Introducing the Evidence to Practice Commentary

Evidence-based practice has been a mantra of healthcare practitioners over the past two decades or so. In this editorial, we are introducing a new feature. Physical and Occupational Therapy in Pediatrics is planning to publish “Evidence to Practice” commentaries on a regular basis. The primary purpose of the commentary will be to highlight an issue or research finding from a selected article, emphasizing the relevance to pediatric therapy practice. In this editorial, we provide a brief historical overview of evidence-based practice (including some of its limitations), highlight some of the issues with its implementation, and describe the new feature and its anticipated outcomes.

Evidence-based medicine was pioneered at McMaster University in Hamilton, Ontario, Canada, in the 1980s by David Sackett and his colleagues ([Sackett et al., 1991]). Their definition of evidence-based medicine evolved from solely considering research evidence to inform practice to using a combination of current best evidence, clinical expertise, and client or patient values in making collaborative decisions about the care of individuals ([Sackett et al., 2000]). Muir Gray extended the scope from medicine to healthcare and emphasized that clinicians must take into account a client's condition, baseline risk, values, and circumstances. In her introductory chapter of evidence-based rehabilitation, Mary Law (2002) highlighted the link to client-centred practice and the importance of clinical expertise and creativity to apply the results of group studies to individuals. As indicated by the expanded definitions of evidence-based practice, research knowledge is clearly just one source of evidence to support practice; other sources include the values, beliefs, and experiences of the client and the clinician ([Miller and Lee, 2004]), as well as practice-generated knowledge ([Higgs, Andresen, and Fish, 2004]).

Medical practitioners have promoted a hierarchy of research designs for a variety of clinical problems (Philips et al., 2001); however, alone, this hierarchy is insufficient given the complexity and breadth of questions in rehabilitation sciences focusing on function and disability, which are interactive phenomena among body structure and function, activity and participation, in specific personal and environmental contexts. We support a perspective in advocating for evidence from a variety of designs based on the “goodness of fit” to the research question, rather than its placement in the hierarchy of levels of evidence ([Bartlett et al., 2006]; [Hyde, 2004]; [Tickle-Degnen and Bedell, 2003]).

Although we have a clear idea about the contribution that research-generated knowledge makes to practice, implementation into the “real world” has been problematic ([Mead and Bury, 1998]). Barriers include, but are not limited to, lack of time, access to information, critical appraisal skills, inclination, and institutional or organizational support. Indeed, implementation science is a growing field targeted to study the effectiveness of a variety of strategies to ensure uptake of research knowledge to practice ([Fixsen et al., 2005]).

In this new feature, we plan to invite individuals with expertise to highlight relevant aspects of selected articles. The focus could be on a theoretical framework, a service need, assessment or outcome evaluation, risk or prognostic factors, intervention approaches (including new technologies), or contextual factors such as family dynamics. The commentary will describe and emphasize the potential utility of this new knowledge in practice settings with clear examples of how this knowledge may be used by physical therapists and occupational therapists to promote best practice. Potential barriers and facilitators to the uptake of findings can be highlighted, with possible strategies to enhance effective translation of this knowledge to the clinical arena.

We hope this new feature assists physical therapists and occupational therapists become more skilled—and creative—in applying research evidence from a variety of methodological designs, in addition to other sources of professional knowledge, to improve care to individual clients and their families. Let us know how we are doing with this goal!