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Ferreira RM. New evidence-based practice: Artificial intelligence as a barrier breaker. World J Methodol 2023; 13:384-389. [PMID: 38229944 PMCID: PMC10789101 DOI: 10.5662/wjm.v13.i5.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 12/20/2023] Open
Abstract
The concept of evidence-based practice has persisted over several years and remains a cornerstone in clinical practice, representing the gold standard for optimal patient care. However, despite widespread recognition of its significance, practical application faces various challenges and barriers, including a lack of skills in interpreting studies, limited resources, time constraints, linguistic competencies, and more. Recently, we have witnessed the emergence of a groundbreaking technological revolution known as artificial intelligence. Although artificial intelligence has become increasingly integrated into our daily lives, some reluctance persists among certain segments of the public. This article explores the potential of artificial intelligence as a solution to some of the main barriers encountered in the application of evidence-based practice. It highlights how artificial intelligence can assist in staying updated with the latest evidence, enhancing clinical decision-making, addressing patient misinformation, and mitigating time constraints in clinical practice. The integration of artificial intelligence into evidence-based practice has the potential to revolutionize healthcare, leading to more precise diagnoses, personalized treatment plans, and improved doctor-patient interactions. This proposed synergy between evidence-based practice and artificial intelligence may necessitate adjustments to its core concept, heralding a new era in healthcare.
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Affiliation(s)
- Ricardo Maia Ferreira
- Department of Sports and Exercise, Polytechnic Institute of Maia (N2i), Maia 4475-690, Porto, Portugal
- Department of Physioterapy, Polytechnic Institute of Coimbra, Coimbra Health School, Coimbra 3046-854, Coimbra, Portugal
- Department of Physioterapy, Polytechnic Institute of Castelo Branco, Dr. Lopes Dias Health School, Castelo Branco 6000-767, Castelo Branco, Portugal
- Sport Physical Activity and Health Research & Innovation Center, Polytechnic Institute of Viana do Castelo, Melgaço, 4960-320, Viana do Castelo, Portugal
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Ahmed N, Shaikh SA, Riaz A, Midhet F, Zia N. Public sector rehabilitation services for physical disabilities in tertiary care hospitals of Karachi, Pakistan: A qualitative study. Injury 2023; 54 Suppl 4:110798. [PMID: 37573067 DOI: 10.1016/j.injury.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Around the globe there are 2.4 billion people in need of rehabilitation. Disability and rehabilitation have not gained much importance in the public health arena, possibly due to limited research and awareness regarding the significance of rehabilitation. This study aimed to provide an in-depth understanding of the barriers and facilitators to the provision and utilization of rehabilitation services in public sector tertiary care hospitals of Karachi, Pakistan. METHODOLOGY This qualitative exploratory study was conducted from August to September 2015 in two tertiary care hospitals of Karachi. The criterion for hospital selection included the availability of functional rehabilitation services. Twenty-four key informant interviews were conducted with health professionals, including doctors, physiotherapists, occupational therapists, prosthetists, orthotists, as well as patients and caregivers. Qualitative content analysis was performed using a consensual qualitative research approach. Responses from key informant interviews were coded into free nodes and then categorized into themes. RESULTS Two themes emerged from the data: constraints to the provision of rehabilitation services, and barriers to the utilization of rehabilitation services. Basic infrastructure was available at both study sites; however, a lack of structured guidelines for referring patients to these services, a lack of information-sharing and guidance to the patients, and a limited supply of equipment (treatment modalities) hampered the provision of services. The barriers to rehabilitation services included cost pertaining to transport, environmental barriers, lack of support from the employer, and strain on and lack of support from caregivers. CONCLUSION Rehabilitation services require attention and investment in research and allocation of funds to strengthen the service delivery system. Hospitals, alongside the department of health, need to develop a strategic plan to set future directions and standards of available rehabilitation services.
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Affiliation(s)
- Naveed Ahmed
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
| | - Saeed Ahmed Shaikh
- Department of Orthopedic Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Atif Riaz
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Farid Midhet
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Piller A, Torrez E. Defining Occupational Therapy Interventions for Children with Fine Motor and Handwriting Difficulties. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2019. [DOI: 10.1080/19411243.2019.1592053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Aimee Piller
- Occupational Therapy, Piller Child Development, Phoenix, USA
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Abstract
The knowledge to action (KTA) process proposed by Graham et al (2006) is a framework to facilitate the development and application of research evidence into clinical practice. The KTA process consists of the knowledge creation cycle and the action cycle. The Evidence Based Review of Stroke Rehabilitation is a foundational part of the knowledge creation cycle and has helped guide the development of best practice recommendations in stroke. The Rehabilitation Knowledge to Action Project is an audit-feedback process for the clinical implementation of best practice guidelines, which follows the action cycle. The objective of this review was to: (1) contextualize the Evidence Based Review of Stroke Rehabilitation and Rehabilitation Knowledge to Action Project within the KTA model and (2) show how this process led to improved evidence-based practice in stroke rehabilitation. Through this process, a single centre was able to change clinical practice and promote a culture that supports the use of evidence-based practices in stroke rehabilitation.
