Evidence Based Practice
If basic research design was used in the clinic, practice would already be substantiated.
Changes in health care delivery and reimbursement have significantly impacted therapy professions. No longer can a technique or theory be supported only because it has become “traditional” or “endorsed to work” by experts with experience. Reimbursement is made for what has been “proven” to work. There is a danger here. Much of the traditional knowledge and skills of experienced therapists that are taken for granted are “at risk” of no longer being used as these are no longer reimbursed. When treatment is recognized only in predetermined billing categories, new and important information for improved practice may not be developed, or go unrecognized.
THE SOLUTION: EVIDENCE BASED PRACTICE
In the time crunch of the modern clinic and demand for effective efficient treatment, some frivolous and ineffective treatment passed on by tradition can now be discarded as superfluous. But how does one recognize the good from the bad, and the most effective from less effective? The answer lies in documented study that substantiates practice, i.e. research. Who will do this research? There is never time, yet in the long run evidence based practice is critical to our clinical treatment and survival of treatment. Therapists need templates on how clinical research can done now, today, given the time constraints and demands of a busy practice.
Moving beyond the threats to professional practice from a changing healthcare environment can be uniting in effort – we can help each other to network on these skills.
The first step is in revisiting the definition of “research”. Research is actually the “heart” of practice. What therapist in making orthoses does not keep a successful pattern and discard the unsuccessful ones? This problem solving in identification of effective treatment is the beginning of research. Every therapist has learned the need for problem solving in clinical treatment. Good therapists routinely use problem solving skills in clinical treatment of patients, adjusting treatment with the widely varying needs of individual patients.
The second step is in learning the basic principles and tenets of research design and how these apply to the clinic. Some principle tenets such as “first do no harm” are already ingrained in practice and need only be acknowledged and integrated. But others, e.g. “It is often not as important what is done but that it is done consistently ” challenge the therapist’s incorporating research in the clinic. If only therapists would use basic research design in consistent documentation, comparison, and analysis of measurements, practice and patient outcome would be fully substantiated.
The third step is for therapists to bring the need for research into their perceptual world and support the concept as an objective in the clinic. Practicing therapists are much more in number than university and outside researchers, and are in better position to understand the needs for patient treatment validation, and directions for research. Degree programs have become so competitive that they are accepting only students with the highest academic credentials – the potential is there. Some university programs have recognized the need for research skill development at an undergraduate level. Why not take full advantage of our collective talents and skills to address the need for substantiation of practice, documentation of patient outcome, and redesign research so it fits and is at home in the clinic?