Evidence-based practice

Evidence-based practice (EBP) is the idea that occupational practices ought to be based on scientific evidence. While at first sight this may seem to be obviously desirable, this proposal has been controversial.[1] Evidence-based practices have been gaining ground since the formal introduction of evidence-based medicine in 1992, and have spread to the allied health professions, education, management, law, public policy, and other fields.[2] In light of studies showing problems in scientific research (such as the replication crisis), there is also a movement to apply evidence-based practices in scientific research itself. Research into the evidence-based practice of science is called metascience.

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Evidence-based practices

The movement towards evidence-based practices attempts to encourage, and in some instances to force, professionals and other decision-makers to pay more attention to evidence to inform their decision-making. The goal of evidence-based practice is to eliminate unsound or outdated practices in favor of more effective ones by shifting the basis for decision making from tradition, intuition, and unsystematic experience to firmly grounded scientific research.[3]

History

For most of history, professions have based their practices on expertise derived from experience passed down in the form of tradition. Many of these practices have not been justified by evidence, which has sometimes enabled quackery and poor performance. Even when overt quackery is not present, quality and efficiency of tradition-based practices may not be optimal. As the scientific method has become increasingly recognized as a sound means to evaluate practices, evidence-based practices have become increasingly adopted.

One of the earliest proponents of EBP was Archie Cochrane, an epidemiologist who authored the book Effectiveness and Efficiency: Random Reflections on Health Services in 1972. Cochrane's book argued for the importance of properly testing health care strategies, and was foundational to the evidence-based practice of medicine.[4] Cochrane suggested that because resources would always be limited, they should be used to provide forms of health care which had been shown in properly designed evaluations to be effective. Cochrane maintained that the most reliable evidence was that which came from randomised controlled trials.[5]

The term "evidence-based medicine" was introduced in 1992. This marked the first evidence-based practice to be formally established. Some early experiments in evidence-based medicine involved testing primitive medical techniques such as bloodletting, and studying the effectiveness of modern and accepted treatments. There has been a push for evidence-based practices in medicine by insurance providers, which have sometimes refused coverage of practices lacking in systematic evidence of usefulness. It is now expected by most clients that medical professionals should make decisions based on evidence, and stay informed about the most up-to-date information. Since the widespread adoption of evidence-based practices in medicine, the use of evidence-based practices has rapidly spread to other fields.[6]

More recently, there has been a push for evidence-based education. The use of evidence-based learning techniques such as spaced repetition can improve students' rate of learning. Some commentators have suggested that the putative lack of any conspicuous progress in the field of education is attributable to practice resting in the unconnected and noncumulative experience of thousands of individual teachers, each re-inventing the wheel and failing to learn from hard scientific evidence about 'what works'. Opponents of this view argue that hard scientific evidence is a misnomer in education; knowing that a drug works (in medicine) is entirely different from knowing that a teaching method works, for the latter will depend on a host of factors, not least those to do with the style, personality and beliefs of the teacher and the needs of the particular children.[7] Some opponents of EBP in education suggest that teachers need to develop their own personal practice, dependent on personal knowledge garnered through their own experience. Others argue that this must be combined with research evidence, but without the latter being treated as a privileged source.[8] This is inline with a school of thought suggesting that EBP has limitations and a better alternative is to use Evidence-informed Practice (EIP). This process includes quantitative evidence, does not include non-scientific prejudices, but includes qualitative factors such as clinical experience and the discernment of practitioners and clients.[9][10][11]

Versus tradition

Evidence-based practice is a philosophical approach that is in opposition to tradition. Some degree of reliance on "the way it was always done" can be found in almost every profession, even when those practices are contradicted by new and better information.[12]

Some critics argue that since research is conducted on a population level, results may not generalise to each individual within the population. Therefore, evidence-based practices may fail to provide the best solution to each individual, and traditional practices may better accommodate individual differences. In response, researchers have made an effort to test whether particular practices work better for different subcultures, personality types etc.[13] Some authors have redefined EBP to include practice that incorporates common wisdom, tradition, and personal values in alongside practices based on evidence.[12]

Evaluating evidence
Further information: Hierarchy of evidence

Evaluating scientific research is extremely complex. The process can by greatly simplified with the use of a heuristic that ranks the relative strengths of results obtained from scientific research called a hierarchy of evidence. The design of the study and the endpoints measured (such as survival or quality of life) affect the strength of the evidence. Typically, systematic reviews and meta-analysies rank at the top of the hierarchy while randomized controlled trials rank above observational studies, and expert opinion and case reports rank at the bottom. There is broad agreement on the relative strength of the different types of studies, but there is no single, universally-accepted hierarchy of evidence. More than 80 different hierarchies have been proposed for assessing medical evidence.[14]

