Why should we bother with evidence based practice? Also, what are the different levels of evidence?
Evidence based practice is important because we want to be a good consumer of research. We also want our clients and families to be good consumers of research. We can have falsely interpreted information given to us and can be injured by that if we are not able to assess correctly. When we look at evidence, it really comes down to fact checking whether or not the question was answered. An example of one of the most famous "catches" is the study that stated hormone replacement therapy correlates with decreased coronary heart disease. This was huge. Actually what they found was hormone replacement therapy caused coronary heart disease, but the association that was in the original study was socio-economic status. This is an example of data being interpreted in a way that is not exactly correct. Often we do not have the tools to go back and check it out. We provide that information to our clients and this could accidentally do harm.
When we look at information through a researcher's model, it is a little different than clinical practice. There are different levels of the evidence, or different ways that we can design a method.
- Level I: Randomized Control Trial
- Level II: Non-randomized Control Trial- Two Group
- Level III: Non-randomized Control Trial- One Group (One Treatment) Pretest
- Level IV: Single Subject Design
- Level V: Narratives/Case Studies
A Level I design, which is a randomized control trial, is one of the most recognized types of research. However, a randomized control trial is often out of scope or out of the reach of clinicians. It is expensive, rigorous, and a very complex method to implement.
There are many kinds of researchable methodologies that we can use. For example, a Level IV, which is a single subject design, or even Level II, which is a non-randomized control trial, are within our scope. They are a part of our obligation. We should be looking at a pre and post test in many of the interventions that we use in practice.
Research is a messy process, and it is always under development. I am a pediatric therapist and I believe that children are some of our most fantastic researchers. They are aggressive researchers. They ask questions like, "What would happen if I took the Cool Whip and spread it all over my brother, the TV, and the floor? Oops, I got in trouble, but it sure did feel good along the way. I could taste it, I could feel it, it was cool." They are gathering data about their world. A baby eating cake is another example. They are wondering, "What happens if I smear it on my hands? What happens if I open my hands up? It goes pop, pop, pop. What happens if I rub it on my face?" Again, children are aggressive researchers, and they are really okay with not exactly knowing how the research is going to progress.
The following is important to remember:
- Research is an iterative process
- Do not expect to get it right the first time
- Talking it through gives you information, then you fine tune
- Multiple iterations moves you toward the “final product”