Evidence Based Practice is the process by which the best research evidence is reviewed and used along with professional experience and patients' preference to make informed clinical decisions.
Hierarchy of Evidence, CC BY-SA 4.0, via Duke University Medical Center Library & Archives
This diagram is the Evidence Based Practice Pyramid. Within the pyramid are listed the various types of evidence. The quality of evidence increases as we climb the pyramid. The highest quality of evidence it the Systematic Review, while the lowest rank of evidence is background information/expert opinion.
Case-Controlled Studies or Case Series Reports - Preliminary studies using few participants or single individuals or events. These are not considered rigorous because the sample population is usually very small and they are not randomized.
Cohort Studies - These studies follow large groups over time. The data is considered more reliable than case studies but they are usually not randomized and are difficult to control for outside variables.
Randomized Control Trials - These are experiments conducted with a careful study design. The patient populations are divided into groups randomly. One group will receive an intervention while the other receives no treatment or placebo. The double-blind randomized control trial requires not informing study participants which intervention they are receiving. These studies may raise ethical questions but they are considered the most rigorous study design and produce the most reliable data.
Critically Appraised Topics - A short summary of the best available evidence.
Systematic Reviews - a systematic process of locating, critically appraising and synthesizing all studies on a topic with the aim of producing an overview. These are the gold-standard of evidence for EBP.
Meta-analysis - a statistical technique used to summarizes results across several studies to determine trends. A meta-analysis is often, but not always included in a systematic review.
Sources:
Libguides: Evidence-based practice: Study Design. Duke University Medical Center Library and Archives. (n.d.). https://guides.mclibrary.duke.edu/ebm/studydesign
Minkow D. The evidence-based Medicine Pyramid! Students 4 Best Evidence. Published April 29, 2014. Accessed March 8, 2023. https://s4be.cochrane.org/blog/2013/02/14/the-ebm-pyramid/
Moule P. Making Sense of Research in Nursing Health & Social Care. 5th ed. Los Angeles: SAGE; 2015.
PICO is an acronym describing a format that you can use to develop a clinical research question. By identifying terms related to each of the four PICO elements, you will be able to perform more precise database searches.
P - Patient population (May be an individual or group)
I - Intervention (The treatment being considered)
C - Comparison (The absence of the treatment, alternative treatment, or control group)
O - Outcome (The result being sought)
(T) - In some cases, the time frame needed to reach the desired outcome is included.
Peer review is a process by which articles are evaluated by other expert scholars prior to publication. The experts critically assess the article for rigor and scientific merit. Once an article passes through this process, it is published in a journal. Journals that require this process prior to publication are considered peer-reviewed.
The benefit of using peer-reviewed literature is knowing that the research is of high quality and credibility.
Peer review is sometimes referred to as "refereed".
What is the difference between peer review and scholarly? Both peer review and scholarly are written by experts in the field of study. The difference is that peer review goes through additional scrutiny when it is reviewed by other scholars.
How do you know if an article has been peer-reviewed?
There are a couple of ways to determine if an article has gone throught the peer review process.
Find the website of the publishing journal. Look up the name of the journal in Google. On the website of the journal for the words "peer review" or "refereed". This information may be on the home page or in the About section.
If you are using an EBSCOhost database like CINAHL with Full Text, look up the journal name in the publications search. The details page for each publication will indicate if a publication is peer reviewed as we see here on the details page for Archives of Physical Medicine & Rehabilitation.
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