Evidence-based practice

The most well used definition of evidence-based practice is that it is the
'conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.'
Sackett, et al (1996) BMJ 312: 71-2
A more recent definition is:
'Evidence-Based Practice (EBP) requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources.
Martin Dawes, et al (2005) Sicily statement on evidence-based practice BMC Medical Education 2005, 5:1

What does this mean for physiotherapists?

The Health Professions Council standards of proficiency for physiotherapists state that registrants must:
'2b1. be able to use research, reasoning and problem solving skills to determine appropriate actions
  • recognise the value of research to the systematic evaluation of practice
  • be able to conduct evidence-based practice, evaluate practice systematically, and participate in audit procedures
2b2. be able to draw on appropriate knowledge and skills in order to make professional judgments
HPC website
The CSP standards of professional practice also expect information relating to treatment options is identified, based on the best available evidence, in order to deliver effective care (CSP, core standards of physiotherapy practice, standard 4). Criterion 4.1 says:
'The physiotherapist considers and critically evaluates information about effective interventions relating to the patient’s condition.'
The sort of evidence members can draw on is listed:
'There will be a range of different sources for obtaining this information, including the patient, relatives/carers, other health care professionals, library facilities, electronic sources, journals, local policies. Research forms an essential part of practice.

'Whilst every practitioner will not necessarily be engaged in generating new evidence through research, all practitioners will use research evidence in some form to inform their own clinical practice.
The guidance that accompanies this standard lists some sources:
  • Research
  • Clinical guidelines, effectiveness bulletins and other summaries of evidence of effectiveness
  • Clinical interest and occupational groups
  • National guidance e.g. National Service Frameworks, National Institute of Health and Clinical Excellence guidelines
  • Local standards and protocols
  • Information derived from the use of outcome measures
  • Patient organisations/groups e.g. The Stroke Association
  • Expert opinion
  • Reflections on practice

Useful places for more information

  1. InteractiveCSP: effective practice network. See the interactivecsp website
  2. Guyatt G, Cook D, Haynes D (2004) Evidence based medicine has come a long way BMJ, 329:990-991 (30 October)
  3. Straus SE & McAlister FA (2000) Evidence-based medicine: a commentary on common criticisms CMAJ, 163, 7: 837 - 841 (3 October)
  4. Goldenberg MA (2006) On evidence and evidence-based medicine: Lessons from the philosophy of science Social Science & Medicine 62 (2006) 2621-2632
  5. Evidence-Based Health Care discussion group: www.jiscmail.ac.uk/lists/EVIDENCE-BASED-HEALTH.html
  6. Centre for Evidence-Based Medicine
  7. Resources for Practicing Evidence-based Medicine
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