‫بسم اهلل الرحمن الرحيم‬

Evidence Based Practice

(EBP)
Presented To : Prof. Dr.\ Wadida Hasan Abdul Kader
 Evidence Based
Practice

Presented By : Mona Ismaiel Saad

Definition
'the integration of best research evidence with best available scientific research
As a Physical therapists want to make
well-informed clinical decisions turns to
evidence-based practice
The concept behind (EBP) is to create a
comprehensive knowledge base that improves patient
treatment outcomes.
Evidence-based practice requires a three-
fold approach

Evidence-based practice

unique knowledge, The patient’s

The Resources skills, and training wants, needs, and
of the therapist values
Following this approach, physical
therapists use their skills as a basis and
identify any gaps in knowledge. To fill
gaps, they may seek further research and
apply literature to the patient’s problem
while acknowledging the patient’s values
to make sure that patient care is informed by the
greatest available research in order to maximize
the benefits that patients receive from therapy and
focus on physical therapy practice away from
habits and tradition to evidence and research

Aims of Evidence-Based
Practice in Physical Therapy
allows physical therapists to translate research
findings into clinical practice
plan and evaluate care
stay up-to-date on medical research and
procedures
improve the decision-making process

Importance of Evidence Based

Practice in Physical Therapy
 better analyze and measure outcomes
 have a thorough understanding of the
risks of medications
 give patients a greater role in the planning
of their care
 create individualized care plans for
patients
 Hierarchy of evidence
based practice

Presented By : Randa Ahmed

Hierarchy of evidence based practice
Level of evidence Description

Level 1 Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trials).
(high quality)

Level 2 Evidence from at least one well-designed RCT (e.g. large multi-site RCT).

Level 3 Evidence from a single well-designed controlled trials without randomization (quasi-experimental studies)

Level 4 Evidence from well-designed case-control or cohort studies

Level 5 Evidence from Expert opinions: reports from expert panels and organizations, not based on research
(Very weak quality)
Quality of each level

Highest quality level of Lower quality level of

evidence evidence
1. Systematic reviews 1. Quasi-experiments
2. Meta-analyses 2. Cohort studies
3. Randomized control 3. case-controlled studies.
trials Individual RCTs
How to do high-quality clinical research
First should be determined exactly what a researcher
wants to learn and defines a study’s scope
Second knowledge of previous research in the
interested topic. A related literature review describes a
previous scholarly articles, books, and other credible
sources relevant to helping readers gain a full
understanding of the topic.
Third. Uses empirical data and proper data analysis
methods. Empirical data is considered objective,
unbiased evidence that has been collected by
researchers through observation, experience, or
experimentation.
How to do high-quality clinical research

Fourth. Representativeness and generalization of research data. Researchers can

ensure their findings that can be generalized to the larger population to achieve the
representativeness data.

Fifth. High external validity and reliability. Achieve high external validity and
reliability through generalization of research’s findings from the sample to the larger
population.
How to do high-quality clinical research

Sixth. Characteristics of research include (Replicability, reproducibility).

 Replicability aids other researchers to test the study’s findings and improve
the trustworthiness of a research’s findings among readers.
 Reproducibility achieved by researchers who has been allowed consistent
results using the same data and analysis methods.
How to do high-quality clinical research
Seventh. Limitations and recommendation for future research.
Researchers present their study’s limitations along with the study’s
findings and conclusion. In many cases, limitation opens doors for the
future studies.
Eighth. Research ethics. According to the World Health Organization,
research ethics provide academic research standards for conducting
studies. Some of the most common violations of research ethics include:
Falsification - This involves the manipulation or omission of data
or findings.
Fabrication - This involves making up data or results and
presenting these as accurate.
Plagiarism - This refers to the use of another person’s work without
giving due credit.
The Importance of High-Quality Clinical Research
Helps to understand complex problems.
Make decisions based on facts and evidence.
Develop new theories and approaches to solving problems.
Produce reliable and valid findings that other researchers can replicate.
Provide teaching materials for experienced researchers.
Factors affecting on quality of the clinical research

