WHAT IS EVIDENCED- BASED PRACTICE?

AND WHY SHOULD WE APPLY IT?

BY NICK DINSDALE, MSST

INTRODUCTION As professional clinicians we are responsible and accountable for our own clinical practice (1) and are expected to offer interventions that maximise benefit and minimise harm to our patients (2). Evidence-based practice (EBP) can help us achieve these aims by underpinning clinical decisions, while delivering both clinical and economical benefits. EBP involves applying contemporary research (3) to provide a service derived from the best available evidence (4) whilst keeping abreast of developments in professional practice (5). According to Sackett (6) EBP “is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (page 71). It is a process of turning clinical problems into questions and then systematically locating, appraising, and using contemporaneous research findings as the basis for clinical decisions (3). Unsurprisingly, failure to provide EBP may lead to possible claims of negligence and malpractice which could be difficult to defend (7). Potential consequences are well documented, for example; poor decision-making (3), inadequate clinical effectiveness (4), harmful to the athlete (8), poor cost effectiveness (9) etc.

EVIDENCE-BASED PRACTICE Evidence-based practice has developed from the principles of evidence-based medicine and is primarily about the interaction between practitioner and individual (10). EBP develops self- confidence and clinical competence. Competence being, “the complex synthesis of knowledge, skills, values, behaviours and attitudes that enable individual professionals to work safely, effectively and legally within a specific scope of practice” (11). EBP must stand on a base of research using the best available external clinical evidence from systematic research findings (12). It is no longer good enough to say something works; the evidence is needed that it does work. EBP is crucial to the professional survival of ‘therapy’ eg physiotherapy (13), sports therapy (14), physical therapy (15) and massage therapy. In the past decade, evidence based medicine has contributed much to how we teach, deliver, and think about clinical services. The uptake of appropriate research evidence into clinical practice remains a priority for politicians, managers and

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Evidence-based practice involves delivering interventions that maximise benefit and are supported by an underpinning, accountable evidence base.

professionals within the National Health Service (NHS) and private practice (16). The need for evidence-based practice has been highlighted for several decades. However, implementing research into practice has often been shown to take 20 years or more. This produces suboptimal care for patients therefore moving evidence more quickly into practice requires strategies (17). Turner (14) reported that throughout the 1990s,

physiotherapy had been subject to considerable criticism for its lack of research and its sparse evidence-base. Similarly, much of sports medicine has developed empirically, and current practice often reflects practitioner experience rather than evidence from research findings (18). The lack of high quality research literature is one reason for this. Following a detailed survey into four major international sports medicine journals to examine the evidence-base of sports medicine, Bleakley et al (19) reported a dearth of studies addressing diagnostic and treatment interventions in the literature. In support of Bleakley’s findings, Hoskins and Pollard (20) carried out an exhaustive literature search into the management of hamstring injuries and concluded there was a distinct lack of high-quality research into methods of treatment and rehabilitation…. “as a result of the findings, an evidence-base for injury management of hamstrings does not exist” (page 180). Naylor (21) suggests, at times, evidence alone may not be sufficient to guide actions. Therefore, interventions may need to be based on inference and clinical reasoning, with its reliance on experience, analogy and extrapolation, to traverse these grey zones of practice. This includes eliciting and respecting the preferences of patients. Clark (22) refers to clinical reasoning as the organisation of thought processes, the prioritisation of interventions strategies, and the application of clinical skills in the evaluation, diagnosis, and treatment of a patient’s problem.

sportEX dynamics 2008;17(Jul):8-10