Patient Evidence (AKA, Boy, Patients Complicate Our Clinical Practice)

Abstract

he mission of IJATT is to publish peer-reviewed reports pertaining to clinical applications of research findings; procedures found to be effective in the recognition, rehabilitation, and prevention of sport-related injuries; and professional practice issues. The major tenet of our mission is to help clinicians find balance between the best available research evidence and their own clinical expertise when making clinical decisions. Over the past 3 years, we have developed a series of editorials to highlight the delicate balance between control and generalizability in clinical research, 1 the importance of the integration of external evidence (best available research) and internal evidence (clinical expertise) when making clinical decisions, 2 and the necessity of outcomes in legitimizing our professional knowledge and ability.3 However, we have not yet provided framework for patient values and preferences, the often forgotten component of evidence-based practice and practice-based evidence.In the midst of adding EBP continuing education requirements for athletic trainers, there emerged a trend to consider clinicians as "in the wrong" by using interventions that were not "evidence-based"… and by 'evidence', it is implied that this is actually 'research-evidence'. We tended to look shamefully upon the foundation of our EBP pyramid (undocumented clinical experience) and praise the glory of the randomized controlled trial.

Starting a Dialogue: Athletic Training Researchers and Clinicians

“…that may influence the effectiveness of a treatment strategy. 6 These clinical CASE reports also provide clinicians and researchers an invaluable insight that can improve patient care and inspire new research studies and collaborations.…”

From Strength of Recommendation to Clinical Implementation: Weighing and Considering the Evidence

“…As clinicians, we re-weigh the probability of events occurring all the time, 6 most typically without "math" and oftentimes based on our own internal evidence 7,8 and the patient's evidence. 9 Again, the SOR is not telling us what we "must" do, but how likely the outcome will be given the same set of initial conditions.…”

“…Furthermore, the preferences and values of the patients must be considered when making clinical decisions. 9 Despite grade A recommendations from the research, patients are still free to choose the best course for them.…”

Using Patient Evidence to Guide Clinical Care: Consulting the Other Expert in the Room

“…1,2 In general, health care professions have applauded the integration of these three sources for making clinical decisions, as it incorporates science/knowledge (external evidence), expertise/experience (internal evidence), and the values/preferences/experiences of the individual patient (patient evidence). 1,2 However, it seems that athletic training has focused predominantly on the utilization of the best available external evidence as the largest contributor to evidence-based practice (EBP); thus, our EBP education has primarily focused on the development of PICO questions (Patient or Population of interest, Intervention, Control or Comparison, Outcome of interest), searching and critically appraising external evidence. In our quest to become evidence-based practitioners, we have not given enough appreciation to the third source-patient evidence 2 (e.g., the patient's values, preferences, experiences, etc.).…”

“…1,2 However, it seems that athletic training has focused predominantly on the utilization of the best available external evidence as the largest contributor to evidence-based practice (EBP); thus, our EBP education has primarily focused on the development of PICO questions (Patient or Population of interest, Intervention, Control or Comparison, Outcome of interest), searching and critically appraising external evidence. In our quest to become evidence-based practitioners, we have not given enough appreciation to the third source-patient evidence 2 (e.g., the patient's values, preferences, experiences, etc.). The integration of the patient in to decision-making in traditional athletic training settings is obscured by a lack of (a) clear clinical standards for achieving patient engagement and (b) the documentation and quantification of the patient's perspective.…”