As part of my online continuing education program that I launched last week, we discuss some information regarding the use of evidence based medicine in our practices. One particular concern that I often hear regarding the integration of evidence into what we do is that it seems daunting and difficulty. Below is a post I had on the member’s only forum at ShoulderSeminar.com, but thought it was a valuable lesson to share for all.
Integrating evidence based medicine into what you do does not have to be difficult and everyone can easily do this.
This is often an intimidating topic to many people, with many wondering how/why/when/where to integrate evidence into what you do. It really isn’t hard. You don’t need to be conducting research on your own (though, that would be great). Let me simplify it for you in 3 easy steps, all are awesome even if you never progress past the first step:
3 Steps to integrate evidence based medicine
Step 1 – Basic Way to Use Evidence Based Medicine For Beginners – Ask “Why?”
To practice evidence based medicine, simply do one thing each and every day – ask yourself “why?” Why are you doing this test, this stretch, this exercise, these sets/reps? If you don’t know the answer, strive to find it. Pubmed.com is an excellent place to start. Then keep going until you’ve answered all your questions and have a sound reason behind everything you do. If you are doing this you then you are doing an excellent job integrating evidence into your practice – see, it wasn’t that hard.
I call this the power of “why?”
Using the “power of why” is a little different than just learning from articles, websites, DVDs, seminars, and online continuing education programs. That is passive learning. This is actively seeking an answer instead of being force feed an answer.
HINT – Get your students and interns to research your questions for you as an assignment! Require 2-3 articles to support their decision to use a specific test, exercise, modality, or even justify specific sets and reps
Step 2 – Intermediate Way to Use Evidence Based Practice – If You Can’t Find the Answer Research it Yourself
What if you can’t find the answer – and remember, not everything we do is supported by evidence – don’t give up. I really believe you shouldn’t stop using that piece of your practice if you have had a good results, that is of course you find evidence stating that your technique is NOT effective. But you have to at least try to find your answers first. Chances are someone smarter than us had the same question and actually studied it well and published it by now. If not, try performing simple research studies even if just with your patients/clients and even if not perfect. It is a start and as you get better with your simple self-performed studies, you will get better at designing these “mini-studies” to assure they have sound reliability and validity. Maybe you can answer some of the questions yourself.
While it would be great if you conducted a sound study with great methodology and perhaps even publish, just try your best and see what happens. Sometimes there isn’t anything wrong with publishing in your own private Journal of Anecdotal Evidence!
HINT – Use this as an excuse to really improve your documentation, implement outcome tools (like the ASES shoulder scale shown here), and perhaps even create your own “research data sheets.” These are sheets I create when I am looking for an answer. They simple allow me to track something specific, such as maybe the results of each SLAP test I perform for specific patients. That way, after several months, I can look back and see the percentage of people with a SLAP that had positive signs on specific tests.
Step 3 – Advanced Way to Use Evidence Based Practice – Once You Find the Answer, Teach it to Others
The next progression is to share what you’ve learned with others. This can be as simple as a small inservice with your coworkers or as advanced as a research platform at one of our national meetings, of course followed by publication in a journal. Unfortunately not many people get to this level because it is hard and time consuming (and not profitable!). The peer-review process is challenging and you really need to understand research methodology. As a reviewer for journals, I see a lot of really bad manuscripts submitted for publication, sad, but true. Realize that for every paper published there are hundreds that don’t make it.
I see nothing wrong with this, and truth be told, we review every manuscript, good or bad. That means, someone that is really good at research reviews and critiques your study before sending it back to you with comments. It is like a free mentor! Even if you don’t get published, you will learn a lot of valuable information through the review process.
HINT – Read as many articles you can that have similar research designs as yours BEFORE you start collecting data. See what they did for their design and methods. Read the article from a different perspective, as a fellow researcher, instead of as a clinician.
As you can see, integrating evidence based medicine into your practice doesn’t have to be that hard, no matter what your profession. Even if you only progress to step 1 above, you are doing great and making a difference.
UPDATE: For those that feel overwhelmed with trying to read research articles, there is a great new education product by Mark Young that shows you how to read the fitness and rehab research, learn more about how to read research. Check it out.
What do you think? How do you integrate evidence based medicine into your practice?