Applications of evidence-based practice

Medicine
Further information: Evidence-based medicine

Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.[15] Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to groups of patients and populations ("evidence-based practice policies").[16]

Whether applied to medical education, decisions about individuals, guidelines and policies applied to populations, or administration of health services in general, evidence-based medicine advocates that to the greatest extent possible, decisions and policies should be based on evidence, not just the beliefs of practitioners, experts, or administrators. It thus tries to assure that a clinician's opinion, which may be limited by knowledge gaps or biases, is supplemented with all available knowledge from the scientific literature so that best practice can be determined and applied. It promotes the use of formal, explicit methods to analyze evidence and makes it available to decision makers. It promotes programs to teach the methods to medical students, practitioners, and policymakers.

A process has been specified that provides a standardised route for those seeking to produce evidence of the effectiveness of interventions.[17] Originally developed to establish processes for the production of evidence in the housing sector, the standard is general in nature and is applicable across a variety of practice areas and potential outcomes of interest.

Mental health

To improve dissemination of evidence-based practices, the Association for Behavioral and Cognitive Therapies (ABCT) and the Society of Clinical Child and Adolescent Psychology (SCCAP, Division 53 of the American Psychological Association)[18] maintain updated information on their websites on evidence-based practices in psychology for practitioners and the general public. An evidence-based practice consensus statement was developed at a summit on mental healthcare in 2018. As of June 23, 2019, this statement has been endorsed by 36 organizations.

Metascience
Main article: Metascience

There has since been a movement for the use of evidence-based practice in conducting scientific research in attempt to address the replication crisis and other major issues affecting scientific research.[19] The application of evidence-based practices to research itself is called metascience, which seeks to increase the quality of scientific research while reducing waste. It is also known as "research on research" and "the science of science", as it uses research methods to study how research is done and where improvements can be made. The five main areas of research in metascience are methodology, reporting, reproducibility, evaluation, and incentives.[20] Metascience has produced a number of reforms in science such as the use of study pre-registration and the implementation of reporting guidelines with the goal of bettering scientific research practices.[21]

Education
Main article: Evidence-based education

In 1997, the National Institute of Child Health and Human Development (NICHD) convened a national panel to assess the effectiveness of different approaches used to teach children to read. The resulting National Reading Panel examined quantitative research studies on many areas of reading instruction, including phonics and whole language. In 2000 it published a report entitled Teaching Children to Read: An Evidence-based Assessment of the Scientific Research Literature on Reading and its Implications for Reading Instruction that provided a comprehensive review of what was known about best practices in reading instruction in the U.S.[22][23][24]

Subsequently, evidence-based practice (EBP) in education (also known as Scientifically based research), came into prominence in the U.S.A. under the No child left behind act of 2001, replace in 2015 by the Every Student Succeeds Act (ESSA).

In 2002 the U.S. Department of Education founded the Institute of Education Sciences (IES) to provide scientific evidence to guide education practice and policy .

This occurred around the same time as such international studies as Progress in International Reading Literacy Study (PIRLS), and the Programme for International Student Assessment (PISA).

Reviews of existing research on education

The following websites review, analyze and publish free results on education research:

  • What Works Clearinghouse[25], established in 2002, is funded by the Institute of Education Sciences (IES) within the U.S. Department of Education. It reviews research on programs, products, practices, and policies in education.
  • Best Evidence Encyclopedia[26] is affiliated with Johns Hopkins University School of Education's Center for Data-Driven Reform in Education (CDDRE) with funding from the Institute of Education Sciences (IES), U.S. Department of Education. It provides information about research evidence on programs available for students in grades K-12.
  • The Coalition for Evidence-Based Policy, that wound down in 2015[27], published a user-guide in 2003 on educational evidence-based practices[28]

See also

External sites
  • "Development of evidence-based medicine explored in oral history video, AMA, JAN 27, 2014".

