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Why DPT Students Need to Embrace EBP

Physical therapists will render evidence based services throughout the continuum of care and improve quality of life for society – APTA Vision 2020

As a student with a background in the arts, I was inclined to shy away from the research aspect of physical therapy. It took effort to get through statistics in undergrad. I learned to respect those that had a passion for research, as I had a fear that statistical analysis would come back to haunt me. It did, multiple times throughout physical therapy school.

The concept of evidence-based medicine, or, more broadly, EBP, marks a shift among health care professionals from a traditional emphasis on actions based on the opinions of authorities to guide clinical practice to an emphasis on data-based, clinically relevant studies and research – Jette et al 2003

Evidence Based Practice (EBP)

The theory of evidence based practice is three-fold. It requires the practitioner to identify the gaps in knowledge, execute a search, and apply the literature to the patient’s problem, while being sensitive to the patient’s values.

The APTA’s 2020 Vision statement regarding the practice of evidence based service is not difficult to comprehend but is important to recognize, especially as future practitioners. Repetition of this type of practice is pivotal in reinforcing the application.

In a study by Jette et al, less than 50% of physical therapists used literature 2-5 times per month in their decision making.

The practice of physical therapy is shifting gears from applying interventions based on beliefs to depending on what the evidence demonstrates. As a student, I’ve shadowed clinicians who do apply EBP, but also frequently fall into reinforcing beliefs that lack foundation in the literature. It is important to recognize the literature as a double-edged sword. It can provide evidence for treatments that work, but can also muddy the waters even more by exposing the gaps in knowledge. In short, the research has a difficult time explaining the question of why. In these situations, I often rely on explanations from either my professors or master clinicians as an attempt to fill these gaps and the best answer at times, despite feeling frustrated enough to say, “I don’t know.” EBP, as stated earlier, is a three-fold beast, but the clinical experience aspect requires definition. My perspective of clinical experience is the integration of anatomy, biomechanics and movement to the literature with human humility.

The information in the literature coupled with what we have learned in school should guide us to think analytically about the source of our patients’ presentation so we can better treat the cause and not just the symptoms. I want to challenge myself, and you, to question common beliefs and not mistake biological plausibility as evidence for causality. Use the literature and the knowledge at your disposal.

Long practicing therapists have emphasized critical thinking as the most critical factor in expertise, and that part of critical thinking is having a healthy skepticism to challenge the common beliefs, including your own.

In PT school we all learn to use the plum line as one assessment tool to because we are taught that abnormal posture contributes to patients’ complaints. The connection between posture and musculoskeletal dysfunction is an understandable hypothesis but the literature is finding discrepancy within this belief.

In a review that assessed subacromial impingement syndrome (SIS) and its postural component, Dr. Adam Rufa concluded that the importance of static posture in the development and treatment of SIS has not been confirmed by the current literature. Of the nine studies that examined self-selected posture in patients with SIS, none showed a correlation between posture and SIS.

In another study that assessed lumbar lordosis in patients with chronic low back pain Youdas et al states, “We concluded that these patients with CLBP [chronic low back pain] had no more standing lumbar lordosis or pelvic inclination than their counterparts with healthy backs but that their abdominal muscle force was less than that of the control subjects.” The study continued to discourage abdominal strengthening exercises in patients with CLBP based solely on the assessment of their relaxed standing posture.

Using the current literature as a guide for treatment not only increases patient outcomes but also decreases waste. In a survey of physical therapists’ use of interventions with high evidence Mikhail et al reported that 68% of the therapists reported using methods for LBP with strong evidence and 90% used methods with no or poor evidence for LBP. This same study also reported that the most commonly reported interventions used by Canadian physiotherapists included mobilization, ice, and ultrasound. As we know, there have been many articles that evaluate the efficacy of ultrasound for treating pain, musculoskeletal injuries and soft tissue lesions, but its effectiveness remains questionable. Ironically, the September 2014 edition of PT in Motion published the top 10 procedures in total payments to PTs and other providers of physical medicine and rehabilitation services in 2012. Ultrasound made the cut coming in at $29,222,458 in total Medicare payments.

As a student, I want to encourage other students and practitioners to let the literature help guide patient treatments and to use our critical thinking skills to fill in the gaps of knowledge that the literature withholds. If we remember that the strength of our beliefs should be proportionate to the evidence we have to support them, I believe therapists can work together to further enhance the quality of care for our patients. In this way we can avoid wasting our patients’ time and further enhance the patient’s outcomes and experience of physical therapy.

And by practicing this way, physical therapists would not only fulfill the concept placed on practitioners by the APTA’s 2020 statement, but also better the profession of physical therapy.

Have Questions? Leave a comment below and we will get back to you ASAP!



1. Robertson VJ, Baker KG. A Review of Therapeutic Ultrasound: Effectiveness Studies. Physical Therapy. 2001;81(7):1339-1350. 2. Bernhardsson S, Öberg B, Johansson K, Nilsen P, Larsson MEH. Clinical practice in line with evidence? A survey among primary care physiotherapists in western Sweden. J Eval Clin Pract. 2015;21(6):1169-1177. doi:10.1111/jep.12380. 3. Karduna AR, Kerner PJ, Lazarus MD. Contact forces in the subacromial space: effects of scapular orientation. J Shoulder Elbow Surg. 2005;14(4):393-399. doi:10.1016/j.jse.2004.09.001. 4. Garber AM. Evidence-Based Coverage Policy. Health Aff. 2001;20(5):62-82. doi:10.1377/hlthaff.20.5.62. 5. Jette DU, Bacon K, Batty C, et al. Evidence-Based Practice: Beliefs, Attitudes, Knowledge, and Behaviors of Physical Therapists. Physical Therapy. 2003;83(9):786-805. 6. Ratcliffe E, Pickering S, McLean S, Lewis J. Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review. Br J Sports Med. 2014;48(16):1251-1256. doi:10.1136/bjsports-2013-092389. 7. Youdas JW, Garrett TR, Egan KS, Therneau TM. Lumbar lordosis and pelvic inclination in adults with chronic low back pain. Phys Ther. 2000;80(3):261-275. 8. Mikhail C, Korner-Bitensky N, Rossignol M, Dumas J-P. Physical therapists’ use of interventions with high evidence of effectiveness in the management of a hypothetical typical patient with acute low back pain. Phys Ther. 2005;85(11):1151-1167. 9. Adam Phillip Rufa. Subacromial impingement and posture. Physical Therapy Reviews. 2014;19(5):338-351 14p. doi:10.1179/1743288X14Y.0000000151. 10. Mafi JN, McCarthy EP, Davis RB, Landon BE. Worsening trends in the management and treatment of back pain. JAMA Intern Med. 2013;173(17):1573-1581. doi:10.1001/jamainternmed.2013.8992.

About Rosemarie Gonzales

Rose Gonzales is in her 2nd year of physical therapy school at New York University. She’s always in need of a pedicure and stops people on the street to pet their dogs. Additionally, Rose has a passion for learning and is in pursuit of projects that inspire her to be a better practitioner. She is a Certified Strength and Conditioning Specialist and her most recent venture is becoming Polestar Pilates certified. When she isn’t studying, she is face timing her bulldog and following her bliss. 

One comment

  1. Thought provoking write-up for sure Rosemarie. I can see where EBP has its merits. Especially for inexperienced students and new grads who can use it to help guide decisions.

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