1. Lack of knowledge and skills of understanding of research processing.

2. Increase the knowledge gap between research and practice.
3. Uses another person’s idea, opinion or theory without paraphrasing of
researcher’s word.
4. Using invalid and unreliability devices and tools.
5. Lack of the resources available for the research.
6. Variation in environment (physical, social, physiological) affects in on
treatment level that estimate of error variance and lead to a type II error.
7. Low of statistical power (estimate null hypotheis due to choosing
inadequate sample size).
Factors affecting on quality of the clinical research

1. Lack of knowledge and skills of understanding of research processing.

2. Increase the knowledge gap between research and practice.
3. Uses another person’s idea, opinion or theory without paraphrasing of
researcher’s word.
4. Using invalid and unreliability devices and tools.
5. Lack of the resources available for the research.
6. Variation in environment (physical, social, physiological) affects in on
treatment level that estimate of error variance and lead to a type II error.
7. Low of statistical power (estimate null hypotheis due to choosing
inadequate sample size).
 Evidence Based
Practice

Presented By : Salah Eid Ahmed Ali

 Steps of Evidence Based Practice

Step (1): Familiarization with the PRISMA framework.

Preferred reporting items for systematic reviews and meta-analysis
(PRISMA) is the evidence based guide consisting of checklist and
flowchart intended to be used as a tools for authors seeking writing a
systematic literature review containing 27 items.
Step (2): Development of the study question. Which should be clear
and unambiguous which may be free form question or structured
question.
Step (3): Development of the study team at least three members with
qualification enough and expertize.
Step (4): Identification of the study concept (intervention and / or
comparative effectiveness studies with completion of the PICO
question.
Step (5): define each term in the study question.
Step (6): Selection of database relevant topic area of research
conduction as PubMed, CINAHL, PsycINFo, MEDLINE, or Web of
Science.
Step (7): Guided by the terms identified and defined in step 5, plan
the systematic search by the first substep is developing key words
used for search.
Step (8): Decide the inclusive and exclusive criteria.
Step (9): Go into database individually with expansion to MeSH
terms.
Step (10): Title review by reference citation managers as Zotero,
EndNote, RefWorks.
Step (11): Creation tables for each database.
Step (12): Abstract review which is important data for the PRISMA
flowchart.
Step (13): Abstract phase screening quality check for strengthening
validity and reliability of search results. Step (14): Organization of
overall process and updating PRISMA flowchart.
Step (15): Critical review assessment quality check with at least
90% agreement.
Step (16): Updating the PRISMA flowchart creating a new clean
included study matrix.
Step (17): Summarization of the evidence.
Step (18): Interpretation of the data.
 Constitutions of evidence

Intervention: Developing the management and monitor plan of care

with avoiding inappropriate prescription of treatment.
Diagnosis: Creating comprehensive and targeted history and
examination, identification of serious and specific conditions and
factors that may delay recovery, and avoiding of unnecessary
imaging and investigations.
Prognosis: Using validated and meaningful measures
examining the prognostic criteria of the patient and
appropriately refer of serious and specific conditions.
Patient experience: providing the most important
education and advice.
 Systematic Review

Systematic review is the most evidence research used for

systematically appraising, synthesized, and evaluating the available
researches in relation to particular question.
Used for information about the clinical practice, identification of
health care areas require further research, and identification and
selection of high quality evidence of treatment.
 PEDro Scale

The PEDro scale a measuring the quality of randomized controlled

trials containing 10 items scores as follow: random allocation,
concealed allocation, similarity at base line, subject blinding,
therapist blinding, assessor blinding, more than 85% follow up for
at least one key outcome, intention to treat analysis, between group
statistical comparison for at least one key outcome, and point and
variability measures for at least one key outcome.
 Evidence Based
Practice

Presented By : Nadia Abdelmoniem

 Meta-analysis
a systematic approach to identifying, appraising and combining the
results of relevant studies to arrive at conclusions about a body of
research .
It is an observational study in which the researchers don't
manipulate variables. Instead, they observe and analyze the data
using statistical methods.

