Evidence-Based Practice versus Practice-Based Evidence
Here at OT Graphically, we talk a lot about how we take evidence and put it into practice, or using evidence-based practice. But how do you use the data that you are seeing as a clinician and track it to make informed clinical decisions? This is called Practice-Based Evidence. There are pros and cons to both strategies.
Let’s start with a few offiical definitions of these terms.
Evidence-Based Practice Defined
Evidence-based practice is a practice supported by scientific, “true” knowledge usually generated as an outcome of randomized control trials. (Biesta, 2010) It includes the research, client experience, and clinical expertise.
Practice-Based Evidence Defined
Practice-based evidence is the opposite of that, where you take into consideration everything you are doing in practice including context, track what is going on using patient reported measures and clinical expertise during practice. According to Swisher (2010, p.4), in practice-based evidence “real world practice is documented and measured, just as it occurs, “warts” and all.”
Another way to think of it is that you are starting at the practice versus starting at the research paper.
What are the pros and cons of each?
Cons of Evidence-Based Practice
The reason why this has become an issue more recently is because there's a really heavy focus on evidence-based practice. In a nutshell, because there's such a strong emphasis on it, it can become your only focus that guides policies or insurance reimbursement. This tends to result in the philosophy or culture of “if you don't have the hard, research evidence, it doesn't count.” So although it is a great thing to have the research, it's also can be very limiting and not capture the whole story.
More specifically, one of the big negatives of evidence-based practice is that is it doesn't take into account the local situation including the culture, the client's personal situation, or personal environment. For a client that comes from a different culture than where the research takes place, it can be really hard for them to adapt that to their specific situation as the original research was conducted in a context that does not reflect their personal experience.
There's some people who argue to just throw out evidence-based practice completely, because that's not working. It is important to remember that evidence-based practice is not JUST the research but also the clinical experience and client values grouped into one.
One way to lean into applying evidence to your local context is something called the key ingredients. A lot of times you may try an intervention in one of our articles for our journal clubs in the library, for example, you do the steps and you may say, “I just can't get this to work in my setting.” What then the next step? Instead of turning away from it, I would argue is to lean in and do reach out to the author and ask them, what are the key ingredients? What are the things that like absolutely have to be done for this to be considered evidence-based. This will give you some wiggle room to see where you can let some of the process go and focus on the meat of the intervention and adapt the other parts of it to fit you situation and client.
Pros of Evidence-Based Practice
The benefits of evidence based practice is that it can isolate an intervention and you can have confidence saying, “when this intervention was done, it changed this specific outcome” and be pretty confident that that was likely true. That's why so many scientists advocate for it. In addition, as occupational therapy practitioners, when we know what works, it helps support our decision making during this time period of information overload and it allow us to focus on practices that are known to be the most beneficial.
Also, there are external reasons why using evidence is absolutely necessary. For one thing, it allows our profession to show our value on a national and international level to those outside of our discipline. Evidence-based practice is respected for both policy makers and insurance companies. If the evidence shows something is effective, we will spend less time in a “trial and error” phase and do what works to help people improve quicker, which is more cost-effective and preferred for everyone. In addition, I have found in my own practice since the start of the pandemic and the age of misinformation, clients want to know that what you are doing is evidence-based. It is important to them, so if we are being truly client-centered, this is an important piece of that.
Now let’s take a look at Practice-Based Evidence…
Cons of Practice-Based Evidence
The downside to doing practice-based evidence is that you do not know if what intervention you are doing is actually the cause what you're attempting to change. You can hypothesize and you can track it, but there are a lot of other variables at play. Also, people are getting all sorts of other interventions at the same time, so that can be tricky to tease out. When you remove that scientific context, you are hoping that what you're doing is helping, and you can see trends, but you can't say for sure.
Pros of Practice-Based Evidence
The benefits of practice-based evidence is that is can be very grassroots and supported by the local culture to allow for more successful implementation. It is a much more culturally competent way of conducting research and takes into account the individuals lived experience.
According to Green & Allegrante (2020), “high-quality evidence from a practice-based source has become increasingly necessary to support implementation of relevant, generalizable and effective health promotion and public health practice.
Practice-based evidence takes into account that people are complex and do not fit the mold of the typical scientific model. This can really support the translation of knowledge into our practice more quickly and help close that research to practice gap. (Swisher, 2010)
What are your experiences with evidence-based practice and practice-based evidence? Share in the comments below.
References:
Swisher, A. K. (2010). Practice-based evidence. Cardiopulmonary Physical Therapy Journal, 21(2), 4.