The True Meaning of Evidence-Based Practice
Chiropractors that run evidence-based practices are able to provide patients with adjusting techniques, recommendations, and advice for wellness and health management that reflect knowledge and experience confirmed by the most up-to-date information. New studies are released all the time, each requiring an analysis of its implications, and a practitioner with a busy practice hardly has the time to pore over studies, and will have little patience and too much wisdom to adapt to each new whim of the day.
A true evidence-based practice, then, is more than research alone. Dr. David Sackett, in his paper “Evidence Based Medicine: What It Is and What It Is Not,” describes this relatively new approach as:
The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
In the eye of a perfect storm, so to speak, a true evidencebased practice resides at the intersection of current evidence, clinical expertise, and knowledge of the individual patient’s needs and desires.
History of Evidence and Chiropractic Care
The field of chiropractic care has always been a balance of generational wisdom and modern discovery. With its inception as a formal practice of healthcare in 1895, criticism and skepticism dominated the narrative. The profession has largely overcome these prejudices, as demonstrated by its emerging popularity.
Within modern chiropractic care, a growing focus on this intensive form of evidence-based care is changing the level of expertise that providers can (and should) offer. Chiropractic students utilizing a curriculum that favors evidence-based practice have shown greater retention and ability to improve their skills. While there is still room for improvement, an evaluation of Australian chiropractors indicated that more than half received training in evidencebased practice, and two-thirds were proficient in reading and evaluating studies to affect their practices.
Schools and philosophies adapt over time to include more education surrounding the use and interpretation of research, but we know that studies alone do not make an evidence-based practice. As Dr. Sackett writes,
External clinical evidence can inform, but can never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision.
With chiropractic care being among the most hands-on, patient-driven practices in healthcare today, developing and improving upon an evidence-based practice comes naturally. Indeed, the care of our patients is what drives the desire to pursue clinical evidence. As Dr. Sackett so eloquently put it, “[Evidenced-based practice], then, is a process of life-long, self-directed learning in which caring for our own patients creates the need for clinically important information.”
Evidence-Based Practice in Action
In order for chiropractors to apply evidence-based philosophy and techniques in their practices, they must look at each step of their interaction with patients and weigh it against the priorities of patient value, up-to-date information, and clinical expertise. The Duke University Medical Center broke this down practically into six steps:
Assess the patient
Ask the question
Acquire the evidence
Appraise the evidence
Apply the information
Self-evaluate the experience
Rather than an attempt to keep up with all new evidence and theories, an evidence-based practitioner takes each patient’s issues and concerns into consideration in light of the data available. These steps take the care provider through the process of thoroughly researching an individual’s circumstance to determine the best course of action. This keeps the patient at the forefront, ensuring that the doctor has spent time with them to understand their situation as fully as possible.
By first assessing the patient, the provider can identify the problem that needs to be resolved, then frame it as a specific question to be researched, such as whether a particular adjusting technique, supplement, or lifestyle change has been shown to benefit a specific issue. At that point, the question at hand can guide the practitioner in his or her research.
For patient-focused, integrative care providers, there is no one-size-fits-all answer. If there is a conclusive answer given, the study itself must have been conducted with the highest quality, with variables as close to the patient’s circumstance as possible if it is to be considered relevant. By self-assessing after each encounter of this sort, the care provider is able to hone his or her practice and improve over time.
ICPA Chiropractors and Evidence-Based Practice
Chiropractors who are members of the International Chiropractic Pediatrics Association (ICPA) are committed to evidence-based care. Within our Practice-Based Research Network, we are constantly evaluating the evidence against the wealth of “generational” professional knowledge, studying concerns that are applicable to chiropractors that are active in the field, and attempting to answer some of the questions that their patients are facing.
To borrow phrasing from Dr. Sackett, evidence-based practice does not exist in an ivory tower, apart from the day-to-day efforts of care providers. It also does not require a statistician in the back of the office constantly analyzing reports as they come in. A truly evidence-based practice is simply a care provider who listens to patients, seeks out relevant information on their concerns, weighs that data against the history of the profession and the history of the individual, and guides the patient to the best possible solution. Nurturing an understanding of the information available and a desire to connect with individuals where they stand, any chiropractor—and, indeed, any care provider— can (and should) create this environment in his or her office.
This article appeared in Pathways to Family Wellness magazine, Issue #56.
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