Evidence-Based Practice (EBP)

Review of Evidence-Based Practice

David Sackett was one of the first to discuss evidence-based practice or evidence-based medicine. He describes evidence-based medicine as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” From: BMJ 1996; 312: 71-2. Evidence-Based Practice integrates research evidence, the expertise of the clinician and the values of the patient when making decisions related to a patient's care.

Disclaimer

There are many organizations that have developed systems for defining and sharing information related to evidence-based practice. It is not our intent to repeat that activity, but identify resources available. We do not sanction one over the other, nor do we imply that these are the only sites available from which to gather this information.

Key Concepts

Evidence-Based Practice and Programs for clinicians is the systematic application of scientific findings and knowledge to clinical practice or clinical decision making. For example, it means that a clinician is using evidence to choose diagnostic tests with the greatest reliability and interventions that have been shown to be effective.

Resources

Programs

Learn about evidence-based programs that are proven to improve the quality of life of people with arthritis. The Centers for Disease Control and Prevention Arthritis Program has created a list of recommended self-management education and physical activity programs.

Additional programs available:

Consolidated Sources of Evidence

Systematic Reviews: A systematic review is a synthesis of the primary studies that uses explicit and reproducible methods to review the literature. Thus, they consolidate the data from many studies on the same topic in an attempt to more clearly answer a research question.

The following sites have databases which contain systematic reviews. Some may require subscription to access.

  1. The Cochrane Library
  2. EPC Evidence Reports - Agency for Healthcare Research and Quality
  3. VA Evidence-Based Synthesis Program

Clinical Practice Guidelines: Guidelines for practice are prepared and published by various associations, groups and agencies with the goal of improving healthcare by providing practitioners with a consolidation of evidence related to a particular topic to guide clinical decision making or define best practice.

  1. Clinical Practice Guidelines - Agency for Healthcare Research and Quality
  2. National Guideline Clearinghouse - Agency for Healthcare Research and Quality

Evaluating the Evidence

Levels of Evidence/Strength of Evidence:
There are many organizations that have developed systems for defining and describing levels of evidence or systematic approaches for evaluating research. It is not our intent to repeat that activity, but identify resources available for practicing clinicians. We do not sanction one over the other, nor do we imply that these are the only sites available from which to gather this information.

  1. Centre for Evidence-Based Medicine - Levels of Evidence
  2. Cochrane Collaboration - Critical Appraisal of Qualitative Research
  3. OT Seeker
  4. Physiotherapy Evidence Database PEDro Scale

Critically Appraised Topics (CATs) are a systematic way of approaching and answering a clinical question.See useful resources and tools for doing your own CATs:

  1. Center for Evidence-Based Medicine - Critical Appraisal Tools>
  2. McMaster University Evidence-Based Practice Resources>

Additional resources for assisting at various steps in the process of conducting Critically Appraised topics (CATs):

  1. KT Clearing House - Defining the Question

Searching the literature through PubMed:

  1. Central-Database with Free Digital Archive of Biomedical Literature
  2. Search the Medline Database of the National Library Of Medicine

Interpreting the evidence:

  1. NIH Medline Plus - Search

Guides for evaluating systematic reviews and clinical practice guidelines:

  1. The AGREE Instrument for Guideline Evaluation
  2. JAMA Evidence - Guidelines for Evaluating Primary Articles by Type
  3. KT Clearing House - Critical Appraisal of Evidence

See ACR's Clinical Practice Guideline Resources

For questions or comments, contact ARHP@rheumatology.org.

ARHP Research Committee reviews this information yearly.