New Zealand Rehabilitation Association, Inc.

Evidence-based Practice: Across the Health Professions. (2009). Hoffman, T, Bennett, S, and Del Mer, C. Chatswood: Elsevier. ISBN: 9780729539029
Price: $77.27 AUD (excl. GST). Approximately $100 NZD (excl. GST)
Available from Elsevier Australia

As someone who teaches interdisciplinary groups of health professionals about critical appraisal of research and its application to clinical practice, I was immediately interested in the content of this textbook. In my experience (and this of course is a massive generalisation) clinicians tend to already have a good understanding of general research design and knowledge about how to appraisal individual studies (e.g. randomised controlled trials and the like). What clinicians can be more uncertain about are issues such as how to distinguish a good systematic review from a bad one, how to read a meta-analysis, how to critically appraisal a clinical guideline, and what to do with qualitative research. I also approached this textbook with a belief that in addition to being able to critically appraise published evidence, clinicians also benefit from guidance regarding how to actually apply evidence to clinical practice. This was the sort of information that I was looking for when I first opened this book.

So I was delighted to find that, without a doubt, Hoffmann and colleagues have provided an excellent resource for learning about and teaching on these (and other) aspects of evidence based practice. Chapter 12 covers in detail the differences between a systematic review and a meta-analysis, between systematic reviews and narrative reviews; what to expect from a good systematic review and the key features of systematic review methods. This chapter also provides clear guidance regarding how to read a forest plot (the primary way meta-analysis data is presented) and how to apply information from a systematic review to clinical practice.

Chapter 13 focuses entirely on clinical guidelines, providing excellent advice about how to be an informed consumer of these ubiquitous documents that have swamped the health sector in past few decades. The quality of clinical guidelines can range widely, but in my opinion clinicians are not always as quick to question the credibility of published clinical guidelines as they are of individual research studies, particularly when a guideline has been produced by an impressively large group of expert stakeholders. Chapter 13 then provides information on how and where to find clinical guidelines, how to evaluate the quality of a clinical guideline (drawing heavily on that excellent resource, the AGREE instrument), and on how to use a guideline in clinical practice.

Critical appraisal of qualitative research is covered in Chapter 10, which is entitled "Evidence about clients' experience and concerns". This chapter provides information on what sorts of research questions can be answered by qualitative studies and provides an overview of the main qualitative methodologies that clinicians are likely to come across in health science literature. It also provides a framework for critical appraisal of qualitative research, basing this on the Joanna Briggs Institute's Qualitative Assessment and Review Instrument.

There is one aspect of qualitative research that I would have liked to have read more about in this textbook however, and that is the application of qualitative metasynthesis (aka. systematic review methods for qualitative research) to evidence based practice. Qualitative metasynthesis is touched on very briefly in Chapter 12 in reference to the potential value of combining qualitative and quantitative studies in systematic reviews. However, mainly the authors point out that: ‘There is still significant debate about whether a synthesis of qualitative studies is appropriate and whether it is acceptable to combine studies that use a variety of different methods' (p. 244). While this is indeed true, qualitative metasynthesis is a fast growing area of health science research. Many qualitative metasyntheses are already published in peer-reviewed journals, so clinicians will need to have some skills for reading and interpreting them. There are also an increasing number of texts exploring the strength and weakness of different approaches to qualitative metasynthesis, and some tentative guidelines could still be provided regarding what should be expected of a good qualitative metasynthesis. So this is an area that I would hope to see developed in future editions of this otherwise excellent textbook.

Other chapters in this textbook address the issues related to asking research questions (Chapter 2), finding best evidence (Chapter 3), and evaluating and applying evidence from research on the effects of interventions (Chapter 4), diagnosis (Chapter 6) and prognosis of outcomes (Chapter 8).

In terms of applying evidence to clinical practice; this is achieved in a variety of ways. Several examples are provided throughout the chapters in this textbook of clinical scenarios where the need for each type of evidence is required and sought. Furthermore, a number of additional chapters (Chapters 5, 7, 9, and 11) have been added after each major section in the textbook to provide worked examples illustrating in detail how this taught knowledge can be applied in clinical practice. These examples are provided from the perspective of issues relevant to a range of different health professionals (e.g. occupational therapy, physiotherapy, podiatry, speech language therapy, radiation therapy, dietetics, medicine, and nursing) so there should be something familiar in these examples for everyone. Finally, two additional chapters are included at the back of the textbook that discuss the relationship between clinical reasoning and evidence-based practice (Chapter 15) and how to implement evidence into practice, including the use of clinical audit (Chapter 16).

Finally, there was one additional section in this textbook that I was not initially expecting but was delighted to find regardless.  This was the chapter on talking with clients about evidence (Chapter 14). This chapter included information about how evidence-based practice fits with the client-centred ideology and how to communicate effectively with patients about evidence and evidence-based practice. There are a range of communication methods that are promoted here, some of the most interesting relating to how clinicians can best communicate complex statistical information in a meaningful way with their clients.

All things considered, this textbook gets two thumbs up from me (and that's out of a total possible score of two thumbs for those of you wondering about the denominator in this quality evaluation measure.) In particular, I'd recommend this as a must-have text for clinical departments in hospitals and public health services where development of clinical policies and procedures ought to be grounded in a strong understanding of evidence based practice, and as an excellent resource for health professionals undertaking study or research training at a postgraduate level.

For more information about this textbook, and to view selected extracts from its pages, search for it on the "Google books" website.