I want to pose a gentle reminder to everyone about the definition of evidence-based practice (EBP) and how the modern applications (since the 80s) has incorporated clinical expertise as one of the primary components. In current practice, I find that OTPs often rely on clinical expertise to a much more significant degree than reviewing best research evidence and incorporating the client’s circumstances and values. I know many of those in academia and our representative organization’s push for the incorporation of research evidence into decision-making, and that is due to the incorporation of evidence into OTP decision-making is significantly low and we often rely on our clinical expertise.
Current conceptualizations of the EBP process are illustrated as a process of inquiry (a verb) instead of a singular practice (a noun), much due to the definition of EBP causing significant confusion within healthcare. Misperceptions that the EBP does not value the creativity of practitioners or practitioner-client relationship emerged, obscuring the definition of the EBP process. Controversy and confusion about the original definition increased when reimbursement agencies and legislation incorporated “evidence-based practices’’ within their policies, restricting service delivery to those supported by the best research evidence. Utilizing a common terminology for the EBP process is essential to teach and advocate for practitioners to use their critical thinking skills, empower clients, and to maximize the potential of practice decisions that will provide the quality-of-care clients deserve. To support alleviating this confusion, I embrace the desired construct of EBP as a process and will utilize the term “research-supported” or “empirically supported” when highlighting a specific treatment strategy or practice model regarding its evidence level.
Practice-based evidence (PBE) also is often misused. PBE often requires large sample sizes of participants in a natural setting or highly standardized single-subject designs prior to it being constituted as PBE, and not using an treatment strategy with a singular client (or even a couple) without a standardized design process. Often treatment strategies with a high level of evidence were conducted with perfect conditions, and with PBE, we can continue to provide best practices by trialing these research-informed strategies in our “real and messy” world without control conditions. Clinical practice guidelines and research provide the practitioner with a valuable starting place when faced with a patient scenario. I argue that these protocols in themselves do not fully address the issue of the patient in front of you—with his or her own unique physical, psychological, emotional, environmental, and cultural perspective. The skilled practitioner must take these guidelines and make decisions regarding the appropriateness for the individual patient. However, this is not an excuse to throw out the guidelines entirely and utilize a “guru” approach. As practitioners, it is our responsibility to measure what we do and the outcomes for all patients to create an even richer database of clinical scenarios to improve the guidelines.
Thus, we return to practice informing research, and research informing practice. They are an inseparable team and neither element is complete on its own. I argue selecting a treatment strategy because it has always been used or because everyone uses it for that particular scenario isn’t the most skilled therapy. When we use EBP and PBE correctly, we are maximizing our critical reasoning and how skilled our therapy can be. Both researchers and clinicians have an obligation to work together toward the goal of best practice for all patients we encounter, then we truly will achieve EBP AND PBE.