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Publication of the Medical Rehabilitation is under the auspices of the Committee on Rehabilitation, Physical Education and Social Integration of the Polish Academy of Science
Article
Medical Rehabilitation - quarterly journal
Volume 12 year 2008, Issue number 1
Evidence-based rehabilitation medicine and physiotherapy: a critical appraisal
Authors: Rob A.B. Oostendorp, Maria W.G. Nijhuis-van der Sanden, Yvonne F. Heerkens, Erik H.M.
Medical Rehabilitation 2008; 12(1): 9-15
Rehabilitacja medyczna i fizjoterapia oparte na wiarygodnych i aktualnych publikacjach - ocena krytyczna
Rob A.B. Oostendorp 1,2, Maria W.G. Nijhuis-van der Sanden 2,3, Yvonne F. Heerkens 1,4, Erik H.M. Hendriks 1,5, Peter A. Huijbregts 6
1 Dutch Institute of Allied Health Care, Amersfoort, the Netherlands
2 Radboud University Nijmegen Medical Centre, Research Centre of Allied Health Sciences, Department of Quality of Care Research, Nijmegen, the Netherlands
3 Department of Paediatric Physiotherapy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
4 Occupation and Health, HAN-University, Nijmegen, the Netherlands
5 Centre for Evidence Based Physiotherapy and Department of Epidemiology, Maastricht University Medical Centre+, Maastricht, the Netherlands
6 University of St. Augustine for Health Sciences, St. Augustine, FL, USA
Key words
EBM, rehabilitation medicine, physiotherapy, critical appraisal
Abstract
Evidence-based medicine is the current undisputed predominant paradigm within medicine and allied health care. Guidelines for standardized reporting of research findings have facilitated critical evaluation of the relevant research literature. In addition, systematic reviews of the literature made available through computerized databases allow even busy clinicians and researchers rapid access to current best evidence. Despite the potential benefits of Evidence-Based Medicine (EBM) to clinical practice, over the years various points of criticism with respect to EBM have been formulated. This article provides a critical appraisal of the EBM paradigm discussing perceptions of EBM as cookbook medicine, inconsistency and contradiction in research findings, a proposed research pyramid not necessarily emphasizing the randomized controlled trial, a conceptual framework more relevant to the clinical and research needs of rehabilitation medicine and physiotherapy, the role of and impact on patients within the EBM paradigm, implementation of EBM, but also the current lack of evidence for increased efficacy of patient management based on EBM. The research base used in the EBM paradigm to support clinical decision-making is still far from complete. Demonstrating scientific evidence for EBM is a difficult task. Yet the EBM movement is of great importance for rehabilitation and physiotherapy to allow for increased transparency of care. The purpose of promoting this paradigm is optimum quality of care with conservation of professional autonomy.