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Ryne Foster EBP Presentation
1
Evidence Based Practice in Physical Therapy
Presented By Ryne Foster, PT, DPT, FAFS
Who Am I?
Who?
- From Manchester, Iowa
- Bachelor's in BioPsychology 2006
- St. Ambrose University Davenport, IA
- Played College Football D II
- Doctor of Physical Therapy 2009
- Des Moines University
- Spooner Physical Therapy - Desert Ridge
- 2009- to Present
- Clinic Director 2016- to Present
What Constitutes EBP?
What?
Case Study
16-year old female soccer player with a right ankle sprain that occurred 1 week ago. She has been managing her symptoms with rest, ice, compression and elevation (RICE) with a little improvement. She has pain in standing, and walking with limp. She feels more pain as the day goes on. Her goal is to return to playing soccer by next week to try out for the varsity team at her high school. She has an x-ray by her physician that was negative. Her physician prescribed her medication, but she does not take it to control her symptoms. Patient wants to be treated by a female PT.
Best Available Evidence
Best Available Evidence
With any application of Evidence Based Practice, you must consider:
- What are my goals for this patient?
- What does the literature say?
- What is most appropriate for this patient?
- BEWARE: Over-generalization that research is for each patient and age
Clinical Expertise
When considering an individual patient case and appropriate treatment, evaluate:
- What have I seen within my own treatment practice?
- What is within my personal scope of practice?
- What does the collective experience of my team say?
Patient Values
The center of the evidence based model always revolves around one thing, the Patient.
- What are my patient's goals?
- What societal, cultural, or personal expectations need to be considered?
How do we start?
What do we know about the patient?
- Patient is a 16 y/o female
- Recent ankle injury, traumatic in nature
How?
- Currently experiencing pain, swelling, and pain in standing, walking or playing soccer
- Patient goal is to return to soccer ASAP
- Does not want to use her prescription medication to manage her pain or swelling
- Wants to see a female PT
What does the literature say?
- Parameters of soft-tissue healing and remodeling
- Davis's Law (similar to Wolff's law)
- Evidence regarding edema management using ice, compression, elevation (During acute phase)
- Importance of local inflammation and subsequent IGF-1
- Evidence now after acute phase: Needs to begin manual therapy and exercises to regain function
Appropriate treatment application
This patient out of acute phase and is ready to return to strengthening exercises. Though, this depends on patient presentation. Therapist calls her physician was informed that she has elected to not take her medication and communicate functional progress if unexpected. Commuication key to physician and potential ATC caring for the athlete to return to court. PT gives medical advise as a collaborate approach to patient.
Take Home Message
At the individual level, a treatment approach unique to that patient or client is shaped by not only the most recent peer-reviewed evidence and clinical expertise, but also by the values, preferences and personal circumstances of that patient used to inform the practitioner's decision-making. Make if personal to each patient and use collaborate approach to care for this patient.
In short, MAKE IT PERSONAL!
In short, MAKE IT PERSONAL!
THANK YOU!
Questions?
r.foster@spoonerpt.com