I find that many clinicians still misunderstand what EBP is and what it can do for them. The following is a practical example of how I used EBP in the clinic the other day to aide quick, quality clinical reasoning.
I was working with a 76 y/o female on balance and generalized weakness after a recent string of falls. She was progressing well, so we were increasing difficulty of dynamic balance activities. The patient was performing lateral step-overs across a short hurdle (which she had performed many times successfully). Unfortunately, the patient missed and rolled her ankle on the hurdle. She had immediate pain, and had difficulty weight-bearing through her foot. I let her rest about 5 minutes, but she was still ambulating with an antalgic pattern. The question was: Did she sprain her ankle or fracture a bone in her foot or ankle? Did I need to refer her to PCP, ED, or MD? Did she need imaging?
I decided to utilize a clinical prediction rule (CPR) called the Ottawa ankle rules. The Ottawa ankle rules were developed to aide in clinical decision making when assessing if an ankle or foot injury requires radiography. This CPR is extremely well established and has been through 1. preliminary identification of factors 2. validation(1) 3. Impact analysis.(2) The Ottawa ankle rules has been found to have nearly a 100% sensitivity which means its ability to rule out fracture with a negative result if excellent (1).
Here is what the rule looks like: