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Evidence Based Practice: I ntervention for people with lower limb amputations

Evidence Based Practice: I ntervention for people with lower limb amputations. Karl Schurr March 2007. Plan. Quick review of EBP levels of evidence What evidence is out there? What to do with the evidence? Implications for clinical decision making. Levels of evidence.

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Evidence Based Practice: I ntervention for people with lower limb amputations

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  1. Evidence Based Practice: Intervention for people with lower limb amputations Karl Schurr March 2007

  2. Plan • Quick review of EBP levels of evidence • What evidence is out there? • What to do with the evidence? • Implications for clinical decision making

  3. Levels of evidence • Level 1: Systematic reviews – preferably high quality RCT’s Publication bias: positive outcomes more likely to be published Possibility for concentration of poor quality data • Level 2: RCT: high quality – specific criteria to minimise bias: (egPEDro scale) • Level 3: Pseudorandomised controlled trial (eg alternate allocation) • Level 4: Case series • Level 5: Expert opinion, position statements

  4. Why is expert opinion the lowest level of evidence? • Potential for charismatic “experts” to exert undue influence • Ignore evidence when it already exists • Concentration of one person’s biases/opinions: American paediatrician Dr Spock : “Baby and Child Care” “one of the most influential books of the 20th century” Sold > 22 million copies in 26 languages. Recommended babies to sleep on their stomachs 1970: clear evidence that this was lethally bad advice Estimates of: 10,000 unnecessary cot deaths in UK 50,000 unnecessary cot deaths in US, Australia and Europe

  5. Expert Opinion • Conclusions: • Expert opinion not always correct • Need to maintain a healthy skepticism • Essential to measure the effectiveness of our own intervention decisions • Carefully consider options for each patient

  6. Features of high quality Randomised controlled trials We are all biased! • Concealed random allocation • Assessors blind to allocation • Minimal drop outs • Intention to treat analysis • Standardised reliable measurement • All aim to minimise potential for bias

  7. Minimising personal bias • Movement scientists: • Measure effectiveness of intervention • Each patient becomes a research question • Ongoing review of each patient’s progress • Continue to seek evidence • Uncertainty is a fact of clinical life Learn to enjoy it!

  8. PEDro list

  9. Where else? • Other research areas Normal motor behaviour: • Learn what we practice • Task specificity: muscle actions – force, timing • Postural adjustments: sitting, standing, walking, running • Careful review of patient progress

  10. What are the person’s goals? How to push their limits? Falls risk What specific skills do they need to learn? What are the essential requirements of that skill?

  11. What is this man learning? What does he need to learn ?

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