The book is very well organized and provides a systematic way for the practicing physical therapist to understand and implement principles of evidence-based medicine into daily practice. One of the first things that jumps out at me as I am reading the first part of this text is the careful choice of words used in defining Evidence-Based Practice:
Evidence-based physical therapy practice is "open and thoughtful clinical
decision-making" about the physical therapy management of a patient/client that
integrates the "best available evidence with clinical judgement" and the
patients/client's preferences and values, and that further considers the larger
social context in which physical therapy services are provided, to optimize
patient/client outcomes and quality of life.
Jewell goes on to clarify the quoted aspects of this statement in a very thoughtful manner that leads the reader to understand EBP is not about molding practice patterns solely on published articles or clinical guidelines. Rather, it is a dynamic process of appraising, understanding, and utilizing evidence to the benefit of your patients well-being.
She also takes time to outline the role of evidence in clinical decision making, stating that the use of evidence is a "movement away from unquestioning reliance upon knowledge gained from authority or tradition." Taken in this context, it is difficult to justify avoiding it's use in our daily practice. As always, I do welcome opposing viewpoints on this matter.
Chapter one concludes by advising the practicing therapist that implementing EBP into your daily routine is not a simple process, particularly if you are not accustomed to doing so in the first place. It will require some cortical and habitual effort to begin consciously moving away from easier tradition and authority-based decision making.
I hope you will join me in this process of challenging yourself and refining your practice patterns to the benefit of your patients. You may find nothing changes in your day-to-day practice. If you are like me however, you may find some aspects of your daily practice that should be intensely challenged and refined. It isn't easy and will be downright humbling at times, but the end result will be well worth the effort!
Jewell D. (2008). Guide to Evidence-Based Physical Therapy Practice. Jones and Bartlett Publishers: Sudbury, Massachusetts.