for scholarly publishing and medical libraries.
        J Med Libr Assoc. 2006; 94: 253-262
        • Giglia E.
        Open access in the biomedical field: a unique opportunity for researchers (and research itself).
        Eura Medicophys. 2007; 43: 203-213
        • Lyons M.G.
        Open access is almost here: navigating through copyright, fair use, and the TEACH Act.
        J Contin Educ Nurs. 2010; 41 (quiz 65-6, 88): 57-64
        • Singh N.K.
        The self-archiving principle: a momentous trek.
        Postgrad Med J. 2007; 83: 564-567
        • Maher C.G.
        • Sherrington C.
        • Elkins M.
        • Herbert R.D.
        • Moseley A.M.
        Challenges for evidence-based physical therapy: accessing and interpreting high-quality evidence on therapy.
        Phys Ther. 2004; 84: 644-654
        • Phillips C.V.
        Publication bias in situ.
        BMC Med Res Methodol. 2004; 4: 20
        • Williamson P.R.
        • Gamble C.
        • Altman D.G.
        • Hutton J.L.
        Outcome selection bias in meta-analysis.
        Stat Methods Med Res. 2005; 14: 515-524
        • Dwan K.
        • Altman D.G.
        • Cresswell L.
        • Blundell M.
        • Gamble C.L.
        • Williamson P.R.
        Comparison of protocols and registry entries to published reports for randomised controlled trials.
        Cochrane Database Syst Rev. 2011 Jan 19; (MR000031)
        • Dwan K.
        • Gamble C.
        • Kolamunnage-Dona R.
        • Mohammed S.
        • Powell C.
        • Williamson P.R.
        Assessing the potential for outcome reporting bias in a review: a tutorial.
        Trials. 2010; 11: 52
        • Poole C.
        A vision of accessible epidemiology.
        Epidemiology. 2010; 21: 616-618
        • Pearce N.
        Registration of protocols for observational research is unnecessary and would do more harm than good.
        Occup Environ Med. 2011; 68: 86-88
        • Rushton L.
        Should protocols for observational research be registered?.
        Occup Environ Med. 2011; 68: 84-86
        • Silagy C.A.
        • Middleton P.
        • Hopewell S.
        Publishing protocols of systematic reviews: comparing what was done to what was planned.
        JAMA. 2002; 287: 2831-2834
        • Booth A.
        • Clarke M.
        • Ghersi D.
        • Moher D.
        • Petticrew M.
        • Stewart L.
        An international registry of systematic-review protocols.
        Lancet. 2011; 377: 108-109
      3. Dijkers MP, Bushnik T, Heinemann AW, et al. Systematic reviews for informing rehabilitation practice: an introduction. Arch Phys Med Rehabil. In press.

        • Wyer P.C.
        • Silva S.A.
        Where is the wisdom?.
        J Eval Clin Pract. 2009; 15: 891-898
        • GRADE working group
        (Accessed April 1, 2011)
        • Guyatt G.H.
        • Oxman A.D.
        • Vist G.E.
        • et al.
        GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
        BMJ. 2008; 336: 924-926
        • Jaeschke R.
        • Guyatt G.H.
        • Dellinger P.
        • et al.
        Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive.
        BMJ. 2008; 337: a744
        • Craig P.
        • Dieppe P.
        • Macintyre S.
        • et al.
        Developing and evaluating complex interventions: the new Medical Research Council guidance.
        BMJ. 2008; 337: a1655
        • Tonelli M.R.
        Integrating evidence into clinical practice: an alternative to evidence-based approaches.
        J Eval Clin Pract. 2006; 12: 248-256
        • Berguer R.
        The evidence thing.
        Ann Vasc Surg. 2004; 18: 265-270
        • Institute of Medicine
        Finding what works in health care: standards for systematic reviews.
        The National Academies Pr, Washington (DC)2011
        • Centre for Evidence-Based Medicine
        (Accessed April 25, 2011)
        • Edlund W.
        • Gronseth G.
        • So Y.
        • Franklin G.
        Clinical practice guidelines process manual. 2004 ed. American Academy of Neurology, St. Paul2004
        • Dijkers M.P.
        • Task Force on Systematic Review and Guidelines
        (editors)When the best is the enemy of the good – the nature of research evidence used in systematic reviews and guidelines. SEDL, Austin2009
        • Schlosser R.W.
        • Sigafoos J.
        ‘Empty’ reviews and evidence-based practice.
        Evidence-Based Communication Assessment and Intervention. 2009; 3: 1-3
        • Concato J.
        • Shah N.
        • Horwitz R.I.
        Randomized, controlled trials, observational studies, and the hierarchy of research designs.
        N Engl J Med. 2000; 342: 1887-1892
        • McKee M.
        • Britton A.
        • Black N.
        • McPherson K.
        • Sanderson C.
        • Bain C.
        Methods in health services research.
        BMJ. 1999; 319: 312-315
        • Kunz R.
        • Oxman A.D.
        The unpredictability paradox: review of empirical comparisons of randomised and non-randomised clinical trials.