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Sizer PS, Mauri MV, Learman K, Jones C, Gill N'S, Showalter CR, Brismée JM. Should evidence or sound clinical reasoning dictate patient care? J Man Manip Ther 2016; 24:117-9. [PMID: 27559281 PMCID: PMC4984817 DOI: 10.1080/10669817.2016.1185296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Phillip S Sizer
- Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Manuel Vicente Mauri
- Masters Program in Physical Therapy and Rehabilitation, Universidad del Desarrollo, Santiago, Chile
| | - Kenneth Learman
- Department of Physical Therapy, Youngstown State University, Youngstown, OH, USA
| | - Clare Jones
- Bellingham Physical Therapy, Bellingham, WA, USA
| | - Norman 'Skip' Gill
- Doctor of Physical Therapy Program, Baylor University, Fort Sam Houston, TX, USA
| | | | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Campbell GB, Skidmore ER, Whyte EM, Matthews JT. Overcoming practical challenges to conducting clinical research in the inpatient stroke rehabilitation setting. Top Stroke Rehabil 2015; 22:386-95. [PMID: 25775955 PMCID: PMC4573785 DOI: 10.1179/1074935714z.0000000045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND There is a shortage of published empirical studies conducted in acute inpatient stroke rehabilitation, though such studies are greatly needed in order to shed light on the most efficacious inpatient stroke rehabilitation interventions. The inherent challenges of inpatient research may dissuade researchers from undertaking this important work. OBJECTIVE This paper describes our institution's experience devising practical solutions to research barriers in this setting. METHOD Through concentrated efforts to overcome research barriers, such as by cultivating collaborative relationships and capitalizing on unanticipated benefits, we successfully facilitated conduct of five simultaneous inpatient stroke studies. RESULTS Tangible benefits realized include increased effectiveness of research participant identification and enrollment, novel collaborative projects, innovative clinical care initiatives, and enhanced emotional and practical support for patients and their families. We provide recommendations based on lessons learned during our experience, and discuss benefits of this collaboration for our research participants, clinical staff, and the research team.
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Hammel J, Magasi S, Mirza MP, Fischer H, Preissner K, Peterson E, Suarez-Balcazar Y. A Scholarship of Practice Revisited: Creating Community-Engaged Occupational Therapy Practitioners, Educators, and Scholars. Occup Ther Health Care 2015; 29:352-369. [PMID: 26270148 DOI: 10.3109/07380577.2015.1051690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Trends in policy, practice, and research point to the need for a community-engaged Scholarship of Practice (SOP) model that can be used to inform the development of occupational therapy practitioners, educators, and researchers. This article describes a community-engaged SOP model, the evidence justifying the need for such a model, and strategies to effectively create community-engaged practitioners, educators and career scientists within occupational therapy. We highlight several examples of community-based participatory research to further inform this model, and in turn, translate this knowledge back to communities for action and systems change that can affect the lives of people with disabilities and the communities in which they seek to live and participate long term.
