Building an Evidence-Based Practice
Many RMTs agree that their practice should be based on the latest available evidence. However, it can be hard to determine what an evidence-based practice will mean for each individual RMT. Using research to inform your decision-making can seem obvious, but it can be hard to find, evaluate and apply the best research. There are also other forms of evidence to consider including the RMT’s clinical expertise and the biopsychosocial factors affecting each patient’s experience. There are a variety of elements to consider when building an evidence-based practice.
- There’s a variety of free research available. Although there is research hidden behind a paywall, there’s a lot of research you can access for free. Pubmed is a large medical database and you can search there for articles about massage therapy, filtering by free full text to ensure you can see the full article.
- Evaluate all aspects of research. You should evaluate a variety of parts of the research to ensure that it is of high quality and would be beneficial to you. This can be done using the CAARP method. This stands for currency, which is how recently the article was published, authority which evaluates the credentials of the person who authored the information, accuracy which is how credible the information is and whether the authors cited their sources, relevance which would determine if the information has direct value to your topic, and finally purpose, which determines if the information has a particular bias or agenda.
- Different types of research hold different weights. Different types of scientific research are given more weight and are considered stronger. Systematic reviews are at the top of the research hierarchy followed by randomized control trials, cohort studies, case control studies, case reports and case studies, animal and cell studies and finally anecdotes and expert opinion. This doesn’t mean that types of evidence lower in the hierarchy have no value, it just means the higher in the hierarchy you go, the stronger the research.
- Tailor your approach to the patient. Focus on developing a positive relationship based on trust with your patients. Your decision-making should be based on an individual patient’s needs, goals and experiences. You should use the patients’ attitudes about their pain, beliefs about movement, personal factors that might limit their recovery and past healthcare experiences to guide your treatments.
- Question your assumptions. There are many things that you may have learned in school or adopted early in your practice that were based on the best available evidence at the time, but new evidence may have since come to light suggesting that different approaches might be more effective. For example, it was once commonly accepted that bedrest was ideal for back pain, but it is now understood that this is an outdated assumption. It is valuable to periodically review the evidence related to common conditions you see in your practice.
- Define your goal. Although it is admirable to want to incorporate more research into your practice, it is more effective to determine how you want the evidence you’re incorporating to impact your patients. You may want to use research to help your patients achieve better outcomes, to help you communicate homecare recommendations to your patients, or to allow you to help a wide variety of patients. When searching for research you should keep your ultimate practice goals in mind so you can best apply what you find.
With those tips in mind, it can still be difficult to determine where to start when it comes to incorporating evidence into your practice. The five steps below can help you take a structured approach to incorporating evidence into your practice.
- Ask. Formulate an answerable clinical question that is based on an individual patient’s concern or issue, that will help you offer that patient the best possible care. PICO is an acronym that defines the elements of well-articulated questions. A question should focus on the population or problem, outline the intervention that is to be delivered to the population, compare to a similar alternative or scenario that might achieve similar outcomes, and define the outcomes, or what you hope to accomplish.
- Acquire. Find the best available evidence. This involves determining what search terms you will use based on your question in step 1, as well as where you will search.
- Appraise. Critically evaluate the evidence to determine which studies are interesting yet weak, and which are the strongest to support the answer to your question asked in step 1. Research should be considered one source of information to make decisions relating to a patient, and you should determine whether the results of the research apply to your practice.
- Apply. You can combine the best available research along with your clinical expertise and your patients’ preferences to guide your clinical decision-making.
- Audit. Evaluate the effectiveness of your decision as it relates to your patient. You should determine whether your question in step one was answered, whether you found the best available evidence, and whether you’ve improved the outcomes for your patients.
Although accessing research can seem intimidating and you may not know where to start, it’s important to recognize the importance of incorporating evidence into your practice. This article provides some tips to help you to access and evaluate evidence, which can ultimately improve your patients’ outcomes.