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You have recently started working as a physiotherapist on a post-surgical unit. The unit is very busy and you are the only physiotherapist. You are wondering whether you should provide prophylactic physical therapy for all patients undergoing upper abdominal surgical procedures. You decide to visit the hospital librarian to plan an EB-PT search for up to date information to guide your care.
Step One: The Clinical Question
1. Which one of the following would be a good PICO question for this scenario?
A. Is prophylactic physical therapy for patients undergoing upper abdominal surgery effective in preventing post-operative pulmonary complications?
B. Is surgery more effective when accompanied by prophylactic physical therapy?
C. Is physical therapy good for patients undergoing upper abdominal surgery? Does it make their lives better?
Step Two: Conducting an EB-PT Literature Search
2. Which one would be the best Medline (PubMed) strategy?
A. (("physical therapy modalities"[TIAB] NOT Medline[SB]) OR "physical therapy modalities"[MeSH Terms] OR physical therapy[Text Word]) AND (("postoperative period"[TIAB] NOT Medline[SB]) OR "postoperative period"[MeSH Terms] OR postoperative[Text Word]) AND (("lung"[TIAB] NOT Medline[SB]) OR "lung"[MeSH Terms] OR pulmonary[Text Word]) AND ("complications"[Subheading] OR complications[Text Word])
B. "physical therapy modalities"[MeSH Terms] AND (("postoperative period"[TIAB] NOT Medline[SB]) OR "postoperative period"[MeSH Terms] OR postoperative[Text Word]) AND "pulmonary complications"[All Fields] AND (Randomized Controlled Trial[ptyp] OR Review[ptyp]) AND English[lang] AND "humans"[MeSH Terms]
C. "physical therapy modalities"[MeSH Terms] AND (("postoperative period"[TIAB] NOT Medline[SB]) OR "postoperative period"[MeSH Terms] OR postoperative[Text Word]) AND Review[ptyp] AND English[lang] AND "humans"[MeSH Terms]
Step Three: Evaluating Evidence
Say you found this citation:
Prophylactic respiratory physiotherapy after cardiac surgery: systematic review. BMJ. 2003 Dec 13;327(7428):1379.
3. Even though this is a systematic review why wouldn't you use the findings to make any firm decisions in your setting?
A. Of the 18 trials identified, most were of low quality. Plus the data of this review makes you wonder if the search for relevant studies was detailed and exhaustive. New studies on this topic could have come out in the past two years.
B. They searched the Cochrane controlled trials register and this is not a good place to find quality studies.
C. It unclear if study really attempted to remove bias during the review of studies
D. A and C
4. Which of these questions would you NOT ask yourself when reviewing a Randomized-Control Trial?
A. Did experimental and control groups begin the study with a similar prognosis? Were patients randomized? Was randomization concealed?
B. What are the results in the abstract? How fast can read this? How new is the data?
C. Were patients analyzed in the groups to which they were (originally) randomized? Were patients in the treatment and control groups similar with respect to known prognostic factors?
D. Did experimental and control groups retain a similar prognosis after the study started? Aside from the experimental intervention, were the groups treated equally? Was follow-up complete?
E. Are the results of this study valid?
Step Four: Applying the evidence to clinical practice
5. What is the most important thing to determine when applying a study to clinical practice?
A. How confident you are that you can apply the results to a particular patient or patients.
B. How significant were the benefits?
C. Is the treatment worth the effort or will just cause more harm than good?
D. Were all clinically important outcomes considered?
Step Five: Evaluating your Performance as a Practitioner of EB-PT
6. When you finish a EB-PT search you ask yourself questions about your ability to " "?
A. Ask an answerable clinical question
B. Find the best external evidence
C. Critically appraise the evidence and evaluate it for its validity and potential usefulness
D. Integrate critical appraisal of the best available external evidence from systematic research with individual clinical expertise in personal daily clinical practice
E. All of the above
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