Evidence-based practice -- imperfect but necessary

Abstract

Evidence-based practice implies the systematic use of best evidence, usually in the form of high quality clinical research, to solve clinical problems. This article considers a series of objections to evidence-based physiotherapy including that (1), it is too time-consuming, (2), there is not enough evidence, (3), the evidence is not good enough, (4), readers of clinical research cannot distinguish between high and low quality studies, (5), clinical research does not provide certainty when it is most needed, (6), findings of clinical research cannot be applied to individual patients, (7), clinical research does not tell us about patients' true experiences, and (8), evidence-based practice removes responsibility for decision making from individual physiotherapists. We argue that, while there is some truth in each of these objections, they need to be weighed against the potential benefits of evidence-based practice. The overwhelming strength of the evidence-based approach to clinical practice is that it takes full advantage of the only potentially unbiased estimates of effects of therapy - those which are derived from carefully conducted clinical research. The evidence-based practice model may be imperfect, but it may be the best model of clinical practice that is currently available.