        BMJ. 1998; 317: 1185-1190
        • Johnston M.V.
        • Sherer M.
        • Whyte J.
        Applying evidence standards to rehabilitation research.
        Am J Phys Med Rehabil. 2006; 85: 292-309
        • DeLisa J.A.
        The 31st Walter J. Zeiter Lecture.
        Arch Phys Med Rehabil. 1999; 80: 1-12
        • Rothwell P.M.
        External validity of randomised controlled trials: “to whom do the results of this trial apply?”.
        Lancet. 2005; 365: 82-93
        • Van Spall H.G.
        • Toren A.
        • Kiss A.
        • Fowler R.A.
        Eligibility criteria of randomized controlled trials published in high-impact general medical journals: a systematic sampling review.
        JAMA. 2007; 297: 1233-1240
        • Depp C.
        • Lebowitz B.D.
        Clinical trials: bridging the gap between efficacy and effectiveness.
        Int Rev Psychiatry. 2007; 19: 531-539
        • Vallve C.
        [A critical review of the pragmatic clinical trial] [Spanish].
        Med Clin (Barc). 2003; 121: 384-388
        • Smulders Y.M.
        • Levi M.
        • Stehouwer C.D.
        • Kramer M.H.
        • Thijs A.
        [The role of epidemiological evidence in providing care for individual patients] [Dutch].
        Ned Tijdschr Geneeskd. 2010; 154: A1910
        • Barratt A.
        Evidence based medicine and shared decision making: the challenge of getting both evidence and preferences into health care.
        Patient Educ Couns. 2008; 73: 407-412
        • Balas E.A.
        • Boren B.S.
        Managing clinical knowledge for health care improvement.
        in: Bemmel J. McCray A.T. Yearbook of medical informatics 2000 patient-centered systems. Schattauer, Stuttgart2000: 65-70
        • Guihan M.
        • Bosshart H.T.
        • Nelson A.
        Lessons learned in implementing SCI clinical practice guidelines.
        SCI Nurs. 2004; 21: 136-142
        • Engers A.J.
        • Wensing M.
        • van Tulder M.W.
        • et al.
        Implementation of the Dutch low back pain guideline for general practitioners: a cluster randomized controlled trial.
        Spine (Phila Pa 1976). 2005; 30: 559-600
        • Bekkering G.E.
        • van Tulder M.W.
        • Hendriks E.J.
        • et al.
        Implementation of clinical guidelines on physical therapy for patients with low back pain: randomized trial comparing patient outcomes after a standard and active implementation strategy.
        Phys Ther. 2005; 85: 544-555
        • Clinicians for the Restoration of Autonomous Practice (CRAP) Writing Group
        EBM: unmasking the ugly truth.
        BMJ. 2002; 325: 1496-1498
        • Brown P.A.
        • Harniss M.K.
        • Schomer K.G.
        • Feinberg M.
        • Cullen N.K.
        • Johnson K.L.
        Conducting systematic evidence reviews: core concepts and lessons learned.
        Arch Phys Med Rehabil. 2012; 93: S177-S184
        • Dijkers M.P.
        • Boninger M.
        • Bushnik T.
        • et al.
        Guidelines for assessing the quality and applicability of systematic reviews.
        The National Center for the Dissemination of Rehabilitation Research, SEDL, Austin2011
        • Lewis S.
        • Clarke M.
        Forest plots: trying to see the wood and the trees.
        BMJ. 2001; 322: 1479-1480
        • Jensen L.A.
        • Allen M.N.
        Meta-synthesis of qualitative findings.
        Qual Health Res. 1996; 6: 553-560
        • Finfgeld D.L.
        Metasynthesis: the state of the art–so far.
        Qual Health Res. 2003; 13: 893-904
        • Bradley L.
        • Law M.
        Systematically reviewing the evidence.
        in: Law M. MacDermid J. Evidence-based rehabilitation: a guide to practice. 2nd ed. Slack, Thorofare2008: 143-160
        • Centre for Reviews and Dissemination
        HTA database.
        (Accessed May 2, 2011)
      4. Field M.J. Lohr K.N. Clinical practice guidelines: directions for a new program. Institute of Medicine, National Academy Pr, Washington (DC)1990
        • Loke Y.K.
        • Derry S.
        Does anybody read “evidence-based” articles?.
        BMC Med Res Methodol. 2003; 3: 14
        • Laupacis A.
        • Straus S.
        Systematic reviews: time to address clinical and policy relevance as well as methodological rigor.
        Ann Intern Med. 2007; 147: 273-274
        • AGREE Collaboration
        Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project.
        Qual Saf Health Care. 2003; 12: 18-23
        • The AGREE Collaboration
        Appraisal of Guidelines for Research & Evaluation (AGREE) instrument.
        in: St George's Hospital Medical School, London2001
        • MacDermid J.
        Practice guidelines, algorithms, and clinical pathways.
        in: Law M. MacDermid J. Evidence-based rehabilitation: a guide to practice. 2nd ed. Slack, Thorofare2008: 227-261
        • American Physical Therapy Association
        Hooked on evidence.