References
  1. For example: Trinder, L. and Reynolds, S. (eds) (2000) Evidence-Based Practice: A Critical Appraisal. Oxford, Blackwell Science.
  2. Li, Rita Yi Man; Chau, Kwong Wing; Zeng, Frankie Fanjie (2019). "Ranking of Risks for Existing and New Building Works". Sustainability. 11 (10): 2863. doi:10.3390/su11102863.
  3. Leach, Matthew J. (2006). "Evidence-based practice: A framework for clinical practice and research design". International Journal of Nursing Practice. 12 (5): 248–251. doi:10.1111/j.1440-172X.2006.00587.x. ISSN 1440-172X. PMID 16942511. S2CID 37311515.
  4. Cochrane, A.L. (1972). Effectiveness and Efficiency. Random Reflections on Health Services. London: Nuffield Provincial Hospitals Trust. ISBN 978-0900574177. OCLC 741462.
  5. Cochrane Collaboration (2003) http://www.cochrane.org/about-us/history/archie-cochrane
  6. "A Brief History of Evidence-based Practice | Evidence Based Practice in Optometry EBP Australia UNSW". www.eboptometry.com. Retrieved 24 June 2019.
  7. Hammersley, M. (2013) The Myth of Research-Based Policy and Practice. London: Sage.
  8. Thomas, G. and Pring, R. (Eds.) (2004). Evidence-based Practice in Education. Open University Press.
  9. "The Myth of Evidence-Based Practice-Towards Evidence-Informed Practice, The British Journal of Social Work, Volume 41, Issue 6, September 2011".
  10. "Evidence informed practice, Department of Health, Tasmania".
  11. "Evidence-based Practice vs. Evidence-informed Practice, M. Gail Woodbury and Janet L. Kuhnke, Queen's University, ON, April 2014".
  12. Buysse, V.; Wesley, P.W. (2006). "Evidence-based practice: How did it emerge and what does it really mean for the early childhood field?". Zero to Three. 27 (2): 50–55. ISSN 0736-8038.
  13. de Groot, M.; van der Wouden, J. M.; van Hell, E. A.; Nieweg, M. B. (31 July 2013). "Evidence-based practice for individuals or groups: let's make a difference". Perspectives on Medical Education. 2 (4): 216–221. doi:10.1007/s40037-013-0071-2. PMC 3792230. PMID 24101580.
  14. Siegfried T (2017-11-13). "Philosophical critique exposes flaws in medical evidence hierarchies". Science News. Retrieved 2018-05-16.
  15. Evidence-Based Medicine Working Group (November 1992). "Evidence-based medicine. A new approach to teaching the practice of medicine". JAMA. 268 (17): 2420–25. CiteSeerX 10.1.1.684.3783. doi:10.1001/JAMA.1992.03490170092032. PMID 1404801.
  16. Eddy DM (1990). "Practice Policies – Where Do They Come from?". Journal of the American Medical Association. 263 (9): 1265, 1269, 1272, 1275. doi:10.1001/jama.263.9.1265. PMID 2304243.
  17. Vine, Jim (2016), Standard for Producing Evidence – Effectiveness of Interventions – Part 1: Specification (StEv2-1), HACT, ISBN 978-1-911056-01-0, Standards of Evidence
  18. "Society of Clinical Child and Adolescent Psychology (SCCAP)".
  19. Rathi, Akshat. "Most science research findings are false. Here's how we can change that". Quartz. Retrieved 13 June 2019.
  20. Ioannidis, John P. A.; Fanelli, Daniele; Dunne, Debbie Drake; Goodman, Steven N. (2 October 2015). "Meta-research: Evaluation and Improvement of Research Methods and Practices". PLOS Biology. 13 (10): e1002264. doi:10.1371/journal.pbio.1002264. ISSN 1544-9173. PMC 4592065. PMID 26431313.
  21. Ioannidis, John P. A.; Fanelli, Daniele; Dunne, Debbie Drake; Goodman, Steven N. (2015-10-02). "Meta-research: Evaluation and Improvement of Research Methods and Practices". PLOS Biology. 13 (10): –1002264. doi:10.1371/journal.pbio.1002264. ISSN 1545-7885. PMC 4592065. PMID 26431313.
  22. "National Reading Panel (NRP) – Publications and Materials – Summary Report". National Institute of Child Health and Human Development. (2000). Report of the National Reading Panel. Teaching children to read: An evidence-based assessment of the scientific research literature on reading and its implications for reading instruction (NIH Publication No. 00-4769). Washington, DC: U.S. Government Printing Office. 2000. Archived from the original on 2010-06-10.
  23. "National Reading Panel (NRP) – Publications and Materials – Reports of the Subgroups". National Institute of Child Health and Human Development. (2000). Report of the National Reading Panel. Teaching children to read: an evidence-based assessment of the scientific research literature on reading and its implications for reading instruction: Reports of the subgroups (NIH Publication No. 00-4754). Washington, DC: U.S. Government Printing Office. 2000. Archived from the original on 2010-06-11.
  24. "Teacher's Guide, Put Reading First - K-3, NICHD, edpubs@inet.ed.gov" (PDF).
  25. "What Works Clearinghouse, IES".
  26. "Best Evidence Encyclopedia, Johns Hopkins University School of Education".
  27. "Coalition for Evidence-Based Policy".
  28. "Identifying and Implementing Educational Practices Supported By Rigorous Evidence: A User-Friendly Guide, 2003" (PDF).
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