實證物理治療

Evidence-Based Physical Therapy

在實證醫學之潮流下，物理治療也推動實證執業。本文簡介實證物理治療（evidence-based physical therapy，簡稱EB-PT）歷史與發展、於個案處理模式中進行實證物理治療步驟、物理治療實證資料庫（PEDro）與PEDro 量表，藉以讓讀者對實證物理治療有概括之了解。美國物理治療學會建議物理治療執業的程序可根據「個案處理模式」，由評估、評量、診斷、預後、介入至最後成果之檢視六個階段，此六階段之進行都與實證醫學之問問題、找資料、評斷、應用與評估成果之步驟相關。有關實證物理治療的概念，早在1990 年代隨著實證醫學興起EB-PT 就被提起，目前在澳洲雪梨大學物理治療實證中心設立物理治療實證資料庫（the Physiotherapy Evidence Database，簡稱PEDro），以收集物理治療相關療效研究、系統性回顧、臨床指引為主。PEDro 是一個免費查詢的資料庫，其文獻可追溯至1929 年。PEDro 量表為治療性研究證據強度的評分表，共有10 個項目，其具信效度。系統性回顧也於2005 年開始發表於台灣物理治療雜誌上，並有越來越多之傾向。

Evidence-based practice of physical therapy has been promoted under the influence of evidence-based medicine (EBM). This article covers the history of evidence-based physical therapy (EB-PT), the integration of EB-PT with the patient/client management model (CMM), the influencing factors and the promotion strategies of EB-PT, the Physiotherapy Evidence Database (PEDro) and the PEDro scale. The CMM model has been proposed in the Guide to Physical therapist Practice by the American Physical Therapy Association. The elements of CMM include: examination, evaluation, diagnosis, prognosis, intervention and outcomes. All these elements could be integrated with the five steps of EBM: question, searching, appraisal, application and audit. The concept of EB-PT started in 1990s. The Physiotherapy Evidence Database (PEDro) was established by University of Sydney to provide free journal abstracts related to randomized clinical trials, systematic reviews and clinical guidelines in physical therapy since 1929. The 10-item PEDro scale with acceptable reliability and validity is used to appraise the levels of evidence for intervention studies related to physical therapy. Systematic review articles have gradually increased in the Formosan Journal of Physical Therapy since 2005 in Taiwan.