“Evidence-based practice is the conscientious, explicit and judicious use of current best empirical evidence when making decisions about how to practice when providing information and care for client/patients. This best evidence should be combined with practitioner expertise and should consider the characteristics, state, needs, values and preferences of those who will be affected.” – MNU 2016
Source: Mac Nutrition Uni
There is a hierarchy of evidence. Not all studies, and not all research is created equally. We concentrate on the highest quality research that is currently available. Evidence informs and shapes our practice.
In research the strongest evidence is often from a meta-analysis or systematic review. These combine the data from numerous similar studies to get a bigger overall picture on a specific topic.
With that said there are often limitations with research, and we need to understand what we should account for when applying the findings to a client. For example a lot of nutritional research is from observational studies where the results show correlations, but a correlation does not equal causation.
Understanding how to apply the research to the situation of our client is key. As a practitioner this is being able to assess what is the best recommendation that will work to help you achieve your goals. The research shows us the principle to apply and our experience informs the method.
What you, the client, as an individual wants matters! It’s our role as practitioners to offer advice that works within your lifestyle. This includes your values (we aren’t going to include animal products in the recommendation for a vegetarian for example), goals, abilities and needs. A plan that doesn’t allow for this you almost certainly won’t adhere to, especially long term. Your input plays a part.
Working with these principles increases the likelihood that you will achieve the best results. It also protects you as you’re being given advice from a solid basis. We all have heard lots of anecdotal (n=1) stories of success. However people can achieve success by the wrong means, or by luck. That then may mean replicating the same method will not replicate the result (and you may not understand why, after all it it worked for them!).
Someone evidence based should be able to give you a reference to back up what they say. The onus is always on the person making a claim to show where the evidence behind it came from. Or if they can’t they should explain the reasons why (it may be an area where there aren’t any studies so the advice is from experience).
Most good practitioners are giving similar advice. We may explain the principles in different styles, but the core information is the same. If one person is offering a magic fix it’s much more likely they’re wrong (knowingly or otherwise), rather than all the others are!
Being evidence based doesn’t mean you’re never wrong. New studies come out with new information. As an EBP you must be willing to update your knowledge, and continue to learn and develop.
We all have some confirmation bias where we look for information to back up a viewpoint we already hold. What we should do is look for information that disproves our view! Doing that you’ll either see you were wrong and need to be pragmatic and change your view. Or it strengthens your position so you can be more confident in your advice. Cherry picking isolated points to back up a narrative that is not representative of the research as a whole is not evidence based practice!
We all have personal biases. My own health and fitness journey has given me plenty of data on what does and doesn’t work for me. But that’s an n=1 anecdote, it works for me! I favour certain methods over others, However as a practitioner I want the best option for you, and your plan would be individualised to your needs, not my preferences.
I mentioned Observational Studies above. These are as they sound where the behaviours of groups of people are observed, usually to look for patterns between lifestyle choices and specific health markers. We also look at Randomised Control Trials (RCTs) where an intervention is tested against an alternative intervention or control group. The results are then compared to see the effectiveness.
Some research is on animals (or even just in vitro), but from those it can be quite a leap to apply it to humans. The strength of the evidence should inform how applicable it is.
