What is it?◦ “…use of treatment methodologies for which there is

scientifically collected evidence that the treatment works.” (Stout and Hayes, 2005)

Two ways to have an Evidence-Based Practice1. Inform your practice by reading the scientific

literature of your field and continually educate yourself as to standard protocols that have been scientifically supported.

2. Develop standards for your own practice that shows evidence that your treatment intervention was actually the variable that has produced the changes seen in your clients.

Developing Evidence Based Research from your Own Practice

At the HEART of every practicing clinician is a Scientist!

We use Scientific Method to investigate the complex nature of our client’s ailments.

Clinicians Practice Scientific Method

Observe Describe Predict Test Analyze Draw conclusions Replicate

Example:Mary comes to the office complaining of the following symptoms: She cannot concentrate, she is often irritable, she experiences shortness of breath, and lately she has had much trouble sleeping. She has also experienced an increase in back pain for the past several weeks. She finds that she can cry “at the drop of a hat” and there is nothing in her life right now that would be causing this.

What are the fundamentals of Scientific Method?

Observe◦ Gather info from Mary about her symptoms and make own observations

Describe◦ Write down your formal descriptions as objectively and clearly as possible◦ Cluster of symptoms= diagnosis (Psychologists)◦ Cluster of symptoms = “totality of symptoms” (Homeopaths)

Predict◦ Form an hypothesis (due to the totality of symptoms I think it is

A B Test

◦ Give Mary a remedy based on your hypothesis Analyze

◦ “See” if Mary starts to feel better (her symptoms decrease) after you’ve given the remedy

Draw conclusions◦ Every time I give X ( the remedy), the symptoms decrease

Replicate◦ When I gave X for a similar “totality of symptoms” (another client) the

symptoms decreased◦ Other clinicians show similar results with similar cases

In the Past… we relied on1. Our Ethical Intent (Hippocratic Oath- “Do no

Harm”)2. Our Clinical Judgment (I think my treatment is

working)

These are necessary conditions to have but they are not sufficient to show that our conclusions are valid.

We need to show that it is our treatment and not some other variable that is causing the change in symptoms.

Scientific Scrutiny : Are our conclusions valid ?

1700’s physicianCured physical and mental ailments with

“animal magnetism” –there were “magnetic fluids in nature” that could be used to cure disease.

“All the rage” Mozart and Marie Antoinette were advocates.

King commissioned French Academy of Sciences to investigate claim

Ben Franklin (one of those on commission) had Mesmer’s asst. D’Eslon magnetize a tree and others were not magnetized. Blindfolded a 12 yr. old boy who embraced series of trees, as he moved further away from magnetized tree, he said he was experiencing stronger magnetic forces which resulted in his fainting. (one of the first placebo controlled tests). Commission reported that there was NO SCIENTIFIC EVIDENCE it was “animal magnetism” rather it was a form of “self-delusion”

Franz Anton Mesmer

When we test our hypothesis, we need to be able to show evidence that it is our independent variable (supposed cause, or in our case, our treatment) that is producing the effect, NOT some other variable.◦ In Mesmer’s case, the experiment showed that it

was some other variable (a “form of self-delusion”) that produced the results. His treatment was unfortunately labeled “quackery”. Perhaps if he would have known a little more about scientific research strategies he could have supported his theory better.

Internal Validity

Because we are practitioners, we collect evidence about 1 client at a time.

Makes it less likely that we will be using randomized control groups and/or trials to collect evidence.

Risk Factor- can our treatment and results from 1 client be generalized to other clients, other settings, and even with other practitioners?

External Validity

Outcome Data!what are we measuring?is it objective or subjective?how clearly are we measuring it?can we put it on a graph?can we show progress by repeated measures?

Design Practice Protocol for Scientific Rigor

Florence Nightingale

Founder of NursingPioneer in use of “Statistical graphics” (circular histogram or “Nightingale’s Rose Diagram”)

Our Evidenced Based PracticePsychologists Homeopaths

1. Cluster of symptoms2. Diagnosis3. Functional

impairments4. Keep track of them 5. Likert scale6. Global assessment of

functioning scale (0-100)

1. Cluster of symptoms2. Totality of Symptoms3. Functional

impairments4. Keep track of them5. Intensity of symptoms

scale◦ Mild = 1◦ Moderate= 2◦ Severe = 3

6. Energy scale (0-100)

Presenting Problem Functional Impairments Treatment Plan Progress Note Evaluation of measurements

◦ Show by repeated measures Stable state behavior trends

Evidence Based Protocol

Single Subject Research DesignThe 1 subject serves as his own control- see stable state/trends

Kazdin, 2011

Single Subject Design used by Behavior Analysts – different treatments

Phillips, 1968

Single Subject Design –no reversal-different treatments in Education

Ingram,2005

Single subject for practice based primary care

Janosky, 2005

Single Subject Design in Physical Therapy

Roy et al., 2009

Design your outcome measures Make your own progress note to include

Likert scales and graphing capabilities How can you measure baseline? How can you measure reversals or

withdrawal of treatment? What is your scale and wording for energy

level?

Experiential Exercise