Evidence based orthopedics is application of principles of evidence based medicine to the field of orthopedics. Because each of the medical specialty has its own set of challenges and unique applications, therefore, while the core principles remain same, the methods and the applications must meet the need of each.
What is Evidence Based Medicine and What Is Need For It?
In a typical traditional paradigm, the clinicians evaluate and solve the problems by reflecting on their own clinical experience, underlying biology and pathophysiology or textbook, training or expert colleague. This paradigm places a very high value on traditional scientific authority and adherence to standard approaches, traditional medical training and clinical acumen is considered as sufficient bases for practice, evaluating new tests and treatments.
Similarly, content expertise and clinical experience are considered as sufficient bases for generating guidelines for clinical practice.
In actual state, these things are necessary but are inefficient guides because they may not be correct and lead to inaccurate predictions about the performance of diagnostic test and efficacy of the treatments.
Evidence based medicine agrees to the point that the clinical experience and clinical instinct development are crucial elements 0f physician competence but it also has several additional points that are include
- To identify important knowledge gaps and information needs
- Phrasing those needs in form of answerable questions
- Identifying potentially relevant search
- Accurately assess the validity of available evidence and results
- Developing clinical policies that align research evidence and clinical circumstances
- Appropriate application of research evidence to individual patients with their particular experiences, expectations and values
Evidence based orthopedic practitioners must regularly consult the literature and other reliable sources of evidence to help them solve clinical problem.
For effective use of literature demands an ability to independently assess the credibility of the opinion offered.
One must understand that their exists hierarchy of evidence and all studies do not offer the similar quality of the evidence.
When searching the literature, one must search for highest quality of the evidence. If the best is not available, next best must be sought.In a case where not enough literature is available or it is altogether lacking the answer one is searching for, one must rely on understanding of biology and pathophysiology of the particular disease and clinical experience.
Evidence based medicine or evidence based orthopedics have become widespread in literature and therefore, the clinician using the literature must become well verse with the concepts and terminology.
Once one learns the skills enough, it would allow him to function more rationally and his/her diagnosis making and therapy will be more based on sound knowledge rather than memory or advise.
Limited access to information and limited time allocated to continued education causes the knowledge to deteriorate.
Evidence based orthopedics allows access and the physician can screen and apply information more efficiently.
Moreover, a clinician who bases his practice on EBM principles does contribute to collection of better evidence.
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