EDITORIAL

HIGHLIGHTS OF THE BASIC COMPONENTS OF

EVIDENCE-BASED PRACTICE

Claire Johnson, MSEd, DCEditor in Chief, JMPT

0161-4754/$34Copyright © 20doi:10.1016/j.jm

Fig 1. Shining a lexperience combin

ABSTRACT

This editorial provides a brief review of the basic components of evidence-based practice. (J Manipulative Physiol Ther2008;31:91-92)

Evidence-based practice (EBP) offers a rational modelfor practitioners that allows them to provide the bestpossible care for their patients. However, for a few,

there is a misunderstanding about EBP. Some people may

.0008 by National University of Health Sciences.pt.2008.01.001

ight on each of the 3 components of EBP: EBP occe together with the aim of providing best possible

think that EBP represents an bevidence-onlyQ approach.Some may think that if multiple randomized controlled trialsdo not exist, then one cannot practice EBP. Others maymisuse the term to mean bevidence onlyQ such as to debate a

urs when all 3 areas of best evidence, patient values, and clinicalpatient care.2 (Modified from Sackett et al2.)

91

92 Johnson Journal of Manipulative and Physiological TherapeuticsHighlights of Basic Components of EBP February 2008

point or to deny payment for healthcare services. The misuseof the term creates even more frustration and confusion forpatients and for those practicing in the field, causing somepractitioners to shy away from providing healthcare in anevidence-based way. It is possible that some of the confusionstems from being unaware of the full definition of this model.Upon review of the basic components of EBP, mosthealthcare providers find that the principles on which it isfounded are simple, practical, and appeal to common sense.

The concept of EBP was initially described in 1991.1,2

Since that time, many have expanded on this concept andvarious health professions have embraced this model as ameans to improve patient care.3-9 One may define EBP as bNthe conscientious, explicit, and judicious use of current bestevidence in making decisions about the care of individualpatients.Q4 It is important to note that there are 3 fundamentalcomponents of the EBP model.2 Although each componentis valuable on its own, it is not until all 3 are combinedtogether that we truly have EBP. To shine some light on thematter, Figure 1 demonstrates the 3 components and theircombination to make the EBP model.

Evidence-based practice makes sense because it helps todeliver the most appropriate care to the patient. This care isbased upon the most up-to-date and appropriate scientificclinical evidence, the doctor's knowledge and clinicalexperience, and the values of the patient. Evidence-basedpractice requires that the doctor takes an active role inhealthcare decisions and delivery. This means that EBP is agood fit for practitioners who are critical thinkers and havethe best interest of the patient in mind. However, it is not agood match for those who wish to practice cook-bookhealthcare or have a primary financial focus (eg, the practice

focuses on increasing revenues through practice manage-ment strategies) instead of a focus on what is in the bestinterest of the patient.

Whether one is a doctor of chiropractic, medical doctor,doctor of osteopathy, physical therapist, nurse, or otherpractitioner, healthcare providers fundamentally want to dowhat is best for their patients. The fundamentals ofEBP provide a sound foundation to provide best possiblepatient care.

REFERENCES

1. Dickersin K, Straus SE, Bero LA. Evidence based medicine:increasing, not dictating, choice. BMJ 2007;334(Suppl 1):s10.

2. Sackett DL, Straus S, Richardson S, Rosenberg W, Haynes RB.Evidence-based medicine: how to practice and teach EBM.2nd ed. London, U.K.: Churchill Livingstone; 2000.

3. Guyatt G, Rennie D, editors. Users guides: essentials ofevidence-based clinical practice. Chicago, IL: American MedicalAssociation; 2002.

4. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, RichardsonWS. Evidence based medicine: what it is and what it isn't. BMJ1996;312:71-2.

5. Guyatt G, Cook D, Haynes B. Evidence based medicine hascome a long way. BMJ 2004;329:990-1.

6. Reilly BM. The essence of EBM. BMJ 2004;329:991-2.7. Bolton JE. The evidence in evidence-based practice: what counts

and what doesn't count? J Manipulative Physiol Ther 2001;24:362-6.

8. Nicholson LJ, Warde CM, Boker JR. Faculty training inevidence-based medicine: improving evidence acquisition andcritical appraisal. J Contin Educ Health Prof 2007;27:28-33.

9. Jenicek M. Evidence-based medicine: fifteen years later. Golemthe good, the bad, and the ugly in need of a review? Med SciMonit 2006;12:RA241-51.