Integration of critically appraised topics into evidence-based physical therapist practice.
Physical therapists frequently encounter situations that require complex differential-diagnosis decisions and the ability to consistently screen for serious pathology that may mimic a musculoskeletal complaint. By applying the evidence-based-practice process to diagnosis, screening, and referral, physical therapists can identify diagnostic and screening strategies that positively influence clinical decisions. A critically appraised topic document (a standard 1-page summary of the literature appraisal and clinical relevance in response to a specific clinical question) is a valuable tool in evidence-based practice. The creation of a critically appraised topic makes the educational process cumulative instead of duplicative, allowing the individual clinician to assimilate and consolidate knowledge after a search effort and improving search and appraisal skills. The purpose of this clinical commentary is as follows: (1) to describe the clinical reasoning process of 3 orthopaedic physical therapists that led to the development of specific clinical questions related to screening for nonmusculoskeletal pathology, (2) to describe the search and triage strategy that led each physical therapist to the current best evidence needed to rule out nonmusculoskeletal pathology in the patient, and (3) to discuss the advantages and disadvantages of a critically appraised topic, the implementation of this process, and the tailoring of search strategies to find diagnostic and screening strategies.
US Army-Baylor University Doctoral Fellowship in Orthopaedic Manual Physical Therapy, Brooke Army Medical Center, Fort Sam Houston, TX, USA. michael.crowell2@us.army.mil
Michael S
MS
Crowell
Bradley S
BS
Tragord
Alden L
AL
Taylor
Gail D
GD
Deyle
D000328:Adult; D003937:Diagnosis, Differential; D055317:Evidence-Based Practice; D005260:Female; D015775:Fractures, Stress / Q000175:diagnosis; D006073:Gout / Q000175:diagnosis; D006801:Humans; D016247:Information Storage and Retrieval / Q000379:methods; D017116:Low Back Pain / Q000175:diagnosis; D008297:Male; D008683:Metatarsophalangeal Joint / Q000293:injuries / Q000503:physiopathology; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis; D010024:Osteoporosis / Q000175:diagnosis / Q000503:physiopathology; D026761:Physical Therapy Specialty / Q000592:standards*; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging / Q000293:injuries; D055815:Young Adult