ARTICLE
Too much evidence
Medical knowledge is rapidly increasing . According to Christakis ( 1910 ), there has always been and will always be too much to know . 3 In 1950 , medical knowledge was estimated to be doubling every 50 years . By 2010 , it was estimated to double every 3.5 years , and by 2020 , every 73 days . 4 Observations about natural medicine knowledge are likely to be similar . And yet , without keeping up with the latest evidence , natural medicine practitioners are at risk of not providing the best care for their clients . Clinical guidelines are a useful source of information . They are ‘ statements that include recommendations , intended to optimise patient care , that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options ’. 5 For example , there are clinical guidelines for the treatment of low back pain , guidelines for preventive activities in general practice , and aged care guidelines . However , the number of clinical guidelines is now unmanageable . A 2005 audit of a 24-hour medical intake in an acute hospital included 18 patients with 44 diagnoses and identified 3679 pages of national guidelines ( an estimated 122 hours of reading ) relevant to their immediate care . 6 In 2012 , 1.8 million scientific research articles were published . 7 That is more scholarly literature published in one year than any single scholar can possibly hope to read in a lifetime . Many health professionals report feeling unable to effectively read and understand research , which in turn results in lower research utilisation in practice . 8 Clearly , no practitioner will be able to keep up with so much evidence . 6 Consequently , practitioners need to develop skills to access , interpret , and critically evaluate primary health literature , and do this in an efficient way .
Health practitioners are expected to reflect on their clinical practice , identify their learning needs and undertake further education and professional development . However , given the huge expansion of health knowledge , keeping up to date can be quite a challenge . The following are some suggested strategies for practitioners to rapidly locate high quality research evidence to inform their clinical practice . These skills are not necessarily intuitive , and for most practitioners , they must be learned , practised , and honed .
1 . Identifying quality in research
There are a number of factors that influence the quality of research . These include the design of the study , whether it has been peer-reviewed and , in some cases , whether it has been published as an open access article .
Study designs The study design is the way the research is set up and conducted . It is the overall strategy that makes sure that the research question is effectively addressed . It dictates the way that data are collected , measured and analysed . Examples include : literature reviews , case studies , surveys , randomised controlled trials , feasibility studies , systematic reviews , cohort studies and case-control studies . Good studies usually include the study design in the title ( e . g . ‘ Effective self-stretching of carpal ligaments for carpal tunnel syndrome : a double blind randomised controlled trial ’, ‘ A profile of osteopathic care in the UK : a national pilot using standardised data collection ’, ‘ Dementia – caring , ethics , ethical and economical aspects : a systematic review ’, and ‘ Use of herbal medicines : pilot survey of UK users ’ views ’).
Each research project sets out to answer a research question . An appropriate study design has to be chosen to answer the research question . Questions about lived experiences , for example , require qualitative designs . Questions about the main effects of a treatment require systematic reviews of randomised controlled trials . Questions about overall prognosis require non-randomised cohort studies with a long follow-up . Questions about potential adverse events require non-randomised cohort studies or case-control studies and questions about opinions , experiences and behavior of the public require a survey .
Different research designs will achieve different levels of evidence . Figure 2 is referred to as the evidence hierarchy or evidence pyramid . The study designs at the top of the pyramid are likely to produce better quality evidence than those lower down . A good indicator of the quality of the evidence is the study design : systematic reviews and randomised controlled trials generally produce higher quality evidence than surveys and case studies .
Figure 2 . The evidence pyramid
Peer review is a very important process in ensuring the quality of research . Peer review ensures that research articles are sent to at least two experts in the field to review and comment on the quality of the study . Based on peer review , articles are either accepted for publication with major or minor amendments or not accepted . This process is not without its limits and poor-quality papers are still published . However , it is one of the best systems for guaranteeing the quality of published research and that most papers published in peer-reviewed journals are of high quality . Examples of high-quality peer-reviewed natural medicine journals include : the Journal of Alternative and Complementary Medicine , Complementary Therapies in Medicine , Complementary Therapies in Clinical Practice , BMC CAM , Journal of Natural Products , Cannabis and Cannabinoid Research , Phytomedicine ,
JATMS | Spring 2021 | 135