b'Research REACH: April 2021Research in ActionLevels of EvidenceMia EricksonPT, Ed.D., CHT.Assistant Director and Professor, Physical Therapy Program, Glendale, ArizonaEvidence-based medicine (EBM) hasThere are a number of challengesAdditionally, EBR must integrate the been defined as the conscientious,associated with EBR. While there arepatients unique circumstances which explicit, and judicious use of currenthierarchies of evidence that categorizerequires the clinician to weigh benefits best evidence in making decisionsresearch into different levels ofand risks of integrating the evidence, about the care of individual patients/ quality (lowest being level 5 and theadding to the art of what we do as clients 1 . Steps in EBM are widely knownbest being level 1. [Table]), classifyingclinicians. Pre-appraised evidence, and include formulating a clinicalevidence into a level can be difficult.such as meta-analyses, reviews, and question around a knowledge gap,Also, it can be difficult to identify bias,clinical practice guidelines, that have accessing and appraising availableor threats to validity, and there is nobeen developed by experts in the field evidence, integrating researchsingle gold standard tool for criticalcan be time savers for clinicians. findings with clinical experienceappraisal, although many have beenWith this column, in forthcoming and the patients unique values andpublished in the literature. There mayissues, we hope to provide readers with circumstances, and evaluating thebe study limitations which limit theresources for EBR and explore some result. Evidence-based rehabilitationgeneralizability to certain patientresearch concepts.(EBR) follows a similar process and Lawgroups or individuals. Clinicians also and MacDermid 2have described keyraise concerns over use of EBR in that skills in using EBR. These skills include: it minimizes their experience and 1.awareness of new evidence,doesnt apply to individual patients.REFERENCES:Furthermore, the process of searching1.Sackett DL, Rosenberg WM, Gray JA, 2.consultation, or the ability tofor studies and critical appraisal is timeHaynes RB, Richardson WS. Evidence-communicate research findingsconsuming. based medicine: what it is and what it with patients or clients,Regardless of challenges, EBR canisnt. Brit Med J. 312(7023):71-72.3.judgement to differentiate howprovide a model for clinicians for2.Law M, MacDermid JC. Introduction to evidence should be applied, andprofessional development.evidence-based practice. In: Law M, MacDermid JC, eds. Evidence-Based 4.creativity of application ofOne must understand that thereRehabilitation: A Guide to Practice. evidence in the light of uncertaintyis a fine balance between clinicalSlack, Inc. Thorofare, NJ; 2014:1-14.or in situations that are notexpertise and external clinical straightforward.evidence. 2,p9Table: Levels of evidence for classifying studies related to interventionsLevel 1 Systematic reviews (with or without meta-analyses) of randomized controlled trials Useful links to other Clinical practice guidelines based on systematic reviews and/or randomizedsources related to controlled trials Levels of Evidence:High-quality, individual randomized controlled trialsLevel 2 Systematic reviews of quasi-experimental studies or lesser quality randomizedEssential Evidence Plus: controlled trialsLevels of EvidenceQuasi-experimental studies Centre for Evidence-Based Lesser quality randomized controlled trials Medicine Levels of EvidenceCohort studiesLevel 3 Case-control studiesRetrospective studiesLevel 4 Case seriesLevel 5 Expert opinion4'