One of the most important things to understand for any health or fitness professional is that it is our professional duty to our clients to be sure to stay up to date and follow the evidence as our professions continue to grow. This is what many people believe to be an evidence-based practice.
I believe that this is one of the most important qualities that you must master to truly become an expert in our fields.
We must always learn and stay abreast of the latest research, while keeping an open mind and a growing mindset.
Continuing to follow obsolete concepts that have proven to be ineffective or disadvantageous is a disservice to our customers and ultimately to our professions.
However, it is very common for students and new graduates to push this concept too far. It is not a criticism, but simply a statement that without clinical experience it is often difficult to best follow evidence-based practices.
Paralysis due to lack of evidence
Here’s one thing I want people to understand: a lack of evidence does not mean a lack of effectiveness.
Research is difficult. We are humans. It is difficult to have quality randomized control trials with an adequate methodology to determine exactly what to do at all times. It is the experts I know who understand this concept best.
It is more common for inexperienced people to have what I call “lack of evidence paralysis”. They often state that without clear evidence, we should not perform certain interventions.
It couldn’t be further from the truth in my mind.
What is evidence-based practice?
Evidence-based practice is defined by Sackett et al such as integrating the best current research evidence with clinical expertise and patient values.
It’s super important to grasp. It is not only research, it is also the clinical experience and the values of the patients. My friend Phil Page did a great job breaking it down in a recent presentation for my Inner Circle Online Mentorship Program. Here’s a short snippet from that presentation where Phil defines evidence-based practice, which I found brilliant:
I also really liked the picture of the iceberg, which shows that EBP is not only the best evidence available, but that the experience and values of patients are also hidden beneath the surface.
How to follow an evidence-based practice
In order to best follow evidence-based practices, we need to understand that PBS is a combination of these three elements. No room is stronger than another.
When trying to determine whether an intervention I would like to make is appropriate based on evidence-based practice, I will consider what I call the Convenient, evidence-based lighting system.
- Red light = off. If there is strong evidence from quality randomized controlled trials suggesting a safety concern or lack of efficacy, then you should find an alternative approach that may be more beneficial.
- Yellow light = Continue, but with caution. When there is conflicting information or there are not enough quality studies examining the effect you are assessing, then you should proceed with caution. In this scenario, there may be low quality studies (such as a case study or publication without solid methodology) that show effectiveness, or perhaps even conflicting results in the literature with no overwhelming tendency toward or lack thereof.
- Green light = Come on. If there is strong evidence from quality randomized controlled trials suggesting efficacy, you can easily use this approach with an evidence-based rationale.
We also recently discussed how to proceed in a podcast episode on Use of physiotherapy interventions without evidence of efficacy
If you want to learn more about evidence-based practice, you can watch this full presentation and many more in my Inner Circle Online Mentorship Program.