Milanese Steve
School of Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide, SA 5001, Australia.
Man Ther. 2011 Aug;16(4):403-5. doi: 10.1016/j.math.2011.02.007. Epub 2011 Apr 1.
Evidence based practice has been defined as "the explicit, conscientious and judicious attempt to find the best possible available research evidence to assist the health professionals to make the best decision for their individual clients." (Sackett et al., 1996). In clinical manual therapy practice, this involves integrating research evidence with clinical experience and patient values. Currently randomised controlled trials are considered the highest level of research design in terms of strength of the evidence provided, due to the methodological control of potential sources of bias. However, the mechanisms that ensure internal validity of an RCT, i.e. randomisation, and intervention standardisation, threaten the generalisibility, and therefore relevance of the evidence to manual therapy. Manual therapy represents a complex intervention and therapists need to review the notion of 'research evidence', in the context of the clinical practice of manual therapy. Reviewing the construct of what constitutes an intervention, increasing post-hoc analysis of subject sub groupings and revisiting 'lower levels' of research design are all suggested as possible approaches.
循证实践被定义为“明确、审慎且明智地尝试寻找最佳可得研究证据，以协助健康专业人员为其个体客户做出最佳决策”（萨克特等人，1996年）。在临床手法治疗实践中，这涉及将研究证据与临床经验及患者价值观相结合。目前，就所提供证据的强度而言，随机对照试验被视为最高水平的研究设计，这是由于对潜在偏倚来源进行了方法学控制。然而，确保随机对照试验内部有效性的机制，即随机化和干预标准化，却威胁到了研究结果的普遍性，进而影响了该证据对手法治疗的相关性。手法治疗是一种复杂的干预措施，治疗师需要在手法治疗临床实践的背景下审视“研究证据”的概念。审查构成干预措施的要素、增加对受试者亚组的事后分析以及重新审视“较低层次”的研究设计，都被建议作为可能的方法。
