The Methodology Matters Series: An Introduction

Abstract

This series was borne of a long-held desire of the new Editor-in-Chief of PM&R and her former resident (R.A. S.) to improve the ability of rehabilitation providers to apply evidence-based practice principles to patient care, research, and peer review. In short, we are passionate about evidence-based practice and think that every rehabilitation clinician should learn it. And we are not aloneevidence-based practice is a content area on the United States Medical Licensing Examination. 1 The Journal of the American Medical Association recently released a set of Core Competencies in Evidence-Based Practice for Health Professionals. 2 We know from our experience in learning and teaching evidence-based practice that (1) it takes time, teaching by experts, and frequent supervised application to become proficient; (2) the key knowledge base is often undertaught or under-reviewed in undergraduate and graduate clinical education (across all health care fields); (3) learning evidence-based practice is a lifelong pursuit; and (4) translation of evidence-based practice methods to rehabilitation questions can have additional challenges. The Mission of the Methodology Matters SeriesThe mission of the Methodology Matters series is to educate rehabilitation physicians and allied rehabilitation clinicians, researchers, and peer reviewers in the principles and application of evidence-based practice using rehabilitation examples. Objectives of the Methodology Matters SeriesOur primary objective is to help our readersrehabilitation physicians and allied rehabilitation clinicians-"read a paper." In other words, we want to help clinicians critically appraise, or independently evaluate and interpret, the primary literature evidence base for clinical practice. We also aim to help clinicians apply other principles of evidence-based practice, such as to understand and interpret summarized evidence (systematic reviews, clinical practice guidelines) and interpret diagnostic tests. We do not expect all rehabilitation clinicians to become experts in epidemiology and biostatistics, but to help them maximize their potential as clinicians by increasing their knowledge of evidencebased practice. Our secondary objectives are to help rehabilitation researchers, peer reviewers, and editors understand evidence-based practice principles as applied to study design, interpretation and presentation of results, writing and organization of a manuscript, and critical appraisal of a manuscript. Overview of the Methodology Matters SeriesIn this feature, we give a brief overview of the history of evidence-based practice and the role of two related fields, epidemiology and biostatistics. We discuss the epidemiologic approach to asking questions about human health outcomes, which is also the framework for evidence-based practice. The JAMA Core Competencies in Evidence-Based Practice will form the foundational content for the Methodology Matters series. 2 We routinely link to vocabulary and content from other key evidence-based practice, critical appraisal, and cli...

Evaluation of an Ultrasound-Assisted Longitudinal Axis Lateral Crest Approach to Radiofrequency Ablation of the Sacroiliac Joint

“…The most effective way to establish a causal relationship or interventional efficacy is done in a large, blinded, randomized controlled trial or a large, well-controlled, cohort study. Such rigorous study designs significantly reduce bias, confounding effects, and make the reader more confident in the relationship between an intervention and outcome 30–33 . Less rigorously designed studies reduce the causal relationship’s confidence and the interaction between the independent and dependent variables.…”

“…Such rigorous study designs significantly reduce bias, confounding effects, and make the reader more confident in the relationship between an intervention and outcome. [30][31][32][33] Less rigorously designed studies reduce the causal relationship's confidence and the interaction between the independent and dependent variables. The relationship is referred to as an association and not causal.…”

Summary Measures and Measures of Effect: Summarizing and Comparing Outcomes in Rehabilitation Research. Part 2: Binary Outcomes

“…In evidence‐based practice, we ask if within a population (P), an intervention or exposure (I) is associated with a particular outcome (O) in one group compared to another (C). The strength of the association between the intervention/comparison (I, C) and the outcome tells us about the clinical significance of the relationship between the variables 4 . The first step in making this comparison is to use summary measures to look at the outcome in each group.…”

Summary Measures and Measures of Effect: Summarizing and Comparing Outcomes in Rehabilitation Research. Part 1: Overview

“…For example, we previously interpreted a study that asked, “Are those who play college sports at higher risk of a concussion compared to those who play high school sports?” Gessel et al used rate , or the number of events per person‐time, as the summary measure to describe how often concussion was happening within each group: the rate of concussion was 0.43 per 1000 athlete‐exposures in college athletes and 0.23 per 1000 athlete‐exposures in high school athletes. They used the rate ratio , or the rate in the exposed (college athletes) over the unexposed (high school athletes), as the measure of effect to describe the difference in concussion rates between the groups.…”