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 Types of study

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1) Randomized controlled
trials
Randomized” means divided into groups by
chance. In RCTs participants are randomly
assigned to one of two or more groups. Then
one group receives the new drug A, for
example, while the other group receives the
conventional drug B or a placebo.
 2) Cohort studies

• A cohort is a group of people who are

observed frequently over a period of many
years to determine how often a certain
disease occurs.
• It has two types :a prospective (forward-
looking) design or a retrospective
(backward-looking) design.
 3) Case-control studies
• Case-control studies compare people who
have a certain medical condition with people
who do not have the medical condition.
• Then the two groups are interviewed, or their
medical files are analyzed, to find anything
that might be risk factors for the disease.
 4) Cross-sectional studies

• The classic type of cross-sectional study is

the survey.
• They can provide information on things like
the prevalence of a particular disease (how
common it is) but not informing about the
cause of a disease or what the best treatment
might be.
5) Qualitative studies

• This type of study helps us to understand

what it is like for people to live with a certain
disease.
• It does not rely on numbers and data.
 6) Systematic review

• It examines all the literature related to a

specific research question in a
standardized way which aiming to put
relevant data into a more organized
collection.
 Randomization

is the process of assigning participants to treatment and control

groups, assuming that each participant has an equal chance of being
assigned to any group.

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 Randomization

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 Blinding

Blinding refers to the act of withholding information about the assigned interventions from
people involved in the trial from the time of group assignment until the experiment is complete.

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 Blinding

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 Appraising of an
article

Presented By : Manar Fawzy Mohamed Hussien

Appraising of an article
Definition
Critical appraisal is a systematic process used to identify
the strengths and weaknesses of a research article in order to
assess the usefulness and validity of research finding
The key steps in critically appraising an article
•Reading and understanding the research question.
•Evaluating the study design and methodology.
•Assessing the validity and reliability of the data.
•Analyzing the results and conclusions.
•And considering the relevance and applicability of the
findings to the specific context or population of interest.
Ten questions to ask when critically
appraising a research article.
•Is the study question relevant?
•Does the study add anything new?
•What type of research question is being asked?
•Was the study design appropriate for the research question?
•Did the study methods address the most important potential sources of bias?
•Was the study performed according to the original protocol?
•Does the study test a stated hypothesis?
•Were the statistical analyses performed correctly?
•Do the data justify the conclusions?
•Are there any conflicts of interest?
Appraisal of diagnostic test
Guidelines to critically appraising literature on diagnostic tests:
•Are the results of the study valid?
•What were the results?
•Will the results help me in caring for my patients?

If the answer to any of these questions is “no”, you can save yourself the trouble of
reading the rest of it.
Steps for unbiased study
•Internal and external validity.
•Randomisation and baseline homogenity of groups.
•Concealment of allocation to groups.
•Blinding.
•Completeness of follow up
Internal and External Validity
Therapists must also consider critically appraising the study’s
overall quality and the study’s internal and external validity.
Internal validity relates to elements of research design intended to
exert control over extraneous variables that could
potentially impact the outcomes of the study.
External validity refers to the generalizability of the study’s results.
Randomisation and Homogenity of Groups
Randomization should theoretically ensure that each group of
subjects is similar at baseline so that no extraneous variables that could
potentially affect outcomes in studies.

Concealment of Allocation to Groups

Even when randomization procedures are followed, bias from
investigators influencing subject enrollment and group composition can
threaten validity if allocation to groups is not concealed from those
enrolling subjects in the study.
Blinding
In an attempt to minimize the effect of rater or subject bias.
Blinding (sometimes called “masking”) is usually referred to in the
context of a clinical trial and denotes that 1 or more of the groups of
people involved in a trial do not know whether the trial participants
received treatment.

Completeness of Follow Up
The authors should report the reasons for any patient dropouts from
the study and identify any patients who were lost to follow up
Appraising of intervention article
To analyze intervention processes two methodological
approaches

•quantitative (often questionnaire data), or

•qualitative (often interviews).

