EVIDENCE-BASED PRACTICE WHY?

thought, and leads to a new interpretation of the experience providing food for further thought (26). Reflective practice is used extensively as an educational tool for both students and adults across many professions ie. physiotherapy (27), sports therapy (14), occupational therapy (1), nursing (25) and medicine (28). The concept of ‘reflection’ is also central to portfolio development which is a collection of information used to summarise what has been learned from prior experiences and opportunities (29).

CONTINUING PROFESSIONAL DEVELOPMENT The link between continuing professional development (CPD) and EBP is very clear. CPD is a necessary component for the successful application of evidence-based practice (10). CPD is used to describe the process of systematic maintenance, improvement and broadening of knowledge and skills (11). The following passage is from core standards of the Chartered Society of Physiotherapists (CSP) (23). “CPD is the educational process by which physiotherapists and associate members maintain and develop their skills, knowledge and competency in order to provide safe and effective practice. It is a systematic and cyclical process that is undertaken throughout an individual’s career to develop and enhance performance at work and patient care”. CPD also involves identifying areas of practice that need updating or extending, planning, implementing and identifying learning outcomes (11). Journals are acknowledged as crucial sources of evidence- based information and vital to CPD as research literature is continually changing. Journals enable the therapist to keep up-to-date, whereas, the drawback with textbooks is staying current (24). Failure to keep up-to-date may lead to decay in professional knowledge, resulting in outmoded or ineffective practice (2). However, not all journal articles should be implemented, the decision depends on the research quality, particularly with respect to validity, reliability, relevance and applicability (19). CPD can be achieved by engaging in a variety of activities eg. attending courses and conferences, delivering presentations, the critical reading of journals, sourcing from electronic databases and reflective practice.

REFLECTIVE PRACTICE Reflective practice is recognised as an integral part of EBP and CPD and represents a vital component in professional development. Facilitation of reflection and the development of reflective abilities are acknowledged to be an important component of education. By reflecting on events in day- to-day practice and identifying areas of difficulty or gaps in knowledge, the clinician identifies specific learning needs. The reflective process allows clinicians to question and analyse their experiences and actions as a means of developing their knowledge, skills, and behaviour, to enhance clinical practice (25). Reflection takes place after the event, it is a process of

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OUTCOME MEASURES Historically, measurement of clinical outcomes was not a feature of routine clinical practice. Clinicians did not systematically collect data on patients’ outcomes (30). Clinicians are now under increasing pressure to base their practice more firmly on ‘evidence’, and the rehabilitation professions are increasingly being called upon to differentiate the impact of services they provide and become more accountable for their practices (31). Previously, clinicians obtained incidental impressions of clinical outcomes from clinical observations, or from patients’ comments about satisfaction or dissatisfaction with the services provided. In such environments we hear cries for evidence of treatment effectiveness (15). In the face of mounting pressures to demonstrate that what they do ‘works’, researchers and clinicians within the rehabilitation professions are aggressively pursuing clinical outcomes research (31). Almost 12 years ago, Rothstein highlighted the dilemma…”we clinicians seek to do good, and to do that, we need to know what works in reality, not what works in our perceptions” (15, page 126). Outcome management can contribute greatly to

musculoskeletal practice (32) and evidence-based physical rehabilitation (31). Outcome management is important for quality assurance, used to make informed-decisions, to establish base-lines, document progress, assist with goal settings and motivate patients (31). Outcome management has something to offer the patient, provider, and third party payer (32). In physiotherapy, outcome measurement is emphasised to assess, evaluate and justify clinical practice. Outcome management is the measurement of a patient’s status, either symptomatically or functionally, which begins on the first visit to establish baselines and must be able to evaluate change over time in patient or participant status of either improvement or worsening (33). Appropriate measurement tools are essential for clinicians to effectively monitor treatment and patient response and for the researcher to make informed decisions about treatment effects in clinical trials. Ideally, outcome assessment tools should be reliable and valid, time-efficient, inexpensive, and should not offend the patient (34).

PHYSIOTHERAPISTS AND ASSOCIATE MEMBERS DEVELOP THEIR SKILLS, KNOWLEDGE AND COMPETENCY IN ORDER TO PROVIDE SAFE AND EFFECTIVE PRACTICE

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CPD IS THE EDUCATIONAL PROCESS BY WHICH