Review Process and Methodology
Rationale
Providing a framework for evidence-base practice was championed in the early 1990s, although it was practiced and discussed in medical circles long before this. In 1992, the Evidence-Based Practice Working Group (EBPWG) described a new framework of using research to guide and augment the practice of medicine (Evidence-based Medicine Working Group 1992). Dr. David Sackett, a pioneer in the field and also a member of the original working group described evidence-based practice as:
Evidence based medicine is 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 means integrating individual clinical expertise with the best available external clinical evidence from systematic research. (Sackett et al. 1996)
Although the original definitions were framed for the practice of medicine, the practice has spread to all fields of health care with the more generic term “evidence-based practice”. Evidence-based practice does not ignore clinical experience and patient preferences, but weights these against a background of the highest quality scientific evidence that is available. The importance of clinical judgement was emphasized by Dr. Sackett in his original editorial:
Because it [evidence-based medicine] requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patients’ choice, it cannot result in slavish, cookbook approaches to individual patient care. External clinical evidence can inform, but can never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision. (Sackett et al. 1996)
Acquiring and interpreting the evidence from the research literature can be daunting. Not only is there a wealth of ever changing information from multiple sources, but it is often difficult for a front-line clinician not intimately familiar with the research methods to interpret the results of a study. In addition, the interpretation is further complicated by the presence of multiple studies on an intervention, often with what appears to be conflicting messages. The Spinal Cord Injury Rehabilitation Evidence (SCIRE) Project is dedicated to providing up-to-date, accurate information about the effect of rehabilitation health-care for people with SCI. SCIRE uses a systematic and transparent procedure to assess and synthesize the evidence of the effects of rehabilitation healthcare interventions in SCI and is designed for health professionals inform them of best practice. Consumers with SCI and their families may also find the synthesis useful to better understand their health care. In addition, such a research synthesis will enable relevant decision-making in public policy and practice settings applicable to SCI rehabilitation. Lastly, transparent and unbiased evidence-based reviews will guide the research community and funding organizations to strategically focus their time and resources on the gaps in knowledge and identify research priorities.
