http://www.ptjournal.org Physical Therapy RSS feed -- recent Perspectives articles 1538-6724 Physical Therapy 0031-9023 http://www.ptjournal.org/icons/banner/title.gif http://www.ptjournal.org http://www.ptjournal.org/cgi/content/short/88/9/1068?rss=1 This perspective provides an overview of the randomized controlled trials, systematic reviews, and evidence-based clinical practice guidelines in physical therapy. Data from the Physiotherapy Evidence Database (PEDro) are used to describe key events in the history of physical therapy research and the growth of evidence of effects of interventions used in the various subdisciplines of physical therapy. The 11,494 records that were identified reveal a rich history of physical therapy research dating back to the first trial in 1929. Most of the randomized controlled trials, systematic reviews, and evidence-based clinical practice guidelines in physical therapy have been published since the year 2000. This rapid growth presents a challenge for physical therapists who want to keep up to date in clinical practice.

]]> 2008-08-28 info:doi/10.2522/ptj.20080002 American Physical Therapy Association 9 88 1077 2008-09-01 1068 Perspectives http://www.ptjournal.org/cgi/content/short/88/9/1078?rss=1 Many clinics and payers are beginning programs to collect and interpret outcomes related to quality of care and provider performance (ie, benchmarking). Outcomes assessment is commonly done using observational research designs, which makes it important for those involved in these endeavors to appreciate the underlying challenges and limitations of these designs. This perspective article discusses the advantages and limitations of using observational research to evaluate quality of care and provider performance in order to inform clinicians, researchers, administrators, and policy makers who want to use data to guide practice and policy or critically appraise observational studies and benchmarking efforts. Threats to internal validity, including potential confounding, patient selection bias, and missing data, are discussed along with statistical methods commonly used to address these limitations. An example is given from a recent study comparing physical therapy clinic performance in terms of patient outcomes and service utilization with and without the use of these methods. The authors demonstrate that crude differences in clinic outcomes and service utilization tend to be inflated compared with the differences that are statistically adjusted for selected threats to internal validity. The authors conclude that quality of care measurement and ranking procedures that do not use similar methods may produce findings that may be misleading.

]]> 2008-08-28 info:doi/10.2522/ptj.20070327 American Physical Therapy Association 9 88 1087 2008-09-01 1078 Perspectives