Introduction
Few of us would argue with the importance of evidence-based practice (EBP) in sports
medicine, but to develop such a culture we must have ‘quality’ research literature
(1). Research is simply a way of solving problems. Questions are raised, and methods
are devised in an attempt to answer them (2). Research enables us to convert theory
into practice to solve clinical problems. Research in medicine and sciences has developed
within a framework of thinking that is known as the ‘scientific method’. This framework
has become the predominant model for rigorous research investigation. Unfortunately,
owing to the vast quantities of research material now available, searching and locating
relevant literature can be difficult and often very time consuming. Furthermore,
the ‘quality’ of research evidence cannot always be relied upon for EBP. This article
will attempt to identify some of the typical pit-falls, discuss the necessary research
skills required for EBP.
The Quality Issue
Evidence-based practice (EBP) is a process of turning clinical problems into questions,
then systematically locating, critically appraising, and using robust contemporary
research evidence as the basis for clinical decisions (3). It is widely accepted
the reading of peer reviewed research articles is essential for EBP and vital to
continuing professional development (CPD) (4, 5, 6). Journal reading enables the
therapist to keep up-to-date with current thinking (7). However, research evidence
should never be accepted blindly and certainly not taken at face value (8). Therefore,
research needs to be critically evaluated for both quality (validity) and relevance
(9) to help the clinician make better use of the evidence (10) to inform clinical
decisions and practice. Almost 12 years ago, Rothstein (11) realised the survival
of his profession (physical therapy) depended not on the quantity of dubious research
but on the quality of focused and meaningful research. Rosenberg and Donald (3) said
“we are confronted by a growing body of information, much of it invalid or irrelevant
to clinical practice”.
Many authors share this view, for example; Marshall (8) reminds us of the need to
read literature with a critical mind even that published in peer reviewed journals.
More drastically, Greenhalgh (12) suggests most published articles belong in the
bin, and should certainly not be used to inform practice. According to Del Mar (13)
most research papers are written as communications from scientists to scientists
and relatively few have immediate clinical relevance - most of the remainder are
not rigorous enough to warrant applying clinically. Consequently, the proportion
of useful information is very small. Greenhalgh (12) reported many papers published
in medical journals have potentially serious methodological flaws. Therefore, if
you are deciding whether a paper is worth reading, you should do so on the design
of the methods section. In support of Greenhalgh, Sheldon et al. (14) suggests that
when designing studies investigators should consider how and by whom their results
will be used. The design should be sufficiently robust, the setting sufficiently
similar to that in which the results are likely to be implemented, the outcomes should
be relevant, and the study size large enough for the results to convince decision
makers of their importance. Although textbooks play an important role in providing
basic information to learners the drawback with all textbooks is staying current
(15). Some concepts described in textbooks can lag behind the empirical evidence
by as much as 10 years. This lag is in part attributable to the more prolonged publication
cycle for textbooks than for journal articles. In summary, treatment interventions
should be chosen from the most relevant, scientifically sound and rigorous evidence
currently available. Fortunately, the use of hierarchies of evidence can assist clinicians
in this process.
Conclusion
The need for effective high-quality research evidence has arisen from evidence-based
practice, fundamentally driven by patients’ expectations and their ever increasing
demands, and rightly so. Indirectly, the need has arisen from increasingly stringent
legislation, and the looming threat of civil action resulting from negligence and
malpractice. Regardless of the driving forces involved, it remains abundantly clear
to all concerned that high-quality evidence is a necessity, now, and will remain
so in the future. Notwithstanding the reasons above, the development of research
skills remains a key issue and constitutes suitable components for future professional
development. Understanding the concept of and the components within the hierarchy
of evidence would represent a good starting point.
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