The evidence-based case report: a resource pack for chiropractors

Evidence-based medicine (EBM) is described as ‘‘. . . the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine requires the integration of individual clinical expertise with the best available external clinical evidence from systematic research.’’ More recently, this definition has been updated to incorporate patient values in the decision process. These key elements of evidencebased clinical decisions are depicted in Fig. 1. The overall aim of EBM is to provide the best possible care for the individual patient. The integration of best research evidence, clinical expertise and patient values, allows clinicians and patients to form a ‘‘diagnostic and therapeutic alliance’’ to optimise clinical outcomes and quality of life. As professionals, we should constantly question clinical practice how and why we practice in the way we do and whether we are providing the most effective care for our patients. To do less is to practice as a technician and not as a professional. The need for evidence-based practice has arisen from the rapid advances in medical knowledge and the large number of clinical papers being published. Traditional sources of information such as textbooks rapidly become out of date. Consequently, a disparity develops between diagnostic skills and clinical judgement that increases with experience and dating of academic knowledge resulting in a decline in clinical performance over time. EBM was developed to help bridge this gap between research and practice. Recent advances in database searching and secondary sources of evidence, as well as improved access to them, have made the practice of EBM a more viable option.