Advice line: the controversial issue of evidence-based medicine

Carley King looks at the controversial issue of evidence-based medicine.

Evidence-based practice (EBP) is always a controversial term – you only have to read the spate of recent letters on the topic in Frontline to realise it triggers a vast range of opinions (see, for example, the letter by Catherine Duff, page 5, 5 August). 
The brevity of this column means I can only scratch the surface of the underlying issues, so this is really just to keep the discussion going. Philosophy underpins EBP. There are so many different ways of ‘knowing’ something that the methods we use to establish what does or doesn’t work at the moment ... this must surely limit the scope of what we know through research alone? 
For example, do we know the impact of just being able to talk to somebody about their pain, or breathlessness? Having said this, the rising profile of qualitative research does perhaps reflect a shift in our thinking about what is an acceptable contribution to the evidence base, and it’s likely that further changes are in the pipeline.
Some physios claim that EBP can stifle autonomy. It isn’t something that takes away the need for clinical reasoning. You need to have a comprehensive understanding of what is happening with the patient in front of you, and apply the evidence where appropriate. How appropriate it is depends on a number of factors, but the two key ones are your patients’ values and your own clinical experience. EBP incorporates patient values, your clinical experience and the evidence (which doesn’t necessarily have to be a randomised controlled trial).
If you’re interested in some of the conversations happening around current thinking on EBP, you might want to visit the Critical Physiotherapy Network website. The address is
Delegates at next month’s Physiotherapy UK event can follow an entire theme dedicated to research into practice, which will explore some of the current controversies in the field of EBP.
Check out the programme here at Physiotherapy UK 2015.  
Carley King CSP professional adviser

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