Evidence Based Practice II

Pillars of EBP

Welcome to the second edition of the newsletter! In this edition, we will try to define Evidence-based practice (EBP) and explore the pillars of EBP.

Let’s look at the definition of evidence-based practice.

Sackett defines EBP as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. ”

Ever since Sackett explained evidence-based medicine, its concept, and definition has evolved over the years. The most widely cited definition of EBP in recent times is “the integration of best research evidence with clinical expertise and patient values.”

The definition highlights three different components of EBP which are also termed as the pillars of the EBP. The three pillars on which the model stands are

1. Best Research Evidence

2. Clinical Expertise

3. Patient values and Preferences

   

   EBP Model

Clinical expertise refers to the clinician’s cumulated experience, education, and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values. The best research evidence is usually found in clinically relevant research that has been conducted using a sound methodology (Sackett D, 2002).

These three interdependent domains of EBP which as per my understanding should not be isolated to appreciate the concept. EBP is an open and thoughtful clinical decision-making process that allows the clinician to choose what is best for the patient within a patient-centered model. The concept of evidence-based practice has been embraced by our profession gradually. Although, it remains unclear on its intense, practical implementation.

With ever-increasing autonomy to the profession of physiotherapy, comes ever-enhanced responsibility too. It is demanded that word of mouth should be replaced by scientific evidence.

Remember, there has been a lot of shift in the way we practice, with newer emerging evidence, we should challenge our practices in the light of recent literature. EBP is not restricted to randomized trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions. This is where the need arises for learning a bit of research methodology.

I will finish it off with an excerpt from the 1996 BMJ Editorial written by Sackett.

“Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.” (Sackett D, 1996)

The editorial titled “Evidence-based medicine: what it is and what it isn’t” by Sackett can be accessed from this link http://www.dcscience.net/sackett-BMJ-1996.pdf.

Let’s ponder and think of ways to better implement EBP in our clinical practice.

Ammar Suhail PT