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As we work to create light for others, we naturally light our own way.

—Mary Anne Radmacher


The information provided in this chapter will assist the reader to:

  • Define evidence-based practice.

  • Understand the three components of evidence-based practice—namely, evidence (research), practitioner skills and knowledge, and client goals, values, and circumstances.

  • Differentiate evidence-based practice from ground-level research.

  • Explore motives for evidence-based practice and consider challenges to engaging in it.

  • Learn and apply five key steps for conducting an evidence-based practice project.

  • Distinguish critically appraised papers (CAPs) from critically appraised topics (CATs).

  • Classify research by its level of evidence.

  • Critically appraise individual research studies.

  • Synthesize multiple research studies to make recommendations for practice.

  • Examine plausible clinical scenarios for application of evidence-based practice.

  • Identify additional resources for evidence-based practice.


The first step in becoming an effective evidence-based practitioner is gaining a clear understanding of the term. The most popular definition of evidence-based practice originated with the pioneer of evidence-based medicine, David Sackett. In his foundational article, evidence-based practice is described as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 71). Although this definition emphasized the importance of using research in the clinical decision-making process, it failed to acknowledge the significance of the practitioner’s knowledge and skills and the patient’s goals, values, and circumstances. Thus, the definition was recently revised by Straus, Glasziou, Richardson, and Haynes (2011), who now identify evidence-based practice as “the integration of best research evidence with our clinical expertise and our patient’s unique values and circumstances” (p. 1). Best evidence refers to the current applicable research available on the efficacy of treatments for particular diagnoses or conditions. This research could include quantitative, qualitative, or mixed methods designs. Although research purporting the value of a particular treatment technique is important, this information cannot be used in isolation. The knowledge, skills, and past experiences of the practitioner are critical to appropriately apply results of the research. In addition, consideration of each client’s goals, values, strengths, weaknesses, and contexts is essential. A client’s context can encompass his or her cultural background, personal demographics, virtual communication, stage of life, and physical and social environments (AOTA, 2008). The integration of these three components—best evidence; practitioner skills and knowledge; and client’s goals, values, and circumstances—comprise evidence-based practice and is illustrated in Figure 10-1.

Figure 10-1

Evidence-Based Practice

Evidence-based practice involves the practitioner searching and appraising available evidence on the treatment being considered or the condition a client presents with. For example, the practitioner might be considering the use of electrical stimulation to treat a client’s low back pain, or he ...

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