Purpose of Profession

1. Purpose of Profession • Develop a knowledge base that maximize the effectiveness of practice • Testing elements of clinical practice through rigorous and objective analysis (scientific research)

2. Homework & Discussion • What is Knowledge of Physical Therapy? • What is clinical practice of Physical Therapy?

3. Knowledge • Tradition • Authority • Trial and error • Deductive reasoning • Inductive reasoning • Scientific method

4. Tradition • We accept certain truths as givens. • Physical Therapy science is in a tradition as a guide to practice and as a foundation for treatment. • A serious problem is that many traditions have never been tested. • Reliance on tradition for making clinical choices avoid the search for new information.

5. Authority • Expert sources of information based on their success, experience, or reputation • We accept something as authority states • New technique is developed, we often jump to use it • Without evidence • Ignoring potential limitations • Theoretical rationale is unclear

6. Try and Error • No basis for making a decision • Disadvantage • haphazard and unsystematic nature and the knowledge is not shared • Time consuming • Experience • Best solution cannot be found

7. Deductive Reasoning • Acceptance of a general proposition and subsequent inferences can be drawn in specific cases • Example • Exercise improves postural stability • People who fall have impaired postural stability • Therefore, exercise will decrease the incidence of falls. (observed facts will confirm, reject, or question) • Limitations • Totally dependent on the truth of its premises

8. Inductive Reasoning • Reverse type of logic, developing generalizations from specific observations. • Example • Patients who exercise do not fall • Patients who do not exercise fall more often • Exercise improve postural stability • Limitation • Dependent on the representation of the specific observation • Basis for generalization, “May not be valid for younger individuals” • Introduction use deductive logic while discussion use inductive reasoning (Format of Article)

9. Typical format of journal article • Journal related to Physical Therapy? (Homework & Discussion) • Where and how can you find articles? (Homework & Discussion)

10. Scientific Method • Most good process for acquiring knowledge • Both deduction and induction in a systematic and controlled analysis of phenomena. • A systematic, empirical, controlled, and critical examination of hypothetical propositions about the associations among natural phenomena • Empirical: documenting objective data and findings in reality rather than personal bias or subjective belief • Control factors that are not directly related to the variables in question

11. Evidence-based Practice • Quality care based on scientific data and research • Best evidence currently available (see attachment) • Reality • Compels practitioners to make best-guess decisions when scientific evidence is not available • Role of us • Consumers of literature • Scientific investigators: collect data, analyze outcomes, efficient methods of providing health care services

12. Clinical Research I • A structured process of investigating facts and theories and exploring connection • examine clinical conditions and outcomes • establish relationships among clinical phenomena • evidence for decision making • Improving methods of practice

13. Outcomes in Physical Therapy • See attachment • Disablement Model • Effectiveness at Reasonable Cost • Requiring the clinicians to demonstrate how the outcomes of care reflect its quality • Outcomes ? • Patients satisfaction • Patient preferences • Self-assessment • Quality of life

14. Disablement Model • Disability – a condition affecting a person’s ability to perform specific functions. (CP) • Impairment – “anatomical, physiological, mental or emotional abnormalities or loss.” (Nagi Model). (contractures) • Function – the action for which a person is fitted or employed (Davies, 2000).(reaching) • Functional Limitation – the limitation in performance at the level of the whole organism or person (Nagi, 1965). (can’t reach clothing hook) • Pathology, impairment, functional limitation, and disability

15. DISABLEMENT MODEL • Nagi disablement model • Impairment functional limitations disability

16. Clinical Research II • Critical • Observable • Examined for their validity • To satisfy one’s curiosity about clinical phenomena • To pursuit truth to understand clinical events • To generate different ways of viewing clinical problems

17. Research Process • Identify research question • Design the study • Methods • Data analysis • Communication

18. Types of Research • Basic versus applied • Experimental and nonexperimental research • Randomized clinical trial • Single-subject design • Sequential clinical trials • Meta-analysis • Continuum of research • Descriptive research • Exploratory research

19. Electronic Source (Homework & Discussion)

20. Databases

21. Reading article

22. Reports • Manuscript writing • Statistical methods • Software