Perspectives on evidence based practice in ABI rehabilitation. "Relevant Research": who decides?

Growing evidence suggests that acquired brain injury (ABI) rehabilitation and research should be guided by a philosophy that focuses on: restoration, compensation, function and participation in all aspects of daily life. Such a broad, more pluralistic approach influences ABI rehabilitation research at a number of levels, including both the generation of evidence, and in searching for, critiquing and applying the evidence to practice. The objective of evidence based medicine/practice (EBM/EBP) is to apply and integrate clinical expertise with evidence gained through systematic research and scientific inquiry to medical/clinical practice. While there is abundant literature debating the practical and sociological implications of EBP, there has been limited examination of EBP within the inherently complex nature of ABI rehabilitation and rehabilitation research. This paper provides a framework for clinical decision making regarding evidence based practice in the context of ABI rehab including: 1. A discussion of the purpose of evidence based practice, 2. Levels of evidence relevant to ABI rehabilitation research, and 3. A rationale for incorporating a broader, more pluralistic concept of evidence or "person-centred EBP". We conclude with a series of key questions for the evaluation and application of systematic reviews of the evidence in the context of ABI rehabilitation.