Practice Based Evidence

By: Joel Luedke

Evidence occurs along spectrum and how you utilize it should also occur along a spectrum.  Evidence based practice (EBP) has been a major push for a long time in a lot of professions.  Lately the increased focused on EBP worked its way through the field of athletic training.*

Evidence is great and the research is needed but I am going to talk about in this post is why we can't jump all in on just EBP and go on to say "there is not evidence" and let that make something we are doing not worth doing.

More Questions than Answers

I read a good amount of research and while there are connections you can make out of the studies there is almost never a study that directly applies to what population you are working with or the issue that you are dealing with.  This makes the transfer of evidence difficult.  Along with this issue there is the problem of repeatability.  Several studies may look at similar circumstances and based on a number of factors come out with extremely different results.  So which one do you use?  Do you use nothing at all?

The research problem is also difficult in that there has to be a long progression of studies building on themselves in order figure out the root of an issue or problem.  That can also be a frustration with research in that most studies leave more questions asked than questions answered.  Problems are identified but rarely are answer ever clear.  This makes implementation difficult.

Individual Response

I would argue training and treatment is just as much art as it is science.  Everyone is so individual in their response to the same stimulus that is it almost impossible to expect success with the same treatment or intervention.  I believe this is where an idea I stumbled upon of 'Practice Based Evidence' comes into play.  While it may not be double blinded or randomized controlled if something works, then it works and I think that is important in and of itself.

By looking at basic concepts that can be found in research (i.e. principles of training or soft tissue work) the partitioner can then find the right instrument for the right person that facilities the best outcomes.  At the end of the day I believe this should be the ultimate goal in getting the client/patient/athlete the best and most efficient outcomes they are searching after.

Research is vital but getting caught up in only practicing a certain way I think leads us down a path of missing things and not fully providing the best practice we are able to.  Ground what you do in research and stay on the cutting edge and most importantly have a 'why' in terms of everything you do but never forget the importance of patient outcomes.

*At no point am I saying that research and evidence shouldn't be a major part of everything we do, it just shouldn't be the only thing focus on.