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A Practical, Evidence-Based
Approach to Strength and
Conditioning

 NSCA 32nd National Conference
 July, 2009
 Ann M. York, PhD
NSCA Mission Statement
• “As the worldwide authority on strength and
  conditioning, we support and disseminate research-
  based knowledge and its practical application to
  improve athletic performance and fitness.”

• “Bridging the gap between science and
  application.”
Objectives
•   Define the process of evidence-based practice (EBP).
•   Discuss the challenges to EBP or EBSC
•   Identify some reasonable approaches to EBSC.
•   Leave with specific strategies and tactics to
    implementing EBSC.
JASPA* Quiz
JASPA =
Journal Associated Score of Personal Angst
• 0 = outlier
• 1-3 = normal range
• >3 = at risk for polythenia gravis and related
  conditions

• Polythenia gravis: increasing sense of guilt and
  inadequacy associated with an inability to keep up
  with the journals.
• Related condition: increased fall risk associated with
  tripping over piles of unread journals.
Evidence-Based Approach




       “Evidence does not make decisions, you do!”
Leaks in the Evidence-Based Knowledge Pipeline
           Aware Accept Target Doable Recall Agree Done



  Valid
Research




                            Strauss, Richardson, Glasziou &Haynes (2005)
From EBP to EBSC….

•       Consistent evidence of failure to translate research
        findings into clinical practice
    ▫     30-40% patients do not get treatments of proven effectiveness
    ▫     20–25% patients get care that is not needed or potentially
          harmful
•       What’s happening in the strength and conditioning
        realm?

                                 Schuster, McGlynn, Brook (1998). Milbank Memorial Quarterly
                                                                    Grol R (2001). Med Care
Pressures Slowing Growth of EBP
What is evidence worth?


 Usefulness = Validity X Relevance
                  Work



                   Strauss, Richardson, Glasziou & Haynes (2005)
Why Bother with EBSC?

Motivation:                Who are you?
 • Client expectation      • Doer (researcher/teacher
 • Competitive advantage   • User (coach/trainer)
 • Lifelong learning       • Replicator (gurus are
 • Satisfaction, pride       good enough for you).
 • Ethical thing to do
 • Contribution to the
   profession
 • Professional
   development
Cycle of EBSC
Step 1: Asking a question
• Background questions
 ▫ general: who, what, where, why, how
• Foreground or PICO questions
 ▫ specific: questions on managing clients

                              Foreground
                              Questions

            Background
            Questions




     Less                Experience          More
PICO Questions
         • P: person/problem

         • I: intervention

         • C: comparison

         • O: outcome
What questions to ask?
•   Most common scenarios
•   Unique situations
•   Desire to become an expert
•   Curiosity

• The more specific the question, the better.
Step 2: Acquiring the Evidence
• How much time do you want to spend?
• What databases to you have access to?
  ▫   Online versus paper
  ▫   PubMed
  ▫   Ebsco
  ▫   Professional membership
• What is your skill level at searching?
• Think QUALITY of evidence!
Evidence Pyramid
                    Synopses

                 Meta-Analysis

              Systematic Review

           Randomized Controlled Trial

                 Cohort studies

                  Case studies

              Basic/Bench Research

            Editorials/Gurus/Colleagues
Narrative v. Systematic Reviews
Narrative                       Systematic
• No systematic                 • Rigorous methodology
  methodology                   • Focused research question
• Tend to be broad              • Search strategy developed
• Potential for author’s bias   • Inclusion/exclusion criteria
• References gathered ad          for references
  hoc                           • Quality assessment
• Qualitative approach          • Quantitative approach



Qualitative                                        Quantitative
Evidence Information Management
Push Technology
 • RSS Feeds*
 • PubMed saved searches*
 • Email alerts*
Pull Technology
 • Specific searches for questions
 • Databases/publications/other resources
Storage Technology
 • RefWorks, Endnote
 • Zotero,* Delicious,* Evernote*

                                            *Free!
York EBSC NSCA July 2009
RSS Feeds + iGoogle = Efficiency




How to use RSS feeds tutorial:
http://www.youtube.com/watch?v=0klgLsSxGsU
York EBSC NSCA July 2009
Step 3: Appraise
• Most traditional EBP training occurs at this step
• Yet it is time consuming/intimidating
• Many do not have skill or time to appraise well…

• Solution?
Let others do the first appraisal
HIGH QUALITY Pre-appraised evidence
  ▫ Systematic Reviews (Cochrane, PubMed)
  ▫ Evidence summaries
  ▫ Professional organization guidelines


  BUT first you must ASK a good question
   and ACQUIRE the summaries!
Then do your OWN appraisal:
• Is the evidence source high quality?

