Guide:
Evidence-Informed Practice

Evidence-informed practice isn’t just about reading and applying research. It involves integrating three key elements:  

• Research evidence – high-quality studies and reviews with sound methodology,  

• Clinical expertise – drawing on your knowledge, skills, and training, and  

• Patient experience – a consideration of your patient’s preferences, context, culture, and goals. Patient-centred communication and care must remain at the forefront of evidence-informed physiotherapy practice.   

These elements work together to guide physiotherapy care.  

When it comes to evaluating new research, it’s important to ask whether this evidence is relevant to your patient’s specific condition, goals, and clinical context. Even high-quality studies may not apply directly to every situation. 

To help you stay current, consider subscribing to a research summary service that will send relevant research information to your inbox to make it easier for you to stay up-to-date. If you are a member of the Canadian Physiotherapy Association (CPA), you have access and can subscribe to research reviews such as PEDro and Ortho Evidence, which offer digestible summaries of recent research. These tools can support your clinical reasoning and make it easier to apply evidence effectively into your practice.  

Levels of evidence provide a framework for understanding the relative strength and reliability of research findings.  

It’s important to note that while higher levels of evidence are generally considered more rigorous, varied forms of evidence can still be appropriate and useful depending on the available research and clinical context. It is not always necessary or possible to rely exclusively on the highest-level studies, and effective decision-making may require integrating evidence from multiple sources.  

“Critically appraise” means carefully checking research to make sure it is trustworthy, useful, and relevant to a specific context or clinical situation. For example, before using a new exercise technique for a patient’s back pain, you could review studies to see if the technique is safe, effective, and fits the needs of your patient. 

Integrating evidence into your practice isn’t just about staying on top of current research – it’s about making thoughtful, informed decisions that are in your patients’ best interests.  

You can break down the integration process into two steps: evaluating the evidence, and assessing clinical relevance. 

Let’s say you learn about a new device for tendon pain at a lunch-and-learn sponsored by the manufacturer. Before using it, you must first evaluate the evidence behind this new tool by: 

• Looking for unbiased, quality evidence, such as peer-reviewed research from independent sources that are beyond the manufacturer’s materials. 

• Making sure the device is approved by Health Canada. 

• Confirming that you are already following best practice for tendon rehabilitation, and that the tool would be an appropriate addition to current evidence-based approaches. 

After you have made sure that the tool and your current treatment approach are backed by evidence, you can take steps to assess its clinical relevance to your practice by: 

• Considering the individual patient’s condition, goals, and context. 

• Discussing the treatment option with the patient and explaining the emerging nature of the evidence. 

• Obtaining the patient’s informed consent and documenting the conversation in the patient’s chart. 

Whether the evidence behind an approach is well-established or still emerging, always proceed thoughtfully and in a patient-centered manner when implementing it into your practice.  

Conversations about evidence often occur as part of the informed consent process. Share enough relevant research to help patients understand your clinical reasoning and the rationale behind your decisions. For example, when treating osteoarthritis, you might explain that the strongest evidence for effective care includes exercise and education, which is why these are key components used throughout their rehabilitation plan. 

According to the Documentation Standard, you must document informed consent and relevant details of the consent process as appropriate to the clinical situation. This means that if the conversation about evidence is pertinent to the patient’s informed consent to the treatment, this must be included as part of the patient’s record. 

As a physiotherapist, your focus needs to be on providing safe and effective care. Innovation is important, but patient safety must never be compromised. Patients should not be used as “test subjects” for new or emerging therapies. 

Where appropriate, prioritize evidence-informed treatments before considering new or emerging therapies. If you choose to use a therapy with limited evidence, you must: 

• Critically evaluate the research to ensure it is credible, relevant, and appropriate for the patient’s condition.  

• Assess the risks and benefits based on the current evidence.  

• Discuss potential risks and benefits with the patient and obtain their informed consent to the approach. 

• Document both the discussion and the patient’s consent to include the new or emerging therapy. 

However, patient consent alone may not be sufficient if a new or emerging therapy is based on evidence that lacks scientific validity or poses unreasonable risks. In these cases, it should not be offered even if the patient agrees to it. 

To balance innovation with quality evidence, make sure that any new approach is offered only when it is backed by credible research relevant to its intended use, and when it can be applied safely and ethically within your clinical context.