The evidence for EBP is not self-evident

There is an interesting paradox to evidence-based practice.

A person who believes in objective facts is likely to believe that there is a ‘best way’ to assess and treat people and that rigorous science is the way to locate it. A lot of our clinical trials, best practice guidelines, and quant research starts out with this premise. (We’ll call this Option 1)

But a person who believes that everyone is unique is also likely to believe that what works depends on the person’s perspective, and that what constitutes evidence will be shaped by their unique life experiences and history. Qualitative research and person-centered care start here. (Option 2)

And then there are people who believe that meaning is a collective, social thing and that the truth is constructed through conversation and negotiation between people. How we think about things like the physiotherapy profession, or common experiences like pain are like this. (Option 3)

But here’s the twist. Those who believe that we can prove that physiotherapy works through science, are only expressing one type of understanding, and theirs isn’t the correct one simply because it manipulates variables, randomized control groups, and statistics.

In fact, it could be argued that when someone makes a case for the scientific basis of physiotherapy they’re advocating for it on the basis of their experience and history, or trying to shape the way the profession thinks. So using Options 2 and 3 to make a case that Option 1 is the only logical choice.

So you can use the way people speak about evidence as a good way to ‘diagnose’ their particular world view. Someone who thinks that only RCTs will tell the truth about physiotherapy, will lack an appreciation for the power of people’s lived experience, and people’s shared realities. Similarly, someone who thinks that individual experience is the only true marker of whether something works or not, will be missing out on the value of rigorous clinical trials and social constructionism.

It always pays to be skeptical of narrow perspectives for things like ‘evidence’ because, as Jacques Derrida once said, “if things were that simple, word would have gotten around”.