“Evidence based” practice or medicine appears to be the phrase of the current generation of health care professionals. A general search utilizing Ovidsp resulted in over 200 journal articles with the phrase “evidence base” in the title. Although the basis of evidence based medicine was first established in the 1970’s, the evidence has grown exponentially in the previous twenty years1,2. Evidence based medicine is the “use of current best evidence in making decisions about the care of individual patients3.” As professionals, but more specifically as APTA members, we can agree that the utilization of evidence is important for our profession4. There are a plethora of articles establishing evidence for various types of medicine, but it is important to understand that evidence based practice also presents with limitations. For example, Jette et al4 reports that physical therapists have a positive attitude towards evidence based practice. A limitation of this study is that the survey was issued only to APTA members. It may be argued that those that have joined their respective professional organization are more proactive than those that have not joined. This study surveyed motivated therapists, which may have led to the positive attitude regarding evidence. Another limitation related to positive results is “publication bias”, which indicates that research with negative results is less likely to be published1. Because not all research is published, specifically negative research, the audience (physical therapists) is inundated with positive outcomes, which may bias the reader that the intervention is statistically effective in treating patients. It has been established that randomized controlled trials (RCT) are the gold standard for providing the best evidence for interventions5. It is the physical therapist responsibility to thoroughly assess the RCT in order to determine if it is applicable to the population treated clinically2. Maher et al1 concluded that individual’s ability to critically assess an article is a limitation, as not all therapists critique an article’s validity to the population treated. Another limitation to evidence based practice noted by Maher et al1 is FUTON bias (full text on the net), which means that therapists are more likely to quote and utilize only the articles which are available in full text. I am guilty of this bias, as I do not find that utilizing an abstract is valid for patient care if I cannot assess the methodology of the study. Additionally, conflicts of interest serve as a limitation to evidence based practice6. Croft et al6 states that professional groups that have an interest may promote a specific intervention. Because of this financial conflict of interest the use of evidence-‐based practice may be used as a marketing tool for individual professions. To answer the question: Do I think that evidence-‐based practice will require a change in the profession? Based on Jette et al4, I do not believe a change is required. Time will eventually dispense of the therapists that are uncomfortable with research, lack the database knowledge, or are unable to critically appraise research. According to the article, younger therapists are more inclined to be researched based practitioners, as they are more confident and able to critically appraise the research out of school. Based on Vision 2020, it is hard to believe that a change needs to take place in order for our profession to become more research based.
1. Maher CG, Sherrington C, Elkins M, et al. Challenges for Evidence-‐Based Physical Therapy: Accessing and Interpreting High-‐Quality Evidence on Therapy. Phys Ther. 2004;84(7):644-‐654.
2. Vaccaro AR, Fisher CG. Evidence and Impact: Should these articles Change the Practice of Spine Care? An Evidence Based Medicine Process [Published Ahead of Print]. DOI: 10.1097/BRS.0b013e3181d4ea37. Accessed on January 25, 2012.
3. Sackett DL, Rosenberg WMC, Muir Gray JA, et al. Evidence-‐based medicine: what it is and what it isn’t. MBJ. 1996;312:71-‐72.
4. Jette DU, Bacon K, Batty C, et al. Evidence-‐Based Practice: Beliefs, Attitudes, Knowledge, Behaviors of Physical Therapists. Phys Ther. 2003;83(9):786-‐ 805.
5. National Health and Medical Research Council. How to Use the Evidence: Assessment and Application of Scientific Evidence. Canberra, Australia Capital Territory, Australia: Biotext;2000.
6. Croft P, Malmivaara A, Van Tulder M. The Pros and Cons of Evidence-‐Based Medicine. Spine. 2011;36(17);1121-‐1125.