In Defense of Evidence Based Practice

In Defense of Evidence Based Practice.

Physiological: Where Physiotherapy Gets Logical author Kenny Venere has a nice defense of EBP on his blog (it is now about a month old) - I just found it today. It is well written and has excellent points.

I agree with his defense of EPB against all of the claims made by critiques addressed in the post. And as I have said several times in this blog, our empirical observations are fundamental to the generation of the knowledge we use in practice. However, I stand by the claim that the knowledge we obtain from empirical observations (otherwise referred to as evidence) on samples (rarely randomly) drawn from populations must go through a rationale process of model building for use as knowledge in practice. And that knowledge is best represented as a causal model since nearly all (if not all) clinical reasoning is founded on causal reasoning.

The role of graphical models is discussed here, which is the post that first presented the KBP graphic. The post on why a KBP is here. And a post from my letter to the PTJ editor in 2005 that really highlights the starting point of my thinking on this topic is here.

Interestingly, just this Tuesday a student in my class asked me what is the difference between EBP and KBP. My response was that all aspects of EBP are included in KBP; that KBP simply attempts to make the process that occurs, that has to occur, between the analysis and interpretation of empirical observations and use in practice. That is a process of knowledge generation. EBP includes a knowledge generation process - that of systematic reviews, clinical practice guidelines - however these can fall victim to empirical epistemological biases and lead to skepticism about the evidence when applying to a particular patient. They are getting better, including decision trees that are clearly based on an underlying causal model is a step in the right direction. But, I do believe that it is more useful to emphasize the causal model than to distill it into a decision tree for improving knowledge and encouraging clinical reasoning.

All in all, I agree wholeheartedly with the post, and enjoyed the place where Physiotherapy Gets Logical, I can get behind that completely, and hope to see DPT programs increase their content of discreet mathematics as a foundational science to include more logic.

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