EVIDENCE-BASED PRACTICE
Overview
How Technology Enhances EBP
Overview
While certainly not a new concept, the last decade has seen evidence-based practice (EBP) emerge as a standard in healthcare1 - one that is critical to survival in a highly competitive climate of increasingly restrictive coverage and limited patient contact. Within this environment, where clinicians are expected to deliver high-quality care, improve treatment outcomes, document those outcomes and reduce costs, EBP is of fundamental importance,2 and is the key to reducing costs and improving reimbursement. In fact, studies have shown that focusing on quality as a business strategy results in greater performance in almost every category, including operating expenses, return on investment and growth.3
The primary purpose of evidence-based interventions is to close the gap between research and clinical practice and to maximize functional outcome. EPB does not compel clinicians to ignore their experience and clinical intuition, or the patient's needs. Instead, it requires clinicians to become more systematic and consistent in how they use information. EPB is a methodical approach to integrating objective and observational evidence with clinical expertise and the needs and expectations of the individual patient.4, 5 It is a systematic approach to integrating current scientific evidence4 to:
- Define a specific clinical problem, i.e. identify pathology and/or disease if possible, and identify functional impairments.
- Formulate a treatment plan to stabilize disease if possible, and target impairments for rehabilitation therapy.
- Monitor treatment progress using direct impairment measures and measurements of function relative to activities of daily living.
- Document treatment outcome, including resolution of the medical condition and/or improvements in function.
This evidence-based approach requires both a thorough medical workup and complete differential assessment of sensory and motor impairments. This is especially important when addressing chronic balance disorders. Without the means to assess systematically the integrated aspects of balance and movement control, it is not possible to define accurately the true nature of a patient's balance disorder or understand fully the associated functional losses. This is discussed further under Assessment & Treatment.
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How Technology Enhances EBP
The historical approach to treating balance disorders held that clinical experience, knowledge and observation were adequate for treatment planning. Treatment that worked for one patient was considered to be appropriate for the next. However, this approach often falls short, as it does not take into consideration the specific underlying causes of a problem that may differ from one patient to the next.
Many patients with similar diagnoses report different symptoms and exhibit different functional limitations, often forcing clinicians to take a trial and error approach to see what works. However, the same treatment that worked for one patient, may not work for the next. Likewise, some patients who appear to have been treated successfully may have actually recovered without the treatment at all.3
Technology backed by sound scientific and clinical research can provide both the clinical accuracy and the evidence necessary to support effective treatment decisions and improve outcomes. When used appropriately, site-of-lesion tests help confirm diagnostic presumptions established during the history and physical exam. Computerized impairment assessments provide the only means to isolate impairments to individual sensory and motor system components of balance. This precise information not only provides the foundation for effective treatment planning, but also helps focus the patient's understanding of his/her problem and provides an objective measure of progress, which can be a significant motivating factor. Technologically based impairment and site-of-lesion tests provide complementary rather than redundant information. This is because patients with similar underlying pathologies can have very different impairments.
Technology should not be viewed as the panacea to clinical diagnosis, however, and each device should be considered carefully. A technological device will enhance EBP only if the device:
- Is well established and has undergone scientific and clinical study
- Provides standardized, systematic assessment protocols
- Provides accurate, objective documentation throughout the course of care
- Provides information which supports the formulation of clinical impressions and treatment
- Is able to isolate specific impairments and, thereby, streamline treatment and ultimately reduces costs
The clinician is equally responsible for understanding the evidence that supports an assessment tool, as well as the scientific basis for their clinical decisions. With an understanding of the validity and efficacy of specific tests for diagnosis and assessment, the clinician is better equipped to approach each patient case in a more efficient and effective manner. Computerized Dynamic Posturography (CDP), for example, is one such tool that has undergone much scientific research and clinical study, and an extensive body of evidence exists to support both the validity and the efficacy of the technology.
Click here for further discussion of the role of technology in the effective assessment and treatment of balance disorders.
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Summary
Evidence-based practices have become critical to survival in the modern healthcare arena. Clinicians today face increasing pressure to improve the quality of care while also reducing costs. While significant advances have been made in treatment, available technology, and methods for predicting who will benefit from a given approach, especially in the treatment of balance disorders, many clinicians continue to treat their patients in the same manner they were originally trained.6 Further, when considering rehab practices from clinic to clinic, it is obvious that great disparity exists regarding the best methods for effective treatment. Ultimately, the goal of EBP is that more systematic approaches to patient care, coupled with better documentation of both assessments and outcomes, will clarify what methods work best and accelerate progress in the quality of care. By incorporating EBP into overall management strategies, clinicians are better able to make more effective treatment decisions for each individual patient in a methodical and efficient manner. Utilization of assessment tools that meet current standards and provide accurate information regarding pathology and underlying functional impairments further empower clinicians to deliver higher quality care, improve outcomes and reduce costs.
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References
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