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Feature Article  - 1-15-09

The 1-Minute Primer on Evidence Based Practice

Evidence-based practice, EBP for short, (or evidence-based medicine when specifically referring to the practice of medicine) is rapidly emerging as the expected approach to health care delivery, embraced by nearly every health care field as the optimal model of practice for improving health care quality. EBP influence actually began outside of the United States and has only recently become a major influence in our health care delivery. However, EBP in some elementary form has been around a long-time, even if use of the terminology is associated with more contemporary practice.

As with most trends that become popular, or create a culture shift, EBP is in danger of becoming (if not already) a “vogue” term, often misunderstood or misrepresented. Before defining what constitutes EBP, let’s first characterize what EBP is not:

• EBP is NOT a synonym for research. Research is a merely a component of EBP. In fact, not all research is given equal weight in EBP.

• Second, it is not a grand scheme of the ”evil” insurance companies, managed care, or government to control costs or impose practice guidelines that mandate specific treatment patterns from which there is little room for deviation.

• Finally, EBP is not “Vulcan” in nature (for non “Trekies”, Vulcans operate only on logic, absent from emotion and feeling) or divorced from consideration of patients’ values and all the inherent emotion and variation associated with them.

What then, is EBP? Evidence-based practice has been defined by David Sackett as: “The conscientious, explicit, and judicious use of the current best evidence in making decisions about individual patients.” Therefore, EBP consists of three interrelated components:

• Clinical expertise

• The use of current best evidence from systematic clinical research. This means research involving human subjects, not rats.

• Patients’ values

The key tenets of modern day EBP are the same ones that underpinned its rudimentary beginnings in times past. Evidence-based practice at it’s core is using one’s own experience in conjunction with the use of best evidence and consideration of individual preferences. Modern day EBP expands these elements by de-emphasizing intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision-making, and instead stresses the examination and application of evidence from clinical research within a patient-centered framework.

For more information on EBP, organizations committed to the propagation of EBP philosophy in healthcare and ways it is currently being implemented in physical therapy practice, visit www.evidenceinmotion.com. For professional social networking centered on EBP physical therapy practice visit www.myphysicaltherapyspace.com. 

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