        (Accessed February 22, 2011)
        • Law M.
        • MacDermid J.
        • Telford J.
        Strategies to build evidence in practice.
        in: Law M. MacDermid J. Evidence-based rehabilitation: a guide to practice. 2nd ed. Slack, Thorofare2008: 207-225
      5. Rehab+.
        (Accessed April 26, 2011)
        • Holm M.B.
        The 2000 Eleanor Clarke Slagle Lecture.
        Am J Occup Ther. 2000; 54: 575-585
        • Murphy S.
        • Lin S.
        Perspectives.
        OT Practice. 2002; 7: 9-10
        • Dysart A.M.
        • Tomlin G.S.
        Factors related to evidence-based practice among U.S. occupational therapy clinicians.
        Am J Occup Ther. 2002; 56: 275-284
        • Salbach N.M.
        • Jaglal S.B.
        • Korner-Bitensky N.
        • Rappolt S.
        • Davis D.
        Practitioner and organizational barriers to evidence-based practice of physical therapists for people with stroke.
        Phys Ther. 2007; 87: 1284-1303
        • McCluskey A.
        • Lovarini M.
        Providing education on evidence-based practice improved knowledge but did not change behaviour: a before and after study.
        BMC Med Educ. 2005; 5: 40
        • Cameron D.
        • Russell D.J.
        • Rivard L.
        • Darrah J.
        • Palisano R.
        Knowledge brokering in children's rehabilitation organizations: perspectives from administrators.
        J Contin Educ Health Prof. 2011; 31: 28-33
        • Menon A.
        • Korner-Bitensky N.
        • Kastner M.
        • McKibbon K.A.
        • Straus S.
        Strategies for rehabilitation professionals to move evidence-based knowledge into practice: a systematic review.
        J Rehabil Med. 2009; 41: 1024-1032
        • Rehabilitation Measures Database
        (Accessed May 2, 2011)
        • Sweetland J.
        • Craik C.
        The use of evidence-based practice by occupational therapists who treat adult stroke patients.
        Br J Occup Ther. 2001; 64: 256-260
        • Groah S.L.
        • Libin A.
        • Lauderdale M.
        • Kroll T.
        • DeJong G.
        • Hsieh J.
        Beyond the evidence-based practice paradigm to achieve best practice in rehabilitation medicine: a clinical review.
        PM R. 2009; 1: 941-950
        • Murphy S.L.
        • Kalpakjian C.Z.
        • Mullan P.B.
        • Clauw D.J.
        Development and evaluation of the University of Michigan's Practice-Oriented Research Training (PORT) Program.
        Am J Occup Ther. 2010; 64: 796-803
        • Lencucha R.
        • Kothari A.
        • Rouse M.J.
        The issue is … knowledge translation: a concept for occupational therapy?.
        Am J Occup Ther. 2007; 61: 593-596
        • Gagnon M.L.
        Moving knowledge to action through dissemination and exchange.
        J Clin Epidemiol. 2011; 64: 25-31
        • Johnston M.V.
        • Dijkers M.P.
        Toward improved evidence standards and methods for rehabilitation: recommendations and challenges.
        Arch Phys Med Rehabil. 2012; 93: S185-S199
        • Guyatt G.H.
        • Oxman A.D.
        • Kunz R.
        • et al.
        GRADE guidelines: 8.
        J Clin Epidemiol. 2011; 64: 1303-1310
        • Sackett D.L.
        Rules of evidence and clinical recommendations on the use of antithrombotic agents.
        Chest. 1989; 95: 2S-4S
        • Robey R.R.
        A five-phase model for clinical-outcome research.
        J Commun Disord. 2004; 37: 401-411
        • McCluskey A.
        Occupational therapists report on low level of knowledge, skill and involvement in evidence-based practice.
        Austr Occup Ther J. 2003; 50: 3-12
        • Jette D.U.
        • Bacon K.
        • Batty C.
        • et al.
        Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists.
        Phys Ther. 2003; 83: 786-805
        • Salbach N.M.
        • Veinot P.
        • Rappolt S.
        • et al.
        Physical therapists' experiences updating the clinical management of walking rehabilitation after stroke: a qualitative study.
        Phys Ther. 2009; 89: 556-568
        • Schreiber J.
        • Stern P.
        • Marchetti G.
        • Provident I.
        Strategies to promote evidence-based practice in pediatric physical therapy: a formative evaluation pilot project.
        Phys Ther. 2009; 89: 918-933
        • Pain K.
        • Magill-Evans J.
        • Darrah J.
        • Hagler P.
        • Warren S.
        Effects of profession and facility type on research utilization by rehabilitation professionals.
        J Allied Health. 2004; 33: 3-9
        • Humphris D.
        • Littlejohns P.
        • Victor C.
        • O'Halloran P.
        • Peacock J.
        Implementing evidence-based practice: factors that influence the use of research evidence by occupational therapists.
        Br J Occup Ther. 2000; 63: 516-522
        • Implementation Science
        (Accessed April 21, 2011)