Discussion Paper: Evidence-Based Practice and Chiropractic

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Chiropractic Journal of Australia 2016; 44: 308–319 ~ FULL TEXT

Phillip Ebrall

Southern Cross University, Australia;
International Medical University, Malaysia;
Tokyo College of Chiropractic, Japan.

Objective:   To present an objective interpretation of the literature reporting evidence based medicine or practice and to raise discussion points based on those findings which, if explored, may advance the chiropractic profession in both its academic and clinical activities.

Data Sources and Synthesis:   The indexed literature and URLs identified by on-line searching. A contextual narrative identifies specific points that may be worthy of formal discussion, either by individual authors preparing papers for publication, or by symposia.

Conclusion:   Evidence based medicine is thought by some to have had its day. The concept of best practice seems embedded within chiropractic education. Whether they appreciate it or not, most chiropractors practice a rich form of evidence based practice into which they inject their experience as a chiropractor and the characteristics including preferences of the patient.

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Keywords   Evidence-Based Medicine; Chiropractic; Medical Education

From the FULL TEXT Article:


In 1996 Sackett et al defined evidence-based medicine (EBM) as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. [1] This notwithstanding EBM was first conceptualised in mid-19th century Paris.1 Since Sackett’s seminal paper in 1996, EBM has been adopted and included in most developed medical and healthcare curricula around the world. [2, 3] However, it is acknowledged that medicine rests on an uneven evidence base. Some interventions are supported by large multi-centre randomised controlled trials that have a low risk of bias and are powered for hard endpoints- a high level of evidence. Others depend on retrospective observational data that provide a lower level of evidence. Yet others were theorised and considered biologically or mechanistically plausible and are heirlooms of ‘eminence-based medicine.’ [4]

Recently, there has been a suggestion the chiropractic profession should become more evidence-based. [5] A ‘soft-resistance’ to the concept of EBP is given as being a change in terminology to ‘evidence-influenced practice,’ and a hard resistance as being a claim that the best evidence is that based on practice experience and not research. [5]

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