How to Proceed When Evidence-based Practice Is Required But Very Little Evidence Available?
SOURCE: Chiropractic & Manual Therapies 2013 (Jul 10); 21 (1): 24 ~ FULL TEXT
Charlotte Leboeuf-Yde, Olivier Lanlo and Bruce F Walker
The Spine Research Centre,
Hospital Lillebaelt, and Institute for Regional Health Research,
University of Southern Denmark,
BACKGROUND: All clinicians of today know that scientific evidence is the base on which clinical practice should rest. However, this is not always easy, in particular in those disciplines, where the evidence is scarce. Although the last decades have brought an impressive production of research that is of interest to chiropractors, there are still many areas such as diagnosis, prognosis, choice of treatment, and management that have not been subjected to extensive scrutiny.
DISCUSSION: In this paper we argue that a simple system consisting of three questions will help clinicians deal with some of the complexities of clinical practice, in particular what to do when clear clinical evidence is lacking. Question 1 asks: are there objectively tested facts to support the concept? Question 2: are the concepts that form the basis for this clinical act or decision based on scientifically acceptable concepts? And question three; is the concept based on long-term and widely accepted experience? This method that we call the “Traffic Light System” can be applied to most clinical processes.
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SUMMARY: We explain how the Traffic Light System can be used as a simple framework to help chiropractors make clinical decisions in a simple and lucid manner. We do this by explaining the roles of biological plausibility and clinical experience and how they should be weighted in relation to scientific evidence in the clinical decision making process, and in particular how to proceed, when evidence is missing.
From the FULL TEXT Article
The clinical encounter has many aspects – evidence-based practice expected
For health care practitioners, the first clinical encounter has several important goals, two of these are:
1) to get an idea of what is wrong with the patient and
2) to detect any cases that should be directed elsewhere.
Chiropractors, and other professionals who often provide manual therapies, will also work out a “technical” diagnosis in relation to where and what to treat. Thereafter follows the treatment itself, any follow-up procedure, and the long-term strategy. This is a relatively complex process, as many different pieces of information must be considered, brought into a coherent picture and acted upon. In addition, clinicians are expected to keep updated on that part of dynamic knowledge – research – that concerns their area of practice and to apply this knowledge on each patient.