Chapter 2: Answering a Clinically Relevant Question

INTRODUCTION

Where Have You Been?

In Chapter 1, you learned what role evidence-based practice plays in being a sport and exercise science professional. You also learned that evidence could be divided into five primary levels. These levels represent the varying strength that can be assigned to the available evidence. The levels range from expert opinion and basic research on the lower end to randomized controlled trials and systematic reviews of randomized controlled trials on the upper end. This ranking system should not be used to ignore some evidence or suggest that it is unimportant; rather, it is a method by which you can sort evidence to ensure that you are making decisions based on the strongest evidence available.

You also learned that ranking evidence does not create a complete picture. Other sources of evidence, including clinical appraised topics and critically appraised papers, should also be included as part of your decision-making process. Finally, by using the Strength of Recommendation Taxonomy, you can assess groups of studies to determine whether the overall results of several studies provide strong enough evidence to recommend a change in practice.

Where Are You Going?

To find evidence to support your evidence-based practice, a five-step process is recommended. In this chapter, you will learn that process. The first step involves asking a focused clinical question that includes defining the following:

1. The patient of interest

2. The intervention or treatment of interest

3. The comparison among treatments defined as the new treatment versus the standard treatment

4. The clinical result or outcome

Once the question is defined, evidence must be found to address that question by searching electronic databases to locate potentially relevant published research. After that, the articles must be assessed for their validity and relevance to your patient or client.

Once the evidence has been found and assessed, it must be applied to your patient. Not all patients have the same set of goals or values or are at the same developmental or clinical stage. Thus, you will need to consider their priorities, so you can choose an effective treatment plan. You will learn that the cultural context of a patient's life affects the value of potential treatment options. Finally, you will learn that the last step in the process is evaluating yourself as an evidence based practitioner. If evidence-based practice is to be effective, you must be good at implementing it. That requires self-assessment. In other words, you need to ask yourself how well you are implementing the evidence into your practice and daily workflow.