An evidence-based practice (EBP) is any practice that relies on scientific evidence for guidance and decision-making. Practices that are not evidence-based may rely on tradition, intuition, or other unproven methods. 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. 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.
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 The goal of evidence-based practice is eliminate unsound or outdated practices in favor of more effective ones by shifting the basis for decision making from tradition, intuition, and unsystematic experience to firmly grounded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.
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.
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.
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.
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 (Hammersley
2013). 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.
Vs. 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.
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.
Some authors have redefined EBP to include practice that incorporates
common wisdom, tradition, and personal values in alongside practices
based on evidence.
Evaluating 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.
Applications of evidence-based practice
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.[10]
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").
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.
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
Not
all mental health practitioners receive training in evidence-based
approaches, and members of the public are often unaware that
evidence-based practices exist. Consequently, patients do not always
receive the most effective, safe, and cost-effective treatments
available. 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)
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.
Social policy
There are increasing demands for the whole range of social policy and
other decisions and programs run by government and the NGO sector to be
based on sound evidence as to their effectiveness. This has seen an
increased emphasis on the use of a wide range of Evaluation approaches directed at obtaining evidence about social programs of all types. A research collaboration called the Campbell Collaboration
has been set up in the social policy area to provide evidence for
evidence-based social policy decision-making. This collaboration follows
the approach pioneered by the Cochrane Collaboration in the health
sciences.
Using an evidence-based approach to social policy has a number of
advantages because it has the potential to decrease the tendency to run
programs which are socially acceptable (e.g. drug education in schools)
but which often prove to be ineffective when evaluated.
Scientific research
As with other fields, many practices in scientific research are rooted in tradition rather than evidence, and are unproven. John Ioannidis 2005 paper "Why most published research findings are false"
found evidence that these poor practices regularly result in false
findings and enormous waste. The paper was the most downloaded in the Public Library of Science, and has the highest number of Mendeley readers across all science."
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. The application of evidence-based practices to research itself is called metascience.
Metascience 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. 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.
