RESEARCH SKILLS EBP

attribute effects to causes (1), allows for meta-analysis (24) and is often regarded as the gold standard (25,26). Rigorous RCTs greatly reduce systematic errors (bias) by ensuring that the groups being compared are similar, achieved mainly through randomisation (27,28). Care is required, however, as Juni and colleagues report that there is ample evidence that many controlled trials are methodologically weak and increasing evidence that deficiencies translate into biased findings of systematic reviews (29). Therefore, the influence of the quality of included studies should be examined routinely.

The hierarchy is not fixed in tablets

of stone; the rankings may change, and there is debate over the relative positions of systematic reviews and large RCTs. Furthermore, there is much controversy over the kind of evidence that is actually most relevant to clinical practice. Despite this, the hierarchy of evidence is still recognised as probably one of the most reliable and simplest ways of classifying research quality. Table 2 represents a compilation derived from various sources, including Greenhalgh (20) and Sackett and colleagues (26). The table represents a fair consensus of current thinking with respect to the grading of evidence.

CONCLUSION The need for effective high- quality research evidence has arisen from EBP, fundamentally driven by patients’ expectations and their ever-increasing demands – and rightly so. Indirectly, the need has arisen from increasingly stringent legislation

and the looming threat of civil action resulting from negligence and malpractice. Regardless of the driving forces involved, it remains abundantly clear to all concerned that high-quality evidence is a necessity now and will remain so in the future. Notwithstanding these reasons, the development of research skills remains a key issue and constitutes suitable components for future professional development. Understanding the concept of, and

www.sportEX.net

the components within, the hierarchy of evidence would represent a good starting point.

References 1. Bleakley C, MacAuley D. The quality of research in sports journals. British Journal of Sports Medicine 2002;36:124—125 2. Thomas JR, Nelson JK. Research methods in physical activity, 4th edition. Human Kinetics 2001. ISBN 0736030050 3. Fine EV, Bliss DZ. Searching the literature: understanding and using structured electronic databases. Journal of Wound, Ostomy and Continence Nurses Society 2006;33:594–605 4. Bury TJ, Mead JM. Evidence-based healthcare: a practical guide for therapists. Butterworth Heinemann 1998. ISBN 0750637838 5. Steves R, Hootman JM. Evidence-based medicine: what is it and how does it apply to athletic training? Journal of Athletic Training 2004;39:83–87 6. Herbert RD, Maher CG, Moseley AM, Sherrington C. Effective physiotherapy. British Medical Journal 2001;323:788–790 7. Glasziou P, Vandenbroucke J, Chalmers I. Assessing the quality of research. British Medical Journal 2001;328;39–41 8. Hendry C, Farley A. Reviewing the literature: a guide for students. Nursing Standard 1998;12:46–48 9. Del Mar C. Clever searching for evidence. British Medical Journal 2005;330:1162–1163. 10. Bryman A. Quantity and quality in social research. Unwin Hyman 1988. ISBN 0415078989

11. Bell J. Doing your research project, 4th edition. Open University Press 2005. ISBN 0335215041 12. Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problem-solving British

Medical Journal 1995;310:1122–1126

13. Turner PA, Whitfield ATW. Physiotherapists’ reasons for selection of treatment techniques: a cross-national survey Physiotherapy Theory and Practice 1999;15:235–246

14. Turner PA. Evidence-based practice and THE AUTHOR

Nick Dinsdale originally trained as a sports masseur and later qualified as an osteopath before completing a BSc (Hons) in sports therapy, gaining a first class degree. Over the years Nick has worked as team masseur to the GB and England cycling teams, covering both domestic and overseas events. Nick has been a keen athlete, competing in running and cycling events at all levels, culminating in winning the national cyclo-cross series. Nick is a part-time tutor at the Northern Institute of Massage (NIM). Specialist workshops include: i) Electrotherapy, ii) Lower limb biomechanics and orthotic prescription. Nick is a visiting lecturer at Teesside University and has carried out consultancy work for the University of Central Lancashire.

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physiotherapy in the 1990s. Physiotherapy Theory and Practice 2001;17:107–121. 15. Alsop A. Evidence-based practice and continuing professional development British Journal of Occupational Therapy 1997;60:503–550 16. Marshall G. Critiquing a research article. Radiography 2005;11:55–59 17. Straus SE, Sackett DL. Using research findings in clinical practice. British Medical Journal 1998;317:339–342 18. Cape J. Clinical effectiveness in the UK: definitions, history and policy trends. Journal of Mental Health 2000;9:237–246 19. Rothstein JM. Outcomes and survival. Physical Therapy 1996;76:126–127 20. Greenhalgh T. How to read a paper: getting your bearings (deciding what the paper is about). British Medical Journal 1997;315:243–246 21. Sheldon TA, Guyatt GH, Haines A. When to act on the evidence. British Medical Journal 1998;317:139–142 22. Bero LS, Grilli R, Grimshaw JM, Harvey E, et al. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. British Medical Journal 1998;317:465–468 23. Coopey M, Nix MP, Clancy CM. Translating research into evidence- based nursing practice and evaluating effectiveness. Journal Nurse Care Quality 2006;21:195–202 24. Greenhalgh T. How to read a paper: assessing the methodological quality of published papers. British Medical Journal 1997;315:305–308 25. Merrick MA. “I can’t believe we don’t know that!” Journal of Athletic Training 2006;41;231–232 26. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, et al. Evidence based medicine: what it is and what it isn’t. British Medical Journal 1996;312:71–72 27. Ennos R. Statistical and data handling skills in biology. Prentice Hall 2000. ISBN 0582312787 28. Sackett DL, Wennberg JE. Choosing the best research design for each question. British Medical Journal 1997;315:1636 29. Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. British Medical Journal 2001;323:42–46 30. Cochrane Collaboration. Glossary of Cochrane Collaboration and research terms, version 4.2.5. Cochrane Collaboration 2005. www.cochrane.org/resources/ glossary.htm