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Copyright © 2006, Medical Library Association Physiotherapy Evidence Database (PEDro) Governors State University, University Park, Illinois Paul Blobaum: p-blobaum@govst.edu Physiotherapy Evidence Database (PEDro). Centre for Evidence-Based Physiotherapy, School of Physiotherapy, The University of Sydney, P.O. Box 170, Lidcombe 825 NSW, Australia; +61.2.9351.9547; fax, +61.2.9351.9278;. http://www.pedro.fhs.usyd.edu.au; free Website. Building on private citation databases of the Steering Committee of the Centre for Evidence-Based Physiotherapy, School of Physiotherapy, The University of Sydney, and contributions of abstracts of randomized controlled trials of physical therapy from the Cochrane project, the Physiotherapy Evidence Database was launched on the Web in 1999. Commonly known as “PEDro,” the purpose of the database according to the Website is “to give rapid access to bibliographic details and abstracts of randomised controlled trials (RCT's), systematic reviews, and evidence-based clinical practice guidelines in physiotherapy.” “Physiotherapy” is the term most used outside of the United States regarding the treatment of pain, injury, or disability through physical means. “Physical therapy” is the term used most in the United States, where the scope of practice can vary widely. Currently, more than 180 US professional programs offer a doctor of physical therapy degree, and around 90 offer a master of physical therapy degree, both of which are entry-level degrees needed for licensure examinations in the field. The profession and its supporting literature developed following the first and second World Wars. PEDro helps fill the void of a comprehensive international index to the physical therapy literature. Currently, literature searches must be conducted among each of the major medical indexes (that is, the EMBASE, MEDLINE/PubMed, PsycINFO, and CINAHL databases) to form a complete picture of the literature published in the field. For those seeking evidence-based practice information, even expert searchers and librarians, the process of figuring out evidence-based quality filters in each of these database is overwhelming, never mind the peccadilloes of particular publisher's search engines! PEDro, therefore, has the potential to be a “go-to” source for citations to evidence-based physical therapy literature. The fact that the Website does not charge for searching does not necessarily give it a “free pass” to be added to a medical library's Web page. Clearly written selection criteria for each of the three types of literature that constitute the database can be located on the Website. Citations of RCTs, guidelines, and systematic reviews are added to the database upon retrieval by a set of quality filters in preformatted search strategies (also known as SDIs), which are performed automatically in the above databases on a regular basis. Further, the Cochrane Database of Effective Systematic Reviews, the Cochrane Clinical Trials Register, and the Database of Abstracts of Reviews of Effectiveness (DARE) are searched for new material when they are updated. A cadre of volunteers, known as “Friends of PEDro,” assists the Centre for Evidence-Based Physiotherapy to identify other citations and links to practice guidelines to be added to the database, but it is unclear just who the editorial board reviewing and approving the recommendations is. The editorial board, if any, is not identified on the PEDro Website. However, the fact that recommendations of additions, deletions, or corrections can be forwarded via email and that detailed criteria of selection are published leads one to believe that subject authorities are making the editorial decisions, not the civil service staff. MAJOR FEATURES What impresses librarians, besides the fact that PEDro is free, is that PEDro rates randomized clinical control trials according to the “PEDro Rating Scale,” a rubric consisting of 11 criteria. The rating scale is a checklist of “yes or no” answers to each criteria that totals the “yes” answers. The highest score is therefore an 11, which would make that trial of particular interest. A team of volunteer physiotherapists and “casual” center staff apply the rating scale to each RCT in the database. The PEDro Rating Scale has been studied for reliability of rating quality of RCTs in an article published in Physical Therapy [2003 Aug;83(8):713–21]. Also, an article comparing the PEDro scale to the Jadad scale for rating the quality of randomized controlled trials has been published in the Journal of Clinical Epidemiology [2005 58:668–73]. The oldest citation in the database, according to the Website, was published in 1929, and recommendations for additions or corrections of the information included are welcome. Even though trials may be judged to be of poor quality by this scale, they are not removed from the database. Ratings are subject to revision on further review. Searching the database is straightforward. By clicking on Search, a pull-down menu appears. The Simple Search screen allows input of search terms in one search box. Under Advanced Search, a set of search criteria can be applied based on typical bibliographic search criteria such as author, title, source, date, abstract or title words, and citation entry date. Additional limits as to therapeutic modality, body part, type of problem, subdiscipline, and document type can be applied. Results are displayed by title, method (i.e., type of article), and rating scale. Systematic reviews appear first followed by clinical practice guidelines, both in reverse chronological order. The remaining citations are sorted by PEDro Rating Scale score. Complete citation information is displayed after clicking on the title of the article, and links to full-text practice guidelines or PubMed records are available in many records. It is helpful that results can be reviewed and selected for printing or emailing after all results are reviewed, as is standard in many commercial databases. The Centre for Evidence-Based Physiotherapy should be congratulated for their support of this database, which is a substantial commitment for a nonprofit educational institution in any part of the world. The list of Australian supporters is a good example of a collaboration of multitype national and local health care stakeholders for the sake of the nation's health. Additional support comes from the Australian Physiotherapy Association, the Motor Accident Authority of New South Wales (Australia), and other organizations. International support by individuals is prominent. Through the efforts of international volunteers, the Website search engine and informational pages are published in French, German, Arabic, Korean, Portuguese, and Spanish. Although not clearly defined in the help files, it is apparent that literature indexed in PEDro is limited to English language publications. The database is updated on a monthly basis. ADVANTAGES/DISADVANTAGES PEDro's nonprofit status and the sponsorship of the University of Sydney and the Australian Physiotherapy Association establish the database as a highly credible, authoritative source with multiple levels of review. Links to full-text practice guidelines from other Internet locations are provided to facilitate access. Since its establishment in 1999, physical therapists and medical librarians have come to identify “PEDro” with evidence-based physical therapy practice. However, PEDro is not a full-text resource and cannot be customized to local institutional needs. The ability to link to journal collections through OpenURL, as in PubMed's LinkOut, should be investigated by the developers. Librarians know that clinical practitioners and students want that full-text article and complain when it is not available through the database in which a particular citation is located. Searchers sometimes find that PEDro does not respond to search queries or that the Website is unavailable. It is unclear whether this is due to a limit on the number of searchers who can access the database simultaneously or to network connection problems. The database is usually available after a few minutes' wait. SIMILAR RESOURCES The American Physical Therapy Association's (APTA) evidence-based practice initiative, Hooked on Evidence, differs significantly from the scope of PEDro. Hooked on Evidence is a membership benefit of the APTA or available through subscription to physical therapy professionals only. Hooked on Evidence uses volunteer groups of professionals to recommend articles for submission to the database and to compile and publish short synopses of them. In addition to systematic reviews and practice guidelines, Hooked on Evidence also includes non-peer-reviewed resources and Websites that are compatible with evidence-based practice. It should be noted that the physical therapy and occupational therapy literature have some overlap, but are distinct fields of practice. Citations to occupational therapy literature will be found in PEDro; but some occupational therapy resources are not searched systematically for inclusion in the database. Following the publication of PEDro in 1999, a parallel initiative in the field of occupational therapy was undertaken by the University of Queensland and University of Western Sydney to establish OT Seeker <http://www.otseeker.com> in 2002, with similar goals to facilitate evidence-based practice. CONCLUSION PEDro is recommended for inclusion in presentations and programs on evidence-based health care practice and for library resource pages at institutions with professional preparation programs for rehabilitation professions. |
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