Which sequence best describes the hierarchy of evidence in evidence-based physical therapy decision-making?

• A. Clinical guidelines -> Systematic reviews -> Primary studies
• B. Case reports -> Editorials -> Expert opinions
• C. Primary studies (individual studies) -> Systematic reviews -> Clinical guidelines
• D. Animal studies -> In vitro studies -> Opinions

Answer: (C)

In evidence-based physical therapy decision-making, you move from the smallest, most direct sources of data to broader, synthesized guidance, ending with practical recommendations. Primary studies provide the raw results, but each study has design limits and variability. Systematic reviews take multiple studies, assess their quality, look for consistency, and combine findings to give a clearer overall effect. Clinical guidelines then translate that synthesized evidence into actionable recommendations for practice, considering not just the data but also patient values and real-world feasibility. Lower-tier sources like case reports, editorials, or opinions lack systematic synthesis and are not reliable for guiding broad practice decisions. Animal or in vitro studies contribute important mechanistic insights, but they don’t directly inform human clinical care, so they sit further from the decision-making you apply with patients.