Evidence-Based Practice in Rehabilitation

Sometimes we are faced with problems other than patient-specific interventions. Like those, we need to clearly understand the problem,  conditions and causes that create the problem to begin with. To define the problem of practice, consider the following two points.

• Consider the problem from multiple perspectives: the patient, physician, nurse, CPO, therapist, counselor, employer, insurer, caregivers, manufacturers, front office staff, technicians, and any other individuals who may have a stake in the problem and it’s potential solution.
   

• If the problem is related to a specific population, consider describing all categories of the ICF.

• Consider the complexity and level that the problem exists

  • Is it related to diagnosis, specific personal or environmental factors, specific practitioner issues, or something at the level of the health service, policy or social context?

  • “…having more than one level challenges us to use more than one theoretical approach.” (Campbell et. al. 2007)
    
     

• Consider all of the potential causes and pathways

  • Draw connections between the causes and problem
     

• What does the evidence (empirical or anecdotal) tell us?

  • Is there a problem with the innovation?; Is there a problem with the way the intervention gets implemented?; Is there a lack of money or organizational structure?; Is there difficulty generalizing the research findings to practice situations?; Is there a lack of time, skills or resources?

  • What is the extent of the problem?
     

• Avoid the “zone of wishful thinking”. Consider whether the intervention to address the problem of practice is actionable. Is it something that is doable and achievable? Sometimes the problem of practice is too broad. Consider ways to break the problem down into parts – then tackle just one part of the problem.
   

• Recognize that defining the problem of practice and selecting the appropriate intervention is an iterative process