Evidence-Based Rehabilitation: A Guide to Practice.

Law M, ed. Thorofare, NJ 08086. Slack Inc, 2002, paperback, 379 pp, illus, ISBN: 1-55642-453-1, $37.

This text is written as an introduction to evidence-based rehabilitation and is geared to either the student rehabilitation professional or the practicing clinician. It is not intended to instruct the student or clinician on how to perform research but rather on how to become a critical consumer of research. Mary Law, the editor of this text, has written and lectured extensively in this area and is well qualified to organize and edit a text on this subject.

As an introduction to evidence-based practice, this text is right on target. Dr Law takes a developmental approach to this topic. She divides her text into 4 sections: "Introduction to Evidence-Based Practice," "Finding the Evidence," "Assessing the Evidence," and "Using the Evidence." This text is very well organized, and the individual chapters maintain a consistent style and format throughout, a difficult task when one considers that 18 authors contributed to its content.

Section I, "Introduction to Evidence-Based Practice," makes the case for the necessity of evidence-based practice. This section also covers the development of knowledge and makes a strong statement that evidence should contribute to, but should not be the sole determiner of, how clinicians practice. Section II, "Finding the Evidence," briefly introduces 2 disablement models and discusses how different outcomes measurements relate to these models. A very brief overview of descriptive and inferential statistics is presented as well as a discussion of how these statistics apply to outcomes measurements. The most valuable parts of section II are the discussion of how to generate a relevant and answerable question that could be used to conduct a search for evidence, the discussion of how to search the literature via the Internet, and the presentation of clear criteria that could be used to judge Internet-based resources.

Section III, "Assessing the Evidence," introduces the reader to methods for critically evaluating quantitative and qualitative research papers. Law also supplies the reader with the necessary guidelines and forms to evaluate both types of studies in appendixes C through G. The concept of systematic reviews is also covered in section III. The reader is informed that systematic reviews are the heart of evidence-based practice and is presented with a method for creating this type of review, along with an example of a systematic review. The reader is introduced to the concept of meta-analysis, the theory underlying it, and its importance to evidence-based practice. The history of the Cochrane Collaboration is presented, with an important discussion of how clinicians can access and use the reviews generated by the Collaboration.

Section IV, "Using the Evidence," introduces the concept of critically appraised topics (CATs). Law defines a CAT as "a one or two page summary of a search and critical appraisal of the literature related to a focused clinical question, which should be kept in an easily accessible place so that it can be used to help make clinical decisions." Law presents the methods used to develop a CAT and includes an example. It appears that CATs would be very appropriate for physical therapist clinicians interested in basing their practice on evidence. Section IV also defines and compares the concepts of practice guidelines, algorithms, and clinical pathways. Finally, in section IV, the need for professionals to communicate the evidence to patients, clients, managers, and third-party payers is discussed.

This text is very well referenced throughout, with complete, up-to-date citations, including some that are Web-based. The text includes 14 appendixes, many of which contain forms used by the McMaster University Occupational Therapy Evidence-Based Practice Research Group.

This book should be very important reading for any physical therapist who wants to engage in high-quality practice. Although many of the contributors to this text were occupational therapists, many, if not all, the topics apply equally to the practice of physical therapy.

Joseph Lucca, PT, PhD

University of Delaware 

Newark, Del

Dr Lucca is Associate Professor in the Department of Physical Therapy. He teaches classes on "Physical Therapy as a Profession," "Research Methods," "Psychosocial Development," "Geriatrics, "and "Life Span Development." His research interests are in health care delivery to older people.