What is Evidence-Based Practice, and Why Is It Important?

You may hear or see the phrase “evidence-based practice/care” thrown around a lot, but what does it really mean? What is evidence-based practice comprised of, and why is it important to know? Let’s dive in shall we. The three pillars of evidence-based practice are the following, and are actually in a particular order. They are current best evidence in research, provider’s clinical expertise/experiences, and patient values/circumstances (1).

1. Current Best Evidence in Research

   The first level of evidence-based practice is undoubtedly the most important, because utilizing the scientific method is the foundation of any scientific profession. You have a theory/hypothesis, you test it, you analyze the results of the test, and you publish your results, in order to contribute to the scientific body of literature. If there is a trend of results based on what’s been published, then it can give confidence to the professionals reading these articles that the information provided could be applied. This method goes through a rigorous peer-reviewed process, in order to ensure the information is as accurate as possible, with minimal bias present, and can take years to develop. There is also the consideration that not all research articles are made equal. There are established ways to determine the quality and level of evidence of the research being published, that may affect the speed of acceptance of the information that’s provided. However, it is necessary to be patient with this process, as it ensures us that we are doing the right thing.

2. Provider’s Clinical Expertise

   This next level of evidence-based practice stems from the first level. In this case, the clinician is in a situation where they need to use their clinical judgement on how to diagnosis and treat a patient, using the information that they currently understand. This is determined by the knowledge of the clinician, the understanding that the clinician has on the research they have read, the skills that the clinician has developed, and the experiences that the clinician has with the situation that they are currently working with. Keep in mind, that this can easily change over time as the clinician analyzes their own data from their past experiences, and also as research advances over time.

3. Patient Values/Circumstances

   The last level of evidence-based practice is by no means unimportant, as it could be summarized in three words; patient informed consent. A patient’s values/circumstances can be influenced by their own level of knowledge and experiences, just like a clinician. However, we cannot ignore the role the provider plays as the expert who is caring for the patient. Therefore, it is the clinician’s job to educate the patient on pertinent information pertaining to their care, and to establish shared-values throughout the treatment process. The patient and the clinician, should work together as a team. This is called patient-centered care, which I wrote about this in the “What is Therapeutic Alliance” article, so feel free to check that out.

Now why is this all important to know? Simple, it gives you a sense of whether or not a clinician you work with is practicing properly/ethically or not. For example, let’s say you are experiencing low back pain that travels down the back of your legs for the first time in your life. You have been inactive for several weeks, it’s not getting any better, you just started noticing some numbness/tingling, you don’t understand what’s going on, and so you decide to seek help. The clinician you see recommends that you receive percussive massage gun treatment followed up with low back/hamstring stretching exercises for two times a week for six weeks. Keep in mind, the clinician recommends this, believing that people value this type of service, because of how heavily advertised this is in today’s mainstream media. However, they fail to tell you that this service has not been proven to help with your specific condition (2), fails to increase muscle activation/strength in general (3) , and that there are other options available that would be better suited to help you return to your previous level of function, while also addressing your pain (2). That is not practicing in an evidence-based manner, and it is also not receiving proper informed consent from the patient. You should not skip steps in evidence-based practice, as this could lead to harmful results. In this case, the patient receiving subpar care that could prolong their recovery time, and cost them more money, than if they were to have received the best available care instead.

Thank you all for reading today’s article, and I look forward to hearing from you!

References:

1. Meira, Erik. “Understanding Evidence-based Medicine Using a Funnel Analogy.” SportRxiv, 10 Dec. 2020. Web.

2. Berry JA, Elia C, Saini HS, Miulli DE. A Review of Lumbar Radiculopathy, Diagnosis, and Treatment. Cureus. 2019;11(10):e5934. Published 2019 Oct 17. doi:10.7759/cureus.5934

3. Konrad A, Glashüttner C, Reiner MM, Bernsteiner D, Tilp M. The Acute Effects of a Percussive Massage Treatment with a Hypervolt Device on Plantar Flexor Muscles' Range of Motion and Performance. J Sports Sci Med. 2020;19(4):690-694. Published 2020 Nov 19.