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Toni Talks about PT Today

It’s Time to Read the Literature

Published April 29, 2009 10:53 AM by Toni Patt
 Last week I had a unique assignment.  I was to read an article, present it where I work and report back on the response.  Specifically, I was to address whether anyone could follow my presentation and knew the statistics.  It didn't surprise me when no one could follow the statistics.  What did surprise me was the lack of familiarity with a critically-appraised article.  Instead of rereading the article, I presented an analysis of the article including its strengths and weaknesses.  If I wouldn't have summarized everything at the end I don't think anyone could have told me what the article had to say.

I'm not picking on my co-workers.  They volunteered to help me with a project by listening to my presentation.  They had no idea what they were getting into.  Each of my classmates did the same thing with the same results.   If I combine everyone's results and generalize the conclusion is that very few current therapists are aware of how to read the literature and analyze what it says.  Let me clarify that statement.  I don't mean they are unable to read the article.   I mean they are unable to draw the pertinent information from the article and determine if that information is valid.  I was guilty of the same thing before I started taking classes.  If I found an interesting article, I read the introduction and the discussion.  I wanted to know what they did and the results.  Sometimes I skipped the actual article and only read the abstract.  Not any more; now I read the whole thing.

Those results aren't surprising.  Until recently, PT schools didn't teach how to interpret articles.  Now that we're moving toward evidence-based practice (EBP), reading and understanding the literature is more important.  There are many courses on EBP or courses that incorporate it into the topic.  I took one last week.  I learned what EBP is, why it's important and how to search for articles.  I didn't learn what to do with the article once I found it.  I don't think I've seen one class on reading the literature, only on using it.  That creates an interesting problem.  How can a PT use the literature if that PT doesn't know how to pull the information from it?  There's a lot more to using literature than reading the conclusion.

Even someone who wants the evidence will have trouble finding literature.  The APTA provides two magazines to its members. They cover a wide variety of topics specifically related to PT and are available both in print and online. The various sections also have a journal or newsletter which includes research more specific to the particular section.  All of these are only available to APTA members.  Section members are required to receive the journals. The APTA also provides Hooked on Evidence and Open Door to assist with finding evidence.  Unless someone is a member or has access to a university library, he or she will have little access to any literature.

There are other benefits from reading literature.  It keeps you up to date on new techniques and treatments.  It enables therapists to communicate more clearly with physicians.  A physician is going to pay more attention to someone with current knowledge who can cite literature to make a point.  Being able to speak knowledgably makes a better impression than speaking in generalities.  It's a lot easier to sell a new program or support a new piece of equipment with proof of effectiveness somewhere else.  More and more research is being devoted to comparing one treatment to another or combinations of treatments for best results.  Every time I've had to do a literature search or answer a question for a class, I've based it on a patient I was treating at the time.  I've learned things that have directly affected what I do in the clinic.  For instance, walking backwards is effective for gait training stroke patients.  Weight bearing on a hemiparetic limb doesn't increase muscle strength or standing balance.

In comes down to being able to read between the lines of the literature.   Not all literature is created equal.  It can be misleading.  Another topic I've looked at is body weight supported treadmill training. I   found articles both pro and con when compared to walking on land.  I've yet to form an opinion because none of the studies were well designed and didn't have a large enough sample size to get significant results.   Personally I want BWS treadmill training to be effective.  I've had good results with it.  I thought I'd find several articles in support, but was wrong. 

These are good examples of why PTs need to be reading the literature.   I was surprised by the results to those searches.  Reading literature doesn't require searching databases.  One well-written article will increase knowledge.   PTs will never embrace EBP until they learn how to read literature.  Even without EBP we should be reading more.  It's just as important to read for knowledge as it is for evidence.  Reading the intro and the conclusion is better than nothing.  Not every article I read is useful, but it is one more piece of information I might need someday.


Great points made. Reading articles can hopefully always stir the thinking process, decision making and treatment ideas. Even might lead to improved clinical research by seeing the weakness of a research article and finding a way to improve on the topic.



Michael Rosenberg, PT June 1, 2009 9:57 PM


You make an excellent point that research is poorly understood.  Granted, I graduated with my entry level PT degree (a BS) about 9 years ago, but I have to look back on the prerequisite courses I had then and the required prerequisites to a basic DPT program now.  Aside from having to actually have a BS degree to actually ENTER the program, the prerequisites really haven't changed at all.  One basic course in statistics. Once in the PT program, one or two research based courses.  

Are we really providing ourselves with adequate amount of infromation to prepare ourselves for EBP?  Between my BS, my transtionary DPT and continuing education in the McKenzie Diploma program, I've taken another research based course at each level. Each time I learn something new. One thing is for certain...basic statistics was not enough to prepare me to really understand concepts such as confidence intervals, kappa values, regression analysis, etc.

Perhaps a more thorough understanding of research based statistics is required...I know it would still help me...I know I still have a lot to learn...despite having three separate research classes.  

Inability to analyze and interpret scientific literature is a huge barrier in any medical field. I think we are at a crossroads where we really need to make a decision on how to best address this deficit.  In the end, I think more statistics would have been very beneficial.  I dont' know if any of you remember your stats class, but mine was all about the chances of pulling a blue marble out of a bad.

Christie , PT April 29, 2009 8:29 PM
Streamwood IL

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