WHAT IS EVIDENCE BASED PRACTICE?
The most common definition of EBP is taken from Dr. David Sackett, a pioneer in evidence-based practice. EBP is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematicresearch." (Sackett D, 1996)
EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician's cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002)
A meta-analysis and a systematic review are both methods used to synthesize research findings, but they differ in their scope and methodology.
Systematic Review:
Meta-Analysis:
In summary, a systematic review can exist without a meta-analysis, but a meta-analysis is always part of a systematic review if the data allows for quantitative synthesis.
Here are the basic types of scientific articles commonly used in evidence-based practice:
Original Research Article (Empirical Study):
Systematic Review:
Meta-Analysis:
Clinical Practice Guidelines:
Case Report/Case Series:
Cohort Studies:
Randomized Controlled Trial (RCT):
These types of articles form the backbone of evidence-based practice, helping to inform clinical decisions and policy-making with the best available scientific evidence.
Overdiagnosis is a common phenomenon. It is defined as the identification of an abnormality that would not have harmed the patient if it had not been detected. However, once detected, the knowledge of such an abnormality alone has the potential to harm the patient, both psychologically and physically.
The use of the best available evidence to inform patient care in evidence-based medicine is reliant on the accurate, complete and transparent reporting of health and medical research. Without a complete and transparent account of what was done and what was found during a research study, findings cannot be fully understood, replicated, assessed for validity and applicability, and used to inform clinical and policy decisions.
For over 50 years, problems of incomplete and poor reporting of research have been widely documented across health and medical research.
The objectives of this scoping review were to provide an overview of existing guidelines for the development and validation of patient-reported outcome measures (PROMs), review them for comprehensiveness and clarity and provide recommendations for their use based on the goals of the instrument developers.
Scoping review.
A literature search was performed in PubMed, Scopus, PsycInfo and Google Scholar up to 2 June 2023 to identify guidelines for the development and validation of PROMs. Screening of records and reports as well as data extraction were performed by two reviewers. To assess the comprehensiveness of the included guidelines, a mapping synthesis was performed and steps to develop and validate a measurement instrument outlined in the included guidelines were mapped to an a priori framework including 20 steps, which was based on the guideline by de Vet et al.
A total of 40 guidelines were included. Statistical advice (at least partially) was provided in 98% of the guidelines (39/40) and 88% (35/40) of the guidelines included examples for steps required to develop and validate PROMs. However, 78% (31/40) of the guidelines were not comprehensive and two essential steps in PROM development (‘consideration and elaboration of the measurement model’ and ‘responsiveness’) were not included in 80% and 72% of the guidelines, respectively. Three guidelines included all 20 steps and six included almost all steps (≥90% of steps) for developing and validating a PROM.
Most guidelines on PROM development and validation do not appear to be comprehensive, and some crucial steps are missing in most guidelines. Nevertheless, for some purposes of PROMs, many guidelines provide helpful advice and support.
At least 15 guidelines may be recommended, including three comprehensive guidelines that can be recommended for the development and validation of PROMs for most purposes (eg, to discriminate between subjects with a particular condition and subjects without that condition, to evaluate the effects of treatments (between a pre and post time-points) or to evaluate a status quo).