Dana Lawrence, D.C., MMedEd, M.A.
Evidence-based medicine developed out of a movement started by a group of medical educators at McMaster’s University during the 1980s. These physicians observed that a gap had developed between what occurred in clinical practice and what was obtainable in reports of clinical research. Essentially, clinicians could not stay abreast with new research because it was being produced so fast; consequently they were not putting into practice the most current information. Evidence-based methods were designed to bridge this gap. This concept has been embraced by the chiropractic profession as well, leading to what we now call evidence-based chiropractic (EBC), or evidence-based clinical practice (EBCP).
EBCP in chiropractic is unique in several ways.
- For example, chiropractic interventions are difficult to investigate by experimental methods, because it is hard, if not impossible, to design an effective placebo, and it is impossible to blind either the doctor or the patient to the interventions being studied. As a result, there are fewer chiropractic articles that use placebo group controls than in other scientific or medical disciplines.
- Chiropractors commonly use a number of treatment modalities in addition to adjustment, while clinical trials may focus on a single intervention in order to isolate its effects.
- Traditionally, it was hard for chiropractors to obtain funding for rigorous research, though this has certainly changed, all the more so here at Palmer College of Chiropractic.
But these challenges have also meant that we have a uniqueness to our profession. While we might not have the most rigorous of studies, we have developed an impressive body of evidence to support what we do.
Sackett has stated that EBCP is “ … the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” This is an important statement, because in it we see that the practitioner’s clinical expertise is an important component; the goal is to integrate clinical expertise with best evidence on behalf of the patient. EBCP is therefore not in any way cookbook medicine or practice, it is the integration of best evidence with the past training and expertise of the clinician, resulting in better care for the patient. And new evidence is replacing old all the time.
Patient preferences also play an important role. This includes the personal values, concerns and expectations that patients have about their care. Considering these are critical steps in the EBCP process.
- Personal values: These are the beliefs patients have about the care being offered to them, which may be based on personal, religious or philosophical reasons.
- Patient concerns: Such as financial concerns, time constraints, office location, ease of parking, etc.
- Patient expectations: This relates to the degree that patients will accept a doctor’s recommendations. Compliance is an ongoing problem in patient care, as well asin clinical trials and other forms of research.
As Haneline states, EBCP is “ Actively seeking support for and improvement of chiropractic clinical practice through the integration of the best available research evidence, combined with clinical expertise and patient values.”