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Evidence-based Back Pain Management (EBM in general)
This document discusses evidence-based back pain management. It introduces evidence-based medicine (EBM) and the 5 A's process of EBM: Ask, Acquire, Appraise, Apply, Act. It emphasizes asking answerable clinical questions using the PICO format. It recommends searching for evidence through clinical summaries, synopses, systematic reviews, and primary studies. It highlights using keywords and MeSH headings to effectively search databases like PubMed and appraising the quality and applicability of evidence. The goal of EBM is to integrate the best research evidence with clinical expertise, patient values and circumstances.
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Evidence-based Back Pain Management (EBM in general)
- 1. Evidence-Based BackPain Management Sohail Bajammal, MBChB, MSc, FRCS(C), PhD(c) Assistant Professor of Orthopaedics May 30, 2010
- 2. What got meinto EBM…. What is a double blind study? Two orthopaedic surgeons reading an ECG
- 3. Double blind inorthopaedics?
- 4. EBM is notnew……. “ ثم نرقى في البحث والمقاييس على التدريج والترتيب مع انتقاد المقدمات والتحفظ في النتائج ونجعل غرضنا في جميع ما نستقرئه ونتصفحه استعمال العدل لا اتباع الهوى ونتحرى في سائر ما نميزه وننتقده طلب الحق لا الميل مع الآراء” الحسن بن الهيثم
- 5. I will tellyou NOTHING about back pain management
- 6. I will showyou how YOU can FIND EVERYTHING about back pain management
- 7. Objectives What isEBM? How to ask an answerable question? How to search for an answer? How to assess the quality of the evidence?
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- 9. National & GulfCenter for EBHP
- 10. Statistically speaking… Anhour presentation is shorter than 5 days workshop (p<0.05)
- 11. What is EBM?Haynes et al. BMJ 2002;324:1350 Clinical Circumstances Research Evidence Patients’ Preferences Clinical Expertise
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- 13. Is this agood question? What is the best treatment of acute back pain?
- 14. Asking a goodquestion (PICO)! P opulation I ntervention C ontrol O utcome
- 15. Is this agood question? In adult patients younger than 50 years old with acute low back pain, does bedrest reduce the risk of recurrence of pain within one year compared with physiotherapy? P: Adult patients <50yr with acute LBP I: Bedrest C: Physiotherapy O: Recurrence of pain within one year
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- 17. How would yousearch for answers? Ask the audience Ask a friend Flip through a textbook Google it up!
- 18. What’s wrong withtextbooks? Excellent for the principles & basic knowledge Usually single authored chapters Likely biased, author’s opinion Not peer-reviewed Outdated (at least 4 years)
- 19. What’s wrong withgoogling?
- 20. What’s wrong withgoogling? Reliability & credibility of source Google Scholar is good
- 21. So what todo?
- 22. 5S Hierarchy ofEvidence Haynes RB. Evid Based Med 2006;11:162-164 RCTs, Cohort, Case control, Case series Expert Opinion: Classical Textbooks
- 23. Primary Sources Originalarticles Through databases: MEDLINE, EMBASE Using: PubMed, OVID You have to retrieve and appraise the articles Strength (pyramid) of evidence
- 24. Pyramid of Evidencehttp://library.downstate.edu/EBM2/2100.htm
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- 27. MeSH (MedicalSubject Headings)
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- 29. It is a“strategy” Acute Low Back Pain OR "Low Back Pain"[Mesh] AND Low Back Ache Low Backache OR OR AND Treatment Management Therapy OR OR OR Surgery
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- 39. Secondary Sources SystematicReviews
- 40. Syntheses The authorshave done the work for you Hopefully : They asked a good question They searched the literature systematically (keywords & MeSH) They identified the studies and assessed their quality This is called Systematic Review If they did statistical combination of results, this is called Meta-analysis
- 41. How to searchfor “Syntheses”? Same databases: MEDLINE, EMBASE Cochrane Library
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- 48. Are all synthesesgood? You still have to appraise the quality of these systematic reviews and meta-analyses It’s time consuming
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- 51. So what’s next?Critically-Appraised Journal Articles & Abstracts Evidence-Based Guidelines & Textbooks
- 52. Synopses Physicians withtraining in research methodology: Read the articles Assess their quality Summarize them for you Many journals: JBJS(A) Evidence-Based Orthopaedics Section ACP Journal Club Database of Abstracts of Reviews of Effects (DARE)
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- 55. Summaries Evidence-based guidelinesand textbooks Examples: UptoDate Clinical Evidence National Guideline Clearinghouse
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- 64. Systems This isthe ultimate goal Computerized decision support Too sophisticated for us to think about now
- 65. All what we’vetalked about Research Evidence
- 66. To practice EBM,we need all the four Clinical Circumstances Research Evidence Patients’ Preferences Clinical Expertise
- 67. We need….. Toapply the evidence as it applies to our local hospitals To involve the patients actively in the decision making To have our own studies: Different social, cultural, ethnic, and economical backgrounds
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- 75. This presentation isavailable online www.uqu.edu.sa/ssbajammal المحاضرات
- 76. Summary EBM isnot only research evidence 5As of EBM: Ask, Acquire, Appraise, Apply, Act Always ask a PICO question Search: Summaries Synopses Syntheses Studies Keywords & MeSH headings Use Clinical Queries Appraise [email_address]