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” 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 would 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.
References:
1. Bannigan K. To serve better: Addressing poor performance in occupational therapy.
British Journal of Occupational Therapy 2000; 63(11): 523-528
2. Alsop A. Evidence-based practice and continuing professional development. British
Journal of Occupational Therapy 1997; 60(11): 503-550
3. Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problem-solving.
British Medical Journal 1995; 310:1122-1126
4. Turner PA, Whitfield ATW. Physiotherapists’ reasons for selection of treatment
techniques: A cross-national survey. Physiotherapy Theory and Practice 1999; 15(4):
235-246
5. Eakin P. The casson memorial lecture 1997: shifting the balance - evidence-based
practice. British Journal of Occupational Therapy 1997; 60(7): 290-294
6. Sackett DL. Evidence-based medicine. Spine 1998; 23(10): 1085-1086
7. Turner PA, Harby-Owen H, Shackleford F, So A, Fosse T, Whitfield TW. Audits
of physiotherapy practice. Physiotherapy Theory and Practice 1999; 15: 261-274
8. Druss B. Evidence based medicine: does it make a difference? Use it wisely.
British Medical Journal 2005; 330: 92-94
9. Cape, J. (2000). Clinical effectiveness in the UK: Definitions, history and
policy trends. Journal of Mental Health 2000; 9(3): 237-246
10. Bury T, Mead J. Evidence-based healthcare: a practical guide for therapists.
Butterworth Heinemann 1998.
11. Roberts S. Continuing professional development: what the future might hold. Journal
of Sportex Medicine 2004; 19:14-16
12. Coopey, M., Nix, M.P., Clancy, C.M. (2006). Translating research into evidence-based
nursing practice and evaluating effectiveness. Journal Nurse Care Quality 2006; 21(3):195-202
13. Turner PA. Evidence-based practice and physiotherapy in the 1990s. Physiotherapy
Theory and Practice 2001; 17:107-121
14. The Society of Sports Therapists’ Codes of Professional Conduct. Competences
and scope of practice for sports therapy 2005.
15. Rothstein JM. Outcomes and survival. Physical Therapy 1996; 76(2):126-127
16. Humphris D, Littlejohns P, Victor C, O’Halloran P, Peacock J. Implementing evidence-based
practice: factors that influence the use of research evidence by occupational therapists.
British Journal of Occupational Therapy 2000; 63(11):516-522
17. Evrin NE. Clinical coaching: a strategy for enhancing evidence-based nursing
practice. Clinical Nurse Specialist 2005; 19(6):296-302
18. Naylor CD. Grey zones of clinical practice: some limits to evidence-based medicine.
Lancet 1995; 345;840-842
19. Clark, N. (2004). Principles of injury rehabilitation. Journal of Sportex Medicine,
19, 6-10.
20. Straus SE, Sackett DL. Using research findings in clinical practice. British
Medical Journal 1998; 317:339-342
21. Buttery Y. Implementing evidence through clinical audit. In: T Bury, J Mead.
(eds) Evidence-based healthcare: a practical guide for therapists. Butterworth Heinemann
1998.
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 is derived from empirical research rather than anecdotal evidence. 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 their particular 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” (2). EBP is crucial
to the professional survival of ‘therapy’ e.g. 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 professionals alike 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 shown to take 20 years or more. This produces suboptimal care for patients;
therefore moving evidence more quickly into practice requires strategies (17).
Naylor (18) 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 (19) 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.
Clinical Audits
As part of the evidence-based cycle, clinicians should evaluate their own performance
(20). Clinical audits is one of the main vehicles for implementing protocols into
everyday practice (21) monitoring the results of effects to changes in practice (9)
and to ‘benchmark’ standards in practice (7). Clinicians employed within the NHS
are generally routinely monitored, audited, and critically appraised. However, clinicians
working in private practice are often left to their own devices, thus, can potentially
become more vulnerable to stagnation and loss in clinical performance.
Conclusion
Evidence-based practice is here to stay; therefore clinicians must accept and understand
the concept of EBP. Thereafter, they can begin to appreciate the clinical and economical
benefits on offer, also, while realizing the potential consequences associated with
failure to apply it. Consideration must be given to the ever expanding scholarly
databases of research information, the continual changes in technology and protocols.
Not to mention the emphasis on more stringent legislation, civil cases of malpractice,
and patients’ increasing demands and expectations. For the more vulnerable clinicians
in private practice, a concerted and ongoing effort is needed to avoid becoming insular
within a confined private clinic environment stagnated by lack of change. Finally,
all clinicians must be proactive towards EBP, particularly CPD. In the future, simply
complying with minimum standards may not be sufficient.
