Sunday, May 4, 2008

Evidence in Practice

Wow seems like it's been a while since my last post. Things have been a little busy around here lately, but now settling down. I registered for my first semester at Texas Tech's doctoral program (I'm way too excited by the way), welcomed a new PT student to the clinic from my alma mater UTMB, and had a crazy week of patient care to boot. It's nice to be able to sit in front of the keyboard and get back to plucking some good information that's out there for us as therapists.

I recently came across an interesting PowerPoint presentation from the Centers for Evidence-Based Medicine (CEBM). The presentation was authored by Paul Glasziou of the University of Queensland and Oxford. It is appropriately titled "Evidence-Based Practice" and provides an excellent overview of practicing EBM. Incidentally, the CEBM has a number of excellent PowerPoint presentations available for free download. If you are interested in getting a better understanding of EBM, this would certainly be a good start.

What is Evidence Based Practice?

I've alluded to Sackett's definition of EBM before but it might be good to restate it here. Evidence-Based Medicine is "the integration of best research evidence with clinical expertise and patient values". It's hard to avoid noticing three key elements of this statement:

  1. The clinical decision-making process should be guided by the best available evidence.
  2. Clinicians are encouraged to utilize their brains during this process and not become slaves to the literature.
  3. The patient's values should be factored into the clinical decision-making process.

In this context it is difficult for me to understand some of the most common objections to evidence-based practice. I have heard colleagues complain that EBP encourages protocol-driven health care and is simply another third party cost-cutting tool. If we incorporate statements 2 and 3 above, this becomes an improbable pitfall for us.

By the same token there are risks to an overzealous approach to EBP. I have seen some of my respected colleagues remove their thinking cap altogether and simply practice according to the latest treatment-based classification system. I don't think this is what EBP is about. A PT whom I still call my mentor used to say "We don't treat MRIs. We treat patients". We also don't treat studies, no matter how well designed. Again a brief look back at the definition of EBP allows us to make sure we make decisions with a broader perspective in mind.

On a lighter side...

If you are into a little irreverant PT editorial, I strongly suggest taking a look at the PT "Whore of the Month" award over on the EIM website. Whether you agree with the terminology or not, it does a good job of letting us know we've got some real numb-nutts within or near our profession out there and to stay vigilant in marginalizing them. Enjoy!

Thanks for putting up with the rant. In the coming weeks I will be hitting the topics of lumbar stabilization, the role of training on unstable surfaces in rehabilitation, and the neurophysiology of pain and our sometimes feeble attempts to manage it in the clinic. The research I've been finding on these topics is fascinating and I'm excited to share it with you. Until then, take care!

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