Towards an understanding of evidence-based practice
By Earle Abrahamson MTI Chair
Recently there has been discussion within our MTI community about the value, definition and general understanding of evidence-based practice (EBP). Some members have a general understanding of the terms, while others require guidance and clarity in fully understanding and appreciating how using research can enhance our practice decisions.
This blog aims to define and build an understanding around EBP as a necessary skill that we as massage practitioners, should use and work towards.
EBP can be defined as the judicious and explicit use of best evidence to support the decisions we make in practice about the collective and individual care of the clients we treat. This means integrating individual clinical expertise with research evidence from systematic scholarly outputs such as journal articles.
Clinical expertise refers to how the practitioner uses experience, education, and clinical skills training to formulate hypotheses about client conditions and presenting signs and symptoms. In a therapeutic relationship, the client brings personal preferences, expectations and judgements about how the treatment ought to be managed. The best evidence to support treatment decisions is often found in methodologically sound research that attempts to fully investigate a range of clinical and client specific parameters such as social, psychological and behavioural.
EBP is formed through the amalgamation of three key components namely:
- best research evidence
- clinical experience
- client values and preferences.
This amalgamation is usually triggered by the consultation, which generates questions around effect of treatment, pain management, and long-term prognosis and daily living activities. Remember that evidence by itself does not make decisions but is used to support the client care process and treatment strategies used by the practitioner.
Take for example, a client who presents with radiating pain down the right forearm. To treat the client effectively using massage therapy, the practitioner may need to engage a series of questions that lead to decisions being made about the most effective treatment strategies. These decisions may rely upon current research findings that suggest one treatment strategy to be more effective than another. In devising treatment for pain management, it is not sufficient to simply cite research and relay upon a solitary finding. True EBP requires one to weigh up the strength of the research findings in an effort to consider how research informs the decisions we make in practice. Do we simply use techniques that we have been taught? Or do we question the efficacy, value and evidence behind the techniques? EBP would require the latter so that practitioners understand the why and not simply the how.
In developing an EBP approach to client care it is useful to consider the following framework.
Start with the client and consider a relevant question or problem that is, or may, arise from the treatment of that client
Construct a question that stems from the client issue identified above - you could use the mnemonic PICO to help formulate an appropriate clinical question: P = patient problem, I = intervention, C = comparison, O = outcome. This mnemonic enables the practitioner to identify the patient/client problem, decide on appropriate interventions, compare interventions, and assess outcomes or change interventions to improve outcomes of treatment.
Select appropriate resources and conduct a search of the presenting issues
Appraise the evidence you find in the search for both validity and applicability to the client's issues
Return to the client and integrate the evidence with clinical expertise, client preferences and application to practice
Evaluate your performance and look for areas to reflect upon or further research.
EBP can appear complex with multiple definitions and factors. The key to remember is that we all aim to achieve the best outcomes for the clients we treat and care for. EBP provides a scaffolding to help us evaluate how we ask questions, use best available evidence to support our clinical decisions, and how best we evaluate the success of the treatment interventions we use. We probably all do this, but rarely question the process that leads us to the product.
The MTI research group is working to make research accessible to all our members and helping our community of practice move towards and integrated EBP approach. As a practitioner, use some of your CPD time to read current research and develop an appreciation for how research evidence can effectively be used to help inform the practice decisions you make.
"When your values are clear to you, making decisions becomes easier" Roy E. Disney.
If you would like to join the research group, email Diana Newson.
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Massage research - march 2013
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Website chocked full of research resources for massage therapists
Guidelines to help practitioners write reflective write-ups for CPD purposes.
Short video by MTI Chair Earle Abrahamson on reflective writing for CPD - different approaches you can take and how to use CPD to reflect on your current practise and change it based on the new knowledge and skill you've gained. For anyone who sends in write ups for CPD purposes.
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