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Affiliation(s)
- Joy Hammel
- a Department of Occupational Therapy, PhD Programs in Disability Studies & Rehabilitation Sciences , University of Illinois at Chicago , Chicago, IL, USA
| | - Susan Magasi
- a Department of Occupational Therapy, PhD Programs in Disability Studies & Rehabilitation Sciences , University of Illinois at Chicago , Chicago, IL, USA
| | - Mansha Parven Mirza
- a Department of Occupational Therapy, PhD Programs in Disability Studies & Rehabilitation Sciences , University of Illinois at Chicago , Chicago, IL, USA
| | - Heidi Fischer
- a Department of Occupational Therapy, PhD Programs in Disability Studies & Rehabilitation Sciences , University of Illinois at Chicago , Chicago, IL, USA
| | - Katharine Preissner
- a Department of Occupational Therapy, PhD Programs in Disability Studies & Rehabilitation Sciences , University of Illinois at Chicago , Chicago, IL, USA
| | - Elizabeth Peterson
- a Department of Occupational Therapy, PhD Programs in Disability Studies & Rehabilitation Sciences , University of Illinois at Chicago , Chicago, IL, USA
| | - Yolanda Suarez-Balcazar
- a Department of Occupational Therapy, PhD Programs in Disability Studies & Rehabilitation Sciences , University of Illinois at Chicago , Chicago, IL, USA
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Evaluating Physical Therapist Students’ Clinical Performance in Acute Care: A Retrospective Analysis Comparing Student-Treated and Staff-Treated Patient Outcomes After Total Knee Arthroplasty. ACTA ACUST UNITED AC 2015. [DOI: 10.1097/00001416-201529020-00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Maitland Schladen M, Groah SL. State of the science on cardiometabolic risk after spinal cord injury: recap of the 2013 Asia pre-conference on cardiometabolic disease. Top Spinal Cord Inj Rehabil 2014; 20:105-12. [PMID: 25477732 DOI: 10.1310/sci2002-105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manon Maitland Schladen
- MedStar National Rehabilitation Hospital , Washington, DC ; MedStar Health Research Institute , Washington, DC ; District of Columbia Veterans Affairs Medical Center , Washington, DC
| | - Suzanne L Groah
- MedStar National Rehabilitation Hospital , Washington, DC ; MedStar Georgetown University Hospital , Washington, DC
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Faux SG, Kohler F, Mozer R, Klein LA, Courtenay S, D’Amours SK, Chapman J, Estell J. The ROARI project – Road Accident Acute Rehabilitation Initiative: a randomised clinical trial of two targeted early interventions for road-related trauma. Clin Rehabil 2014; 29:639-52. [DOI: 10.1177/0269215514552083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 08/27/2014] [Indexed: 01/30/2023]
Abstract
Objectives: To determine the effectiveness of an Early Rehabilitation Intervention (ERI ) versus a Brief Education Intervention (BEI) following road trauma. Primary objective: return to work or usual activities at 12 weeks (for minor/moderate injury) and 24 weeks for major injury. Secondary objectives: Reduction in pain, anxiety, depression, disability and incidence of Post Traumatic Stress Disorder and improved quality of life. Design: A multi-site single-blinded stratified randomized clinical trial (RCT). Methods: 184 patients (92 in each arm) were recruited over 18 months and followed for 12 weeks (minor/moderate injury) and 24 weeks (major injury). Screening questionnaires at 2-4 weeks and follow-up interviews by phone for all outcome measures were undertaken. For those in the ERI group with a positive screen for high risk of persistent symptoms, an early assessment and intervention by a Rehabilitation Physician was offered. Those in the BEI group were sent written information and advised to see their GP. Results: 89.4% of injuries were mild in this cohort. At 12 weeks 73.8% and 69.1% of patients in the ERI and the BEI groups respectively had returned to work or usual activities. There were no significant differences between the two intervention groups with respect to the primary or any secondary outcome measures. Conclusion: This is the first RCT of an ERI following road trauma in Australia. A targeted ERI is as effective as a BEI in assisting those with mild/moderate trauma to return to work or usual activities.
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Affiliation(s)
- SG Faux
- University of New South Wales, Australia
- St Vincent’s Hospital, Sydney, Australia
| | - F Kohler
- University of New South Wales, Australia
- Liverpool Hospital, Australia
| | - R Mozer
- St Vincent’s Hospital, Sydney, Australia
| | | | | | - SK D’Amours
- University of New South Wales, Australia
- Liverpool Hospital, Australia
| | - J Chapman
- Liverpool Hospital, Australia
- Westmead Hospital, Australia
| | - J Estell
- University of New South Wales, Australia
- St George Hospital, Australia
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Mauro V, Biggeri M, Deepak S, Trani JF. The effectiveness of community-based rehabilitation programmes: an impact evaluation of a quasi-randomised trial. J Epidemiol Community Health 2014; 68:1102-8. [PMID: 25194053 DOI: 10.1136/jech-2013-203728] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Community-based rehabilitation (CBR) programmes have been described as highly effective means of promoting the rights and opportunities of persons with disabilities (PwD). Although CBR is often the main way in which PwD in low-income and middle-income countries access rehabilitation services, there is little literature providing rigorous evaluation of their impact on people's well-being. METHODS Data were collected in the Mandya and Ramanagar districts (Karnataka state, India), between December 2009 and May 2010. In total 2540 PwD were interviewed using stratified random sampling: 1919 CBR beneficiaries (who joined the programme between 1997 and 2009) and 621 persons who were living in villages not covered by the programme. We controlled for the systematic differences between people joining and not joining the programme using the propensity score matching method controlling for covariates at individual and village level. We evaluated the impact of the programme on the subgroups of PwD who are disadvantaged on the dimensions of interest: access to pensions, use of aid appliances, access to paid jobs and improvement in personal-practical autonomy after 4 and 7 years of joining the CBR. RESULTS We observed a positive and significant impact of the programme on access to services, rights and opportunities of PwD. The results indicate that compared with the control group access to pensions and allowances, aid appliances, access to paid jobs and personal-practical autonomy increased by 29.7%, 9.4%, 12.3% and 36.2%, respectively, after 7 years. CONCLUSIONS The CBR programme analysed has a positive impact on access to services and the well-being of PwD who are particularly deprived on outcomes of interest.