• Does it apply to my client?

• Is it useful?

• Does this fit with client goals/preferences?
Step 4: Apply the Evidence
      “Evidence does not make decisions, you do!”
Step 5: Assess
• What worked?

• How did this benefit your client?

• What more do you want to know?

• Do you have information to share?
Summary
• What role can EBSC play in your career?

• What is your strategic plan of EBSC?

• What tactics can you use to achieve this plan? List 3
If you only have….
• 1 minute: Write a PICO question

• 5 minutes: Set up an RSS feed, run a quick search.

• 1 Hour: Read a study in depth, discuss a study with a
  colleague, watch a free online tutorial, explore a new
  database.
Objectives Reveiw
• Define the process of evidence-based practice or
  EBSC.
• Discuss the challenges to EBSC.
• Identify some reasonable approaches to EBSC.
• Leave with specific strategies and tactics to
  implementing EBSC.
Resources
No doubt I will add to these slides. Updates, additional
 references, and EBP resources can be found at:

NSCA EBSC Pageflake:
 http://www.pageflakes.com/ayork/2501555
York EBSC NSCA July 2009
Selected References
• Davis, J. (2007). Evaluating education in evidence-based practice. JAMA:
  The Journal of the American Medical Association, 297(1), 39.
• Guyatt, G., & Rennie, D. (Eds.). (2002). Users' guides to the medical
  literature. Chicago, Ill.: AMA Press.
• Ho, P.M., Peterson, P.N., & Masoudi, F.A. (2008). Evaluating the evidence:
  Is there a rigid hierarchy? Circulation, 118, 1675-1684.
• Shaneyfelt, T., Baum, K. D., Bell, D., Feldstein, D., Houston, T. K., Kaatz, S.,
  et al. (2006). Instruments for evaluating education in evidence-based
  practice: A systematic review. JAMA: The Journal of the American Medical
  Association, 296(9), 1116-1127.
• Slawson, D. & Shaughnessy, A.F. (2005). Teaching EBM: Should we be
  teaching information management instead? Academic Medicine, 80 (7),
  685-689.
• Strauss, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005).
  Evidence-based medicine, how to practice and teach EBM. (3rd ed.).
  Edinburgh: Elsevier.
Contact Information
Ann M. York, PhD
Associate Professor
Master of Health Care Administration Program
College of Health Sciences
Des Moines University
3200 Grand Ave
Des Moines IA 50325
515-271-1641
ann.york@dmu.edu
Questions?

