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Evidence Based Medicine

“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.

 

References:

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.

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