In the move to evidence based practice are we shooting ourselves in the foot once again? So much “evidence based practice” is questionable, inaccurate, fraudulent or flat out wrong. I put my stock in practice-based evidence that I can support with good science where I can. In 45 years of coaching I have found that where it is necessary to produce results coaching (clinical) significance trumps statistical significance. I have yet to see a doctor or a scientist innovate a training method or a technical modification. So much of the time the scientists tell us what can’t be done Talk about barriers and limits) and then coaches and athletes go out and exceed the limits and break though the barriers and records are broken!
Here are some resources that will make you rethink or at least look at evidence based practice in a different light:
How to lie in sports medicine using statistics by Rod Whiteley mhttps://www.youtube.com/watch?v=QMZTc-99xQc
Why Most Published Research Findings Are False by John P. A. Ioannidis PLoS Med. 2005 Aug; 2(8): e124. Published online 2005 Aug 30. doi: 10.1371/journal.pmed.0020124 PMCID: PMC1182327
If you don’t want to read the above then read this article on Ioannidis:
http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/308269/
If you want to dig deeper into this and stop following the flock I suggest you read these two books.
Above all think critically and don’t be afraid to slay the scared cows of conventional wisdom that stifle innovation and hold us back!
Paul Ford
Good on you, Vern.
Here’s a similar perspective, although I differentiate between evidence-based research (EBR) and evidence-based practice (EBP).
My own practice has developed as the depth, breadth (and limitations of application) of EBR to EBP have become better understood over the last 20 years. There have been five chief sources to this growth:
(1) exploring the nature of professional accountability and professional knowledge in practice for my M.Ed. degree, partly through the informative texts:
• White (1982) The Nature of Knowledge
• Schon (1985) The Reflective Practitioner
• Turner (1987) Medical Power and Social knowledge
• Goldman (1988) Empirical Knowledge
• Freidson (1988) Profession of Medicine: A Study of the Sociology of Applied Knowledge
• Kennedy (1989) The Industrialisation of Intelligence
(2) working with an alongside sportsmedicine practitioners, sport-scientists, and allied health professionals
(3) being employed full-time in elite sporting organisations, clinical and educational settings – seeking best (and justified) practice
(4) improving and maintaining the professionalism – being well informed and up-to-date – of my own practice and offering the best possible outcomes for various clients or athletes.
EBR is designed to improve EBP by specifying or directing practitioners to make decisions through identifying research according to how scientifically sound (valid, objective and reliable) it is. By being informed by the systematic collection of data from observation (testing & measurement) and experimentation through the formulation of questions and testing hypotheses, particularly randomised controlled trials with properly designed evaluations, it has been *assumed* that this will be best form of treatment, intervention or training.
Through the 2000s, with the momentum of growth of EBP based on EPR, this was the *dominant* source of information sought, yet not always relevant for my coaching practice in terms of:
• elite athlete training, recovery and preparation
• ‘functional’ strength, power and endurance capacity development
• educational program development and delivery (teaching)
• muscle strain rehabilitation – particularly hamstring
• impact of sitting on health, and exercise functional capacity
• bone stress response and stress-fracture rehabilitation
• Achilles and hamstring tendinopathy rehab
• since 2010: exercise and neuroplasticity
However, over the last 10 years I have developed more of an ecological EBP approach – being shown to be more effective in practice where experiential and situational (context) knowledge of the practitioner (me = coach) is used with the empirical knowledge of EPR. This integrates the best possible available evidence with practitioner expertise, other resources, and with the characteristics, needs, values and preferences of clients and athletes. It helps ensure that exercise intervention(s) and training plans/programs are individualized as circumstances are ever-changing and involve uncertainties and probabilities over the course (time: weeks/months) of an intervention or program.
In essence you are aiming to match the best-possible practice to the person/client/athlete, rather than simply prescribe a client to a treatment, or an athlete to a prescription based upon a research finding.
In short, I recommend use what is most relevant to an athlete in terms of *effectiveness* (the training-related outcomes/intervention performed under ordinary, expectable conditions (ie. real life on the track, field, court, gym or pool)) rather than *efficacy* (the outcome of treatment/intervention performed under sterile, controlled trial conditions) sought in laboratories.
Paul Ford