Science- based or Evidence- based?
Evidence-based practice (EBP) is gradually gaining acceptance and common usage among manual therapists and personal training, yet I still find that this term has many loopholes that allow pseudoscience and cargo-cult science to piggy-back upon. The quality of evidence comes in many flavors, ranging from high to low. To me, that also translates to “very trustworthy” to “not very trustworthy,” kind of like product review in Consumer Reports.
While the idea behind EBP has been around as far as back as the 16th century—when scientists and philosophers at the time began to test old ideas that dates back to the Roman Empire—it was only as recent as the early 1990s that EBP has been officially mentioned in scientific literature. However, the problems with “evidence-based” is that even low-quality evidence, like case studies, anecdotes, and “it worked for me” stories can also be used to justify why an intervention works or doesn’t work, as if they hold the same amount of quality as higher-quality evidence, such as randomized-controlled trials, longitudinal cohort studies, and meta-analyses. And sometimes, even the latter suffers from poor methodology setup and various biases in data interpretation and getting samples.
This is where science-based practice (SBP) comes in to sort out the mess. Paul Ingraham of PainScience described SBP (or SBM (science-based medicine) in his blog as a “refinement to [EBP]. The idea of emphasizing science in general instead of evidence in particular...”1
SBP takes several factors into consideration that EBP do not always do so. This includes:
1. Plausibility: Are the claims congruent with the existing knowledge of physics, chemistry, biology, and psychology? Even in the absence of high-quality trials and meta-analyses, claims that can be defended with current scientific knowledge are usually acceptable.
2. Cognitive biases: Because our senses tend to fool us into what we see, hear, and feel (e.g. optical illusions), SBP reminds us that our biases can skew our decisions. For example, we tend to gravitate toward ideas that fit our beliefs and ignore those that do not.
3. Significance: How relevant and applicable are the results to hands-on practice? Significance often comes in two types: statistical and clinical. Statistical significance refers to the likelihood that the outcome is a result happened by chance, while clinical significance emphasizes whether there is a meaningful (and sometimes observable and measurable) outcome for patients. Do not mistaken one for another, and having a positive statistical significance does not mean it has relevant clinical significance—and vice versa.
These are just a few examples that increases the quality of EBP, which is discussed in more details on page 40. Otherwise, anyone’s claim or opinion could be taken as “fact.” As massage therapy professionals, we need good science and reasoning to help us sort out what is good evidence, what is not, and what falls somewhere between the two extremes. ~ Nick Ng
OPINION
Photo: Lance Cpl. Kenneth K. Trotter Jr.
Image: NASA
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