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York EBSC NSCA July 2009

  • 1. A Practical, Evidence-Based Approach to Strength and Conditioning NSCA 32nd National Conference July, 2009 Ann M. York, PhD
  • 2. NSCA Mission Statement • “As the worldwide authority on strength and conditioning, we support and disseminate research- based knowledge and its practical application to improve athletic performance and fitness.” • “Bridging the gap between science and application.”
  • 3. Objectives • Define the process of evidence-based practice (EBP). • Discuss the challenges to EBP or EBSC • Identify some reasonable approaches to EBSC. • Leave with specific strategies and tactics to implementing EBSC.
  • 5. JASPA = Journal Associated Score of Personal Angst • 0 = outlier • 1-3 = normal range • >3 = at risk for polythenia gravis and related conditions • Polythenia gravis: increasing sense of guilt and inadequacy associated with an inability to keep up with the journals. • Related condition: increased fall risk associated with tripping over piles of unread journals.
  • 6. Evidence-Based Approach “Evidence does not make decisions, you do!”
  • 7. Leaks in the Evidence-Based Knowledge Pipeline Aware Accept Target Doable Recall Agree Done Valid Research Strauss, Richardson, Glasziou &Haynes (2005)
  • 8. From EBP to EBSC…. • Consistent evidence of failure to translate research findings into clinical practice ▫ 30-40% patients do not get treatments of proven effectiveness ▫ 20–25% patients get care that is not needed or potentially harmful • What’s happening in the strength and conditioning realm? Schuster, McGlynn, Brook (1998). Milbank Memorial Quarterly Grol R (2001). Med Care
  • 10. What is evidence worth? Usefulness = Validity X Relevance Work Strauss, Richardson, Glasziou & Haynes (2005)
  • 11. Why Bother with EBSC? Motivation: Who are you? • Client expectation • Doer (researcher/teacher • Competitive advantage • User (coach/trainer) • Lifelong learning • Replicator (gurus are • Satisfaction, pride good enough for you). • Ethical thing to do • Contribution to the profession • Professional development
  • 13. Step 1: Asking a question • Background questions ▫ general: who, what, where, why, how • Foreground or PICO questions ▫ specific: questions on managing clients Foreground Questions Background Questions Less Experience More
  • 14. PICO Questions • P: person/problem • I: intervention • C: comparison • O: outcome
  • 15. What questions to ask? • Most common scenarios • Unique situations • Desire to become an expert • Curiosity • The more specific the question, the better.
  • 16. Step 2: Acquiring the Evidence • How much time do you want to spend? • What databases to you have access to? ▫ Online versus paper ▫ PubMed ▫ Ebsco ▫ Professional membership • What is your skill level at searching? • Think QUALITY of evidence!
  • 17. Evidence Pyramid Synopses Meta-Analysis Systematic Review Randomized Controlled Trial Cohort studies Case studies Basic/Bench Research Editorials/Gurus/Colleagues
  • 18. Narrative v. Systematic Reviews Narrative Systematic • No systematic • Rigorous methodology methodology • Focused research question • Tend to be broad • Search strategy developed • Potential for author’s bias • Inclusion/exclusion criteria • References gathered ad for references hoc • Quality assessment • Qualitative approach • Quantitative approach Qualitative Quantitative
  • 19. Evidence Information Management Push Technology • RSS Feeds* • PubMed saved searches* • Email alerts* Pull Technology • Specific searches for questions • Databases/publications/other resources Storage Technology • RefWorks, Endnote • Zotero,* Delicious,* Evernote* *Free!
  • 21. RSS Feeds + iGoogle = Efficiency How to use RSS feeds tutorial: http://www.youtube.com/watch?v=0klgLsSxGsU
  • 23. Step 3: Appraise • Most traditional EBP training occurs at this step • Yet it is time consuming/intimidating • Many do not have skill or time to appraise well… • Solution?
  • 24. Let others do the first appraisal HIGH QUALITY Pre-appraised evidence ▫ Systematic Reviews (Cochrane, PubMed) ▫ Evidence summaries ▫ Professional organization guidelines BUT first you must ASK a good question and ACQUIRE the summaries!
  • 25. Then do your OWN appraisal: • Is the evidence source high quality? • Does it apply to my client? • Is it useful? • Does this fit with client goals/preferences?
  • 26. Step 4: Apply the Evidence “Evidence does not make decisions, you do!”
  • 27. Step 5: Assess • What worked? • How did this benefit your client? • What more do you want to know? • Do you have information to share?
  • 28. Summary • What role can EBSC play in your career? • What is your strategic plan of EBSC? • What tactics can you use to achieve this plan? List 3
  • 29. If you only have…. • 1 minute: Write a PICO question • 5 minutes: Set up an RSS feed, run a quick search. • 1 Hour: Read a study in depth, discuss a study with a colleague, watch a free online tutorial, explore a new database.
  • 30. Objectives Reveiw • Define the process of evidence-based practice or EBSC. • Discuss the challenges to EBSC. • Identify some reasonable approaches to EBSC. • Leave with specific strategies and tactics to implementing EBSC.
  • 31. Resources No doubt I will add to these slides. Updates, additional references, and EBP resources can be found at: NSCA EBSC Pageflake: http://www.pageflakes.com/ayork/2501555
  • 33. Selected References • Davis, J. (2007). Evaluating education in evidence-based practice. JAMA: The Journal of the American Medical Association, 297(1), 39. • Guyatt, G., & Rennie, D. (Eds.). (2002). Users' guides to the medical literature. Chicago, Ill.: AMA Press. • Ho, P.M., Peterson, P.N., & Masoudi, F.A. (2008). Evaluating the evidence: Is there a rigid hierarchy? Circulation, 118, 1675-1684. • Shaneyfelt, T., Baum, K. D., Bell, D., Feldstein, D., Houston, T. K., Kaatz, S., et al. (2006). Instruments for evaluating education in evidence-based practice: A systematic review. JAMA: The Journal of the American Medical Association, 296(9), 1116-1127. • Slawson, D. & Shaughnessy, A.F. (2005). Teaching EBM: Should we be teaching information management instead? Academic Medicine, 80 (7), 685-689. • Strauss, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005). Evidence-based medicine, how to practice and teach EBM. (3rd ed.). Edinburgh: Elsevier.
  • 34. Contact Information Ann M. York, PhD Associate Professor Master of Health Care Administration Program College of Health Sciences Des Moines University 3200 Grand Ave Des Moines IA 50325 515-271-1641 ann.york@dmu.edu