Qualitative approaches
Frame work of qualitative appraisal
Step 1. Take a quick look at the article
Step 2. Click on the Credibility tab above - there are questions to help
you appraise the trustworthiness of the article, read the questions and
look for the answers in the article.
Step 3. Click on each question and our answers will appear.
Step 4. Repeat with the other aspects of Trustworthiness:
Transferability, Dependability and Confirmability
 Evidence Based
Practice

Presented By : Ghoufran Tukaram Shiryan

 Power Analysis & Effect Of
Size
Power Analysis is defined as 

The probability of correctly rejecting the null

hypothesis for a fixed effect size and fixed sample size. As
such, power is a key decision when you design your study,
under the premise that the higher the power of your planned
study, the better.
As such, when planning a study, any good researcher will
consider the following four key elements – “APES”:

• Alpha: most commonly thought of as the significance level (i.e.,

your p- value); usually set at α =.05
• Power: the probability of correctly rejecting the null hypothesis
for a given effect size and sample size, typically set at power =.8
• Effect size: size of the relationship/difference between two
variables.
• Sample size: the number of observations (usually, participants,
but sometimes also stimuli) in your study.
¨There are two relationships in Power Analysis:
1) For a given sample size and α , the power of your study is higher
if the effect you are looking for is assumed to be a large effect as
opposed to a small effect; large effects are easier to detect.
2) For a given effect size and α , the power of your study is higher
when you increase your sample size.

As such from these two relationships, the researchers (since they have
little control over the size of the effect they are trying to detect), they
can instead increase the power of their study by increasing the size of
their sample (and also reducing sources of human and measurement
error in their study).
 Clinical Guidelines In Physical Therapy Practice

 The standard definition of

Clinical Practice Guidelines (CPGs) is 

“Systematically developed statements to assist practitioners and

patient decisions about appropriate health care for specific
circumstances“. Guidelines are designed to support the decision-
making processes in patient care. The content of a guideline is based
on a systematic review of clinical evidence - the main source for
evidence-based care.
• The benefits of clinical practice guidelines
include :

1. Improve clinical outcomes.

2. Reduce variability in clinical practice.
3. Increase use of known effective interventions.
4. Provide greater cost effectiveness.
5. Increase transparency of evidence to justify interventions.
• Clinical Guidelines are important to physiotherapists
because they :
1. Provide quick access to the synthesis of evidence.
2. Give the clinician direct access to the knowledge-base of the
experts.
3. Allow one to self-assess their current practice.
4. Assist with developing direction of future clinical research.
• Clinical Guidelines can be found at:

1. American Physical Therapy Association Guide (APTA).

2. PEDro.
3. Canadian Medical Association Infobase
of Clinical Practice Guidelines.
4. G-I-N International Guideline Library.
5. New Zealand Guidelines Group.
6. AHRQ National Guideline Clearinghouse.
7. National Institute for Health and Clinical Excellence (NICE).
8. Scottish Intercollegiate Guidelines Network (SIGN).
9. National Health and Medical Research Council.
 Evidence Based
Practice

Presented By : Rasha Abdelkader Abdelazeem

Assessing the quality of randomized
controlled trials
Is a relatively new and important development. Three approaches have been
developed:
1. Component approaches.
Evaluate selected aspects of trials, such as masking.
2. Checklists and scales.
Involve lists of items thought to be integral to study quality.
3. Scale Assessment.
Scales, unlike the other methods, provide a summary numeric score of quality,
which can be formally incorporated into a systematic review.
The Physiotherapy Evidence Database
(PEDro) scale
Evaluate the methodological quality of the included studies.
It is a sound option since this instrument is widely used worldwide with
recognized reliability and validity.
The scale is available for free at pedro.org.au and gathers more than 43.000
clinical trials, systematic reviews, and clinical practice guidelines in the field of
physiotherapy.
Assists readers to quickly assess whether a clinical trial presents reliable and
meaningful results for use in clinical practice.
The database classifies clinical trials only and scores them by adding the number
of items on the scale (0-10) that have been met.
There are a number of other instruments that evaluate the
methodological quality for :

A) Randomized clinical trials

1. Collaboration’s Tool 3. The DELPHI List

The Delphi method is a process used to arrive at a

allow students, instructors, and teaching assistants
group opinion or decision by surveying a panel of
to exchange resources in a number of different
experts. Experts respond to several rounds of
ways, depending on what is needed for a particular questionnaires, and the responses are aggregated
task. Tools include document and resource sharing and shared with the group after each round.
and collaboration, as well as web conferencing.
4. CASP Checklist for RCT)
2. The modified JADAD scale
Randomised controlled trial (RCT) is a trial in which
modified Jadad scale was applied in methodological participants are randomly assigned to one of two or
assessment. 10 With an eight-item scale, it is aimed more groups: the experimental group or groups receive
the intervention or interventions being tested; the
to evaluate randomization, blinding, withdrawals
comparison group (control group) receive usual care or
and dropouts, inclusion and exclusion criteria, no treatment or a placebo.
adverse reactions, and statistical analysis
B) Non-randomized trials