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Affiliation(s)
| | - Mario Biggeri
- Department of Economics, University of Florence, Italy
| | - Sunil Deepak
- Associazione Italiana Amici di Raoul Follereau (AIFO), Bologna, Italy
| | - Jean-Francois Trani
- Brown School of Social Work and Institute of Public Health, Washington University in St Louis, St. Louis, Missouri, USA
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Fillion B, Rochette A, Girard A. Challenges of being a scholarly clinician as perceived by stroke rehabilitation professionals. Disabil Rehabil 2013; 36:521-8. [PMID: 23721495 DOI: 10.3109/09638288.2013.797516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Stroke rehabilitation clinicians are responsible for offering quality services through evidence-based practices. How is this role fulfilled on a daily basis? OBJECTIVES (1) To explore the perceptions, experiences, and attitudes of rehabilitation professionals regarding their scholar role; (2) To identify factors that facilitate or hinder this role in their practices. METHOD Qualitative design of a phenomenological orientation. Face-to-face interviews conducted with professionals with at least 1 year experience in stroke rehabilitation using a pre-tested interview guide. Transcripts were coded using QDA-Miner software. RESULTS Mean age of the participants was 40.7 years ± 11.2. Participants were mostly women (n = 9/11). The role of scholar emerged as not having great value. Main themes (5) emerging from the analysis are emphasis on tacit knowledge; experience and clinical intuition leading to self-confidence and comfort in clinical practice; dissatisfaction with the lack of knowledge sharing among clinicians; importance of diversifying clinical tasks; and the underdevelopment of reflective practice. Four factors identified as influencing the role of scholar: motivation, critical incident as a main trigger of reflective practice, interns facilitating reflective practice, and lack of time. CONCLUSION From these results emerged questions about measures to encourage the scholar role and facilitate reflective practice in stroke rehabilitation. Implications for Rehabilitation Reflective practice has to be encouraged in professional rehabilitation of stroke. Managers' involvement is crucial to promote and support the role of scholar among professionals in stroke rehabilitation. The updated knowledge and networking from reading scientific paper, participation in trainings and conferences should be systematically disseminated.
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Affiliation(s)
- Barbara Fillion
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal , Québec , Canada
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Nash MS, Cowan RE, Kressler J. Evidence-based and heuristic approaches for customization of care in cardiometabolic syndrome after spinal cord injury. J Spinal Cord Med 2012; 35:278-92. [PMID: 23031165 PMCID: PMC3459557 DOI: 10.1179/2045772312y.0000000034] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Component and coalesced health risks of the cardiometabolic syndrome (CMS) are commonly reported in persons with spinal cord injuries (SCIs). These CMS hazards are also co-morbid with physical deconditioning and elevated pro-atherogenic inflammatory cytokines, both of which are common after SCI and worsen the prognosis for all-cause cardiovascular disease. This article describes a systematic procedure for individualized CMS risk assessment after SCI, and emphasizes evidence-based and intuition-centered countermeasures to disease. A unified approach will propose therapeutic lifestyle intervention as a routine plan for aggressive primary prevention in this risk-susceptible population. Customization of dietary and exercise plans then follow, identifying shortfalls in diet and activity patterns, and ways in which these healthy lifestyles can be more substantially embraced by both stakeholders with SCI and their health care providers. In cases where lifestyle intervention utilizing diet and exercise is unsuccessful in countering risks, available pharmacotherapies and a preferred therapeutic agent are proposed according to authoritative standards. The over-arching purpose of the monograph is to create an operational framework in which existing evidence-based approaches or heuristic modeling becomes best practice. In this way persons with SCI can lead more active and healthy lives.
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Affiliation(s)
- Mark S. Nash
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA; The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA; and Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA,Correspondence to: Mark S. Nash, Miller School of Medicine, University of Miami, 1095 NW 14th Terrace, R-48, Miami, FL 33136, USA.
| | - Rachel E. Cowan
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA; and The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jochen Kressler
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA; and The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA
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Dijkers MP, Murphy SL, Krellman J. Evidence-based practice for rehabilitation professionals: concepts and controversies. Arch Phys Med Rehabil 2012; 93:S164-76. [PMID: 22683207 DOI: 10.1016/j.apmr.2011.12.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 12/20/2011] [Accepted: 12/21/2011] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Marcel P Dijkers
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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