This concise and modestly priced primer is an ideal resource for busy clinicians who wish to practice in an evidence-based manner. Written primarily by four researchers at the Centre for Allied Health Evidence at the University of South Australia, the book also includes individual chapters written by practising clinicians: a physiotherapist, an occupational therapist, an acupuncturist, two chiropractors, an osteopath, a social worker, a podiatrist, a naturopath, a speech-language pathologist, a prosthetist/orthotist, and a dietician. Each chapter includes a case study for which a clinical-effectiveness question is posed and an appropriate literature search strategy is outlined. The lead author, Dr. Karen Grimmer-Somers, is a physiotherapist, the director of the Centre for Allied Health Evidence, and a member of the International Advisory Board of Physiotherapy Canada.
In addition to the 11 chapters written by practising clinicians are 5 global chapters, each packed with important information about how to begin the search to answer your latest clinical question. Written by Grimmer-Somers, chapter 1 is titled “What Is Evidence?” Definitions and differentiations are given for anecdotal evidence and for research evidence (primary and secondary). Clear steps are then provided for ranking and prioritizing the various types of evidence. Next, the methodological quality of studies is discussed, followed by a discussion of standard approaches for measuring it (i.e., critical appraisal instruments). Appendices in this chapter include a list of Web sites containing clinical guidelines and examples of quantitative research-design hierarchies (e.g., the Centre for Evidence-Based Medicine).
Chapters 2 and 3, contributed by a health sciences reference librarian, describe in a very straightforward and clinician-friendly manner how to plan your search and execute it using evidence-based resources. Chapter 2 explicitly outlines the step-by-step process for planning a search to uncover published systematic reviews that will assist in answering your current research question(s). Chapter 3 describes the various databases that are most important for allied health practitioners. This chapter also differentiates between primary and secondary databases (i.e., between those that contain mostly primary research and those composed of systematic reviews, practice guidelines, protocols, etc.) and between freely available databases (e.g., Google Scholar, PubMed, PEDro) and those that require a subscription (e.g., CINAHL, EMBASE, The Cochrane Library).
Chapter 4 discusses important practicalities in searching, such as reasons to modify a search and strategies for doing so. Common issues that confront the “searching clinician” are also described, such as using key words that are not the same as those in the published research, lack of access to relevant journals or databases, and lack of research published in the area of your clinical question.
The chapter on physiotherapy (chapter 10) was written by a physiotherapist in private practice and uses a case study of a middle-aged woman with a supraspinatus tendon tear. Her medical history is provided, as well as results of an objective examination of her shoulder range of motion and her history of pain. The research question formulated by the physiotherapist is, “What is the evidence for effective and efficient physiotherapy interventions of any type for improving pain and function of rotator cuff/supraspinatus tendon partial tears?” Next the search framework and search terms are provided, followed by a table including 12 studies or systematic reviews found in the nine databases searched. The author then outlines the steps she followed to critically review and summarize the research findings and concludes the chapter with specific, evidence-based recommendations for treating this patient.
In summary, this little book should be every busy clinician's dream! Entry-level physiotherapy students and research graduate students would also be well advised to purchase this primer or to encourage their university library to order a copy. The authors are to be commended for producing such a handy and inexpensive resource of practical tips for finding the evidence to support clinical practice.