MINORS Tool
help change employment and field of work, open up opportunities for career
advancement in the same field or place of employment and give candidates
more perspective." Like choosing a major, it might take some time for
students to decide on a minor.
 Type of Data Base

Presented By : Nada Ashraf

Types of Databases
1-Hierarchical Databases
a type of database that is organized in a tree-like structure called one to many or
parent-child relationship
2-Network Databases
a network database is a hierarchical database, but with a major tweak. The child
records are given the freedom to associate with multiple parent records (many to
many relationship).
3-Object-Oriented Databases
is a database management system that supports the modelling and
creation of data as objects.
4-Relational Databases
A relational model organizes data into one or more tables (or "relations") of
columns and rows, with a unique key identifying each row.
5-Cloud Databases
A cloud database is used where data requires a virtual environment for
storing and executing over the cloud platforms and there are so many
cloud computing services for accessing the data from the databases
such as :

Amazon web services Google cloud platform

6-A centralized database
A centralized database is basically a type of database that is stored, located as well
as maintained at a single location and it is more secure. (desktop)
Centralized database can be accessed by anyone with the proper permissions. This
means that multiple people can work on the same data at the same time,
7-Personal Databases
Collecting and storing the data on its own System and this type of
databases is basically designed for the single user
There is no connectivity with other computer system or database to
access the data. (Microsoft access)
 Appraised and non-appraised Evidence based data
The Appraised research (filtered)  Critical appraisal is a key step in the evidence-
based practice process. By evaluating the studies we find in the database searches,
we are ensuring that we have the best evidence to treat the patient with, it allow a
clinician to assess evidence for its validity, reliability, and applicability to clinical
practice. When an appraisal tool is used to evaluate an article, the article is checked
for:
-Strengths and weaknesses of the articles study design and methodology
-Relevance to your clinical question
-Importance of the research question being answered
-Any potential conflicts of interest
while the non-appraised (unfiltered) data consists of original individual studies such
as controlled trials, cohort studies, and case studies.
Important database for physical therapy
Access Physiotherapy

-CIRRIE Database

-Cochrane Library

-FA Davis Collection

-PEDro

-PT NOW: Evidence-Based Practice Tools

-PubMed

-REHABDATA

-SPORTDiscus

-Scopus
 Pr
Barriers to Applying an Evidence-Based e se
Ab nted
1-lack of knowledge regarding evidence-based strategies. Ab dul by
dd la
ee
2- lack of knowledge regarding how to search for and appraise evidence. n
3- misunderstanding of negative attitudes about research and evidence-based care.

4- time consuming. Insufficient time reflects the mental time and energy required to use research and the
culture of busyness rather than the actual amount of time required.

5-Resarcher skills in applying the research findings into practice culture of getting job done and not spending
time accessing research; managers having other priorities; problem too complex to be solved by research .

6-other factors as: financial considerations: lack of resource and materials, lack of health care centers and
institutes support and the lack of motivation.
How to overcome these barriers?
1-lack of knowledge >>> Several strategies have focused on interactive educational programming and providing clinicians with
opportunities for experimental learning and increase clinicians involvement in research process.

2-negative attitude toward EBP and research >>> One perception that it is a hard science.it may be due to the size and
complexity of the research >>> group working and fund

3-demanding patient work load >>> in considerating patient characteristics, age, degree of illness, culture, social state and
degree of illness affect patient cooperation and following health care advices.

5-Time consuming or lack of time >>> 1. Incorporate EBP as part of your daily work and not an add-on. 2. Use sites that
summaries research rather than reviewing individual articles yourself. 3. Set aside time each month for your
development/research (example of an important/not-urgent task). 4. Give yourself motivational goals as journal clubs or working
on research with others.

6. Reading, attending courses and conferences all are needed.

Naghibi, D., Mohammadzadeh, S., & Azami-Aghdash, S. (2021). Barriers to evidence-based practice in health system: a systematic review. Evidence Based Care, 11(2), 74-82.
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