Practice-based Research in (allied) healthcare

1.5 The five steps of evidence-based practice

When guidelines and systematic reviews give you insufficient (recent) information to answer your question, you must look for evidence in so-called original research articles from various (scientific) journals. Original research articles describe studies that were conducted by the researchers themselves. They may have used myriad different research methods in the process. In the healthcare domain, there are various databases in which you can find original research articles, such as the aforementioned MEDLINE (accessible via PubMed and EMBASE). CINAHL is also frequently used in the care sector. Then there are many more databases of a more specific nature. The libraries of universities and universities of applied sciences with care programmes offer subscriptions that give students (usually free) access to an enormous wealth of information. Furthermore, the library can assist you in your search for information in various different ways. Searching for answers As a physiotherapist, Isa is used to having patients complete a daily routine of resistance exercises with a predetermined level of resistance after having had meniscus surgery. However, her patient tells her that he cannot come to her practice every single day. Isa comes up with appropriate exercises that the patient can do at home for twenty minutes per day with a rubber strap. The patient turns out to have a far shorter recovery period compared to other patients who have undergone the same procedure. Isa wonders whether this is a coincidence. Inspired by her experience with this client, she decides to look into the effects of at-home training using a rubber strap after meniscus surgery. According to the “Treatment of meniscus injuries” guideline, no evidence-based post-treatment protocol is available. She starts looking for more information and soon finds a (somewhat older) systematic review of the effectiveness of physiotherapy after meniscus surgery. However, it contains no information about the exact nature of the recovery process. She tries to further refine her query and begins looking for original research articles. She finds various articles on the frequency of exercise moments and the types of exercises that patients do. Isa is happy with the information she has uncovered, but she wonders whether she has now found all relevant articles or if there is perhaps a better and more efficient way to search for what she needs. How can you develop a good and efficient search strategy? Once you have decided to look for evidence, it is important to come up with a search strategy. Developing a good search strategy can be quite difficult and requires some experience. A few simple tips are more than enough to get you started, though.

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