Evidence occurs along a spectrum and how you utilize it should also occur along a spectrum. Evidence-based practice (EBP) has been a major push for a long time in many professions. The idea focuses on being up to date on the latest evidence and ensuring that is influencing your patient care. Specifically within the athletic training profession, this took on the role of adding EBP continuing education units. This has since changed again and evidence is supposed to be included in everything.
Evidence is essential and research needs to continue but with that comes nuance. That is what we are going to discuss in this article.
More Questions than Answers
I do my best to read a good amount of research and while there are connections you can make out of the studies there is rarely a study that directly applies to what population you are working with or the issue that you are specifically dealing with. This can make the transfer of evidence difficult. Along with this issue, there is the problem of repeatability. Several studies may look at similar circumstances and based on several factors, they come out with extremely different results. So which one do you use? Do you use nothing at all? Potentially more questions than answers.
The research problem is also difficult in that there has to be a long progression of studies building on themselves in order to figure out the root of an issue or problem. That can also be a frustration with research in that most studies leave more questions asked than questions answered. Problems are identified but rarely are answers ever clear. This makes implementation difficult. This is not to fault research at all. In order to run well-conducted studies everything has to be very controlled which can limit the amount of factors that can be tested and ultimately put into practice.
Individual Response
I would argue training and treatment are just as much art as it is science. Everyone is so individual in their response to the same stimulus that is it almost impossible to expect success with the same treatment or intervention. I believe this is where an idea I stumbled upon of ‘Practice Based Evidence’ comes into play. While it may not be double-blinded or randomized controlled if something works, then it works and I think that is important in and of itself.
By looking at basic concepts that can be found in research (i.e. principles of training or soft tissue work) the partitioner can then find the right instrument for the right person that facilitates the best outcomes. At the end of the day,I believe this should be the ultimate goal in getting the client/patient/athlete the best and most efficient outcomes they are searching for.
Research is vital but getting caught up in only practicing a certain way I think leads us down a path of missing things and not fully providing the best practice we are able to. Ground what you do in research, stay on the cutting edge, and most importantly have a ‘why’ in terms of everything you do but never forget the importance of patient outcomes.