Here's an inconvenient truth: researchers don't always agree with each other. And maybe even more inconvenient is the fact that often, the research doesn't even agree with itself: a recent article in Science magazine found that out of 100 psychological studies published in the field's top journals in 2008, fewer than half delivered the same results when replicated.
And yet, in physical therapy and just about every other health care profession, the pressure is on for providers to be in tune with research in order to deliver consistent evidence-based practice that includes patients' and clients' wants and needs, the clinician's knowledge and skills—and the best available evidence.
But when is evidence really evidence? And how do you judge the value of one approach to treatment when a paper published tomorrow could cast that approach as wholly ineffective? How does a PT stay knowledgeable when getting that knowledge sometimes feels like you're trying to nail jello to the wall?
Enter clinical practice guidelines—particularly the guidelines that continue to be developed by APTA's sections through a program facilitated by the association. CPGs are the best way to get an informed, expert view on how to at least consider treating a particular presenting problem.
Whether you're familiar with these resources or just now reading about them, here are 3 things to feel good about when it comes to the APTA CPG offerings through PTNow.
- They're helping to close the research-to-practice time warp.
The general consensus is that clinicians—not just PTs and PTAs, but all health care clinicians—live in a kind of time machine, where their clinical practices lag behind current research by about 17 years.
It's not all that surprising when you think about it, says Matt Elrod, PT, DPT, MEd, NCS, APTA senior practice specialist.
"You conduct the research, verify the soundness of the results, and publish the article in a peer reviewed journal, then it takes a couple of years for that information to be compiled and published as part of book, then a few years for those findings, that book, to be recognized as something that needs to be taught," Elrod says. Then that knowledge needs to get incorporated into the curriculum and absorbed by students who must graduate and begin practicing before they can even think about applying the research they learned.
And that's just knowledge as it gets fed into the education system. When you're on your own as a clinician, that sort of institutional vetting system isn't always readily apparent—or available. It's even possible for those gaps to increase.
CPGs such as the ones offered through PTNow are a way to decrease that gap, helping PTs get to the heart of the matter: finding the best available evidence that will add value to the treatment. "CPGs help you to get to that point, and get there efficiently" Elrod says. The hundreds of CPGs now available include guidelines from outside physical therapy that are relevant to the profession, CPGs developed by APTA's sections, CPGs that have received further expert evaluation through APTA's "CPG+" program, and guidelines that have received full endorsement from APTA. Exploring the offerings will soon be made easier thanks to a revised webpage.
- They aren't the boss of you.
Anne Reicherter, PT, DPT, PhD, OCS, CHES, APTA senior practice specialist, wants to remind PTs that they're called clinical practice guidelines for a reason: because individual clinical judgment is still important.
"CPGs are intended to complement the PT's practice, not dictate it," she says. "We've had a big evolution in our profession toward research and evidence-based practice, and tools like PTNow and CPGs can help you synthesize information and provide clinical support, but they're not the end of the story."
Part of that support is rooted in the idea that the CPGs developed through APTA’s sections must have real-world applicability, meaning that the protocols, tests, and measures they recommend are intended to be practical—not beyond the reach (or budget) of the practicing PT. By keeping the guidelines rooted in the doable, CPGs also serve as 1 more tool to decrease variation in practice—1 of the elements crucial to the profession's continued health and viability in the health care environment of the future.
But a do-this-or-else prescription for treatment? Not exactly, Reicherter says.
"A good CPG is a clear bridge to evidence-based practice, but patient wants and needs, as well as the individual PT's own knowledge and skills, must also be considered."
- Change is baked in. (And you could help with the baking.)
CPGs have been around for long time, but APTA's direct efforts only date back to 2011, meaning that the CPGs produced by the sections and offered up through PTNow are about as fresh as these kinds of things can be. But that doesn't mean they have an infinite shelf life.
"When APTA first started, our goal was to help sections develop CPGs, and we did that through both funding and other kinds of assistance," explains Anita Bemis-Dougherty, PT, DPT, MAS, vice-president of APTA's Practice Department. "And we're still involved in development, but the process also involves continually monitoring what's out there to be sure we're current, and getting the opinion of experts in not just scientific research but relevance to practice."
What that means is, the CPGs available on PTNow (currently 12 of them developed by APTA Sections) are built on a system that recognizes the realities of evidence-based practice—that new and better evidence is always possible, and that the new information may mean that guidelines need to be adjusted accordingly.
To stay agile, however, the program relies on input—both by way of more formal review processes and through an engaged community of PTs and PTAs who read, discuss, and provide input to PTNow. The best way to get involved in creating a CPG is through an APTA section (14 Sections are now involved in some stage of CPG development), and by keeping up with APTA's announcements and annual calls for CPG proposals.
"It's all about getting the best available research and putting it into the hands of clinicians," Bemis-Dougherty said.
This article is a part of APTA's "Profession in Transformation" series. Check it out!