Submitted by: John Stites, DC, DACBR

Position: CHC Immediate Past Chair:

Evidence-based clinical practice, or EBCP, evidence-based medicine, evidence informed practice; all are terms being heard more and more in chiropractic practice. The essential elements of EBCP include the conscientious use of best available evidence with the clinician's experience and the patient’s values. (1) Some of the skills in practice EBCP include asking an answerable clinical question, acquiring information, appraising the literature and applying it in a clinical situation. (2) There are currently four chiropractic colleges with NIH grants supporting educational initiatives to incorporate EBCP into chiropractic curricula, thus further improving chiropractic practitioners with these skills. (3)

The process of EBCP is equally applicable to public health and public health initiatives. Especially in the roles of advocacy and policy development having a firm grasp of the evidence both for and against your position is important. A position based on the synthesis of sound scientific evidence is a powerful tool for the public good. It informs strategic decisions and bolsters success of public health programs. (4)

For example, if you look at an injury prevention initiative encouraging the use of bicycle helmets you can go through the EBCP process. You can ask the clinical question “In recreational bicyclists does the use of a helmet as compared to no helmet reduce mortality and traumatic brain injury?” A quick literature search yields multiple papers supporting the use of helmets including a recent case control study showing the reduction of injury ranging from 30-50 percent. (5) This information is combined with the societal values and balanced with cost, social mores and implementation barriers to determine if bicycle helmet use should be mandated by policy or encouraged by education.

Therefore, the elements of EBCP are easily applied to public health and strengthen the process. Familiarity with basic EBCP principles (6,7) can aid in furthering the public health agenda in local and national venues.

References

1.    Sackett, D.L., Rosenberg, W., William, M.C., Gray, J.A., Haynes, B. and Richardson, W.S., 1996. Evidence-based medicine: What it is and what it isn’t. British Medical Journal 312, pp. 71–72.

2.    Guyatt G, Meade MO, Richardson S, Jaeschke R. Chapter 3. What is the question? In: Guyatt G, Rennie D, Meade MO, Cook DJ, eds. Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. 2nd ed. New York, NY: McGraw-Hill; 2008.

3.    Lefebvre RP, Peterson DH, Haas M, Gillette RG, Novak CW, Tapper J, Muench JP. Training the evidence-based practitioner: university of Western States document on standards and competencies. J Chiropr Educ. 2011 Spring;25(1):30-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113621/pdf/JCE-25-1-30.pdf

4.    Anderson LM, Brownson RC, Fullilove MT, Teutsch SM, Novick LF, Fielding J, Land GH. Evidence-based public health policy and practice: promises and limits. Am J Prev Med. 2005 Jun;28(5 Suppl):226-30.

5.    Amoros E, Chiron M, Martin JL, Thélot B, Laumon B. Bicycle helmet wearing and the risk of head, face, and neck injury: a French case-control study based on a road trauma registry. Inj Prev. 2011 Jun 24.

6.    Johnson C. Evidence-based practice in 5 simple steps. J Manipulative Physiol Ther. 2008 Mar;31(3):169-70. http://download.journals.elsevierhealth.com/pdfs/journals/0161-4754/PIIS0161475408000961.pdf

7.    Johnson C. Highlights of the basic components of evidence-based practice. J Manipulative Physiol Ther. 2008 Feb;31(2):91-2. http://download.journals.elsevierhealth.com/pdfs/journals/0161-4754/PIIS0161475408000146.pdf