Clinical Evaluation and Therapeutic Choices based on Evidence-Based Practice
The following is an abstract of the french article Évaluation clinique et choix thérapeutique fondés par les données probantes (Chaput et al., 2017).
Introduction: Evidence-Based Practice (EBP) has been identified as being necessary for clinical education and clinical practice to improve therapeutic choices and results. The concept dates back to the XXth century and has been refined continuously throughout the years (Sackett et al., 1996; Strauss et al., 2005; Jewel, 2011; Jones & Rivett, 2004). The objective of the article is to improve clinicians’ comprehension of EBP and its application within clinical practice.
Figure 1: Shared decision with the three evidence-based practice's core pillars.
Methods: Based on a reverse engineering process, four clinicians of different background (occupational therapist, physical therapists, speech language pathologist and medical doctor) wrote, edited, improve and updated the article in a subsequent manner.
Results: EBP is a decisional process that integrates three core pillars (Fig. 1):
Clinical Expertise: Based on clinical experience, clinicians are equipped with clinical expertise to select an appropriate assessment and treatment method.
Patient Preferences: Encompasses patients’ values, goals, expectations, and preoccupations.
Research Evidence: Metrological qualities of assessment tools incorporating three criteria:
a) Validity (Normal & Streiner, 2003; Strauss et al., 2005): Tools measures what it is meant to measure. A tool’s validity encompasses its sensitivity (i.e., capacity of tool at condition in a group of subjects who have the condition) and its specificity (i.e., capacity of tool at eliminating a condition in group of subjects who do not have a pathology).
b) Reliability (e.g., intra-reliability – between evaluators, inter-reliability – between measures of same evaluator): Degree of reproductibility of a measurement instrument (i.e., by measuring the same variable, clinicians obtain the same results for the same patient). Standardization of the tool is needed for reliability implying the necessity of acquiring training to utilize assessment tools.
c) Responsiveness: Capacity of instrument to detect a change in condition in patients when there really is a change. A tool’s responsiveness encompasses its Minimal Perceptible Change (i.e., minimum change needed to exceed error associated with tool) and Minimum Clinically Important Difference (MCID) (i.e., change needed to observe a real change in patients’ status).
Research data is presented as: range (i.e., minimum and maximum), mean (i.e., sum of data divided by sample number), Standard Deviation - SD (i.e., variation of data around the mean) and statistical significance (i.e., wether results obtain are likely attributable to a specific cause).
Research is evaluated based on the level of evidence:
Level 1: Systematic reviews and meta-analysis based on randomized clinical trials allowing to establish a tangible fact.
Level 2a: Systematic review of at least two cohorts.
Level 2b: Cohort studies based on data collected prospectively and consecutively either with a small group of patients based on precise inclusion criteria in clinical research or all patients with a prescise status in clinical practice.
The method of Somatosensory Pain Rehabilitation is Level 2b research evidence.
Level 4: Case reports that can provide clinicians with subtleties to improve therapeutic results.
Level 5: The point of view of one expert
Discussion: Integration of EBP in shared decision making increases the probability of obtaining optimal clinical results and a better quality of life for patients. EBP encourages the application of the strongest and most recent research evidences whilst taking into account patients’ preferences and professional clinical experience. Clinicians are encouraged to further their research knowledge to better understand and interpret research evidence. Resesarch provides a common language for all reseachers and clinicians.
References
Chaput, E., Pietramaggiori, G., de Andrade Melo Knaut, S. & Spicher, C. (2017). Ebauche de synthèse : évaluation clinique et choix thérapeutique fondés par les données probantes. e-News Somatosens Rehab, 14(2), 55-65. Téléchargeable (25/02/2025) : urlr.me/uQJdrx
Jewell, D.V. (2011). Guide to evidence-based physical therapist practice (2nd edition). Massachusetts: Jones & Bartlett Learning.
Jones, M. & Rivett, D. (2004). Clinical reasoning for manual therapists. London: Elsevier
Sackett DL, Rosenberg WM, Gray JAM, Haynes RB & Richardson WS. (1996). Evidence based medicine: what it is and what it isn't. BJM, 312, 71-72.
Straus, S., Richardson, W.S., Glasziou, P. & Haynes, R.B. (2005). Evidence-based medicine, How to practice and teach EBM (3rd edition). Philadelphia: Elsevier.