Evidence-based vs evidence-informed

I had an interesting conversation with my buddy, Matt Phillips, last week when he asked my opinion on the difference between “Evidence-Based” practice and “Evidence-Informed” practice.

When I gave it a bit of thought, this is what I came up with (which was just an uneducated opinion at the time).

Evidence-based to me means you’re building a foundation or a BASE to work from in your practice. You’re making that base around research and evidence and work from that standpoint in your clinical setting.

Evidence-Informed to me means you’ve been informed of the evidence and know what the evidence says, but you’re not necessarily working from that information; you know it’s there.

It was then pointed out to me that the research says we’re better to be evidence-informed.

So as always, I had to start looking at the research. 

Looking At Evidence-Based Practice

We have long preached about evidence-based practice, and as I start to look into the research, some other topics worth discussing came up. 

The first article to reference comes from evidence-based medicine or EBM. In general, I had no idea that medicine has faced many of the same issues we face in our profession. 

Much of the EBM arguments were based on creating government policies to identify different therapies or interventions that lacked science or evidence of treatment efficacy. ⁽¹⁾ The intent was to weed out an intervention that didn’t follow science or showed no evidence of treatment efficacy. 

This should generally be a good thing. Right?

It seems there were some limitations to this. 

When these new findings came out, some therapies would get pushed out while more expensive, technological ones became the preference, which was clearly not popular with insurance companies who had to pay for it. So, there are suggestions the root of EBM was to satisfy those insurance companies instead of focusing on patient care⁽²⁾, and even the possibility of some propaganda from pharmaceutical companies having an influence. ⁽³⁾ 

Some argued that the human side of treatment was being sacrificed for the more biomedical model (and we all know how our opinion on a strictly biomedical model), which led to a term I’ve never heard of; ‘scientism.’⁽¹⁾

Those who leaned more toward the humanistic approach were labelled with scientism and accused of being anti-science, where the word ‘dogma’ was also thrown around (where have I heard these kinds of things before!?). 

I would have thought this to be more prevalent in our profession by comparison. Many of the narratives and things we are taught come from what was once just opinion and then taken as gospel. Part of the issue here is that many of those narratives are overinflated claims, relying on anecdotal experience instead of what is actually happening. ⁽³⁾

Fortunately (at least within our profession), this is slowly starting to change. 

The argument is also made⁽²⁾ that when it comes to evidence-based practice (EBP), we evaluate the best evidence for the patients’ problem. It seems the ‘patient’ is not part of the equation. 

This isn’t to say science should not be used as a base for what we do. As this article points out, our challenge is to apply this within a humanistic framework that respects the patient and their values and recognizes the psycho-social aspects. ⁽¹⁾

Where Does Evidence-Informed Come In?

When I do a quick google search for definitions, there are two for the term, base that comes up which are applicable: 

a conceptual structure or entity on which something draws or depends.

and 

“have as the foundation for (something); use as a point from which (something) can develop” (clearly where I got my original idea from).  

When we look at informed, we get: 

give an essential or formative principle or quality to.

and

having or showing knowledge of a particular subject or situation.

We have often heard statements like “well, science just hasn’t caught up yet,” or: “my experience tells me what I’m doing is right.” Usually, statements like this are used as an argument against using research in our practice. 

When we look at that second definition for informed, we have to be careful with its interpretation. Having or showing knowledge of a particular subject or situation does not make us an expert, especially in our clinical practice and the techniques we use. 

This could be misconstrued with some research I’ve cited where it mentions the limitations to evidence-based practice was taking the patient out of the decision-making.

This brings me to a portion of one paper that I have to quote: 

While excluding entirely baseless interventions or interventions rooted in prejudice and superstition, evidence informed practice (EIP) should be understood as leaving ample room for the constructive and imaginative judgement and knowledge of practitioners and clients who must be in constant interaction and dialogue with one another for most interventions to succeed.⁽²⁾

This is where evidence-informed practice becomes a possibly more accurate description of what we should do. 

The evidence-informed practice encourages that we still use research (while discarding those old, false narratives) and suggests we use a more comprehensive range of research to apply in our practice. While evidence-based practice suggests we only apply best practices and minimize social interventions⁽²⁾, evidence-informed promotes including qualitative research and including the patient’s values in the decision-making process. 

This is an essential inclusion for us as Massage Therapists because qualitative research isn’t simply relying on data; it includes looking at things like contextual factors of treatment (which our treatments have A LOT of). 

So, it becomes crucial for us to use our clinical decision-making appropriately. Part of the ability to do this is to apply the current evidence and effectively communicate with our patients, care for them, include them in the decision-making process and goal setting. Then be able to adjust each appointment appropriately. 

It is when we start to see care being informed by evidence rather than based on it, and the patient is the centre of care is where we will have success. ⁽¹⁾ 

So, we should be using evidence to inform, influence, or to build our practice. However, we still need to use our experience, patient values, preferences, and other contextual factors to affect outcomes positively. We can’t rely on narratives rooted in opinion or superstition and altogether avoid new research in favour of our own experience. BUT, our experience still plays a role as we progress to hopefully becoming a more evidence-informed profession. So, as it has been done so many times before, I stand proven wrong on my assumptions and will now start to promote evidence-informed over evidence-based (although I’m sure I’ll screw that up somewhere along the way…old habits die hard). In all honesty, I don’t care what we call it, (perhaps EBIP would be better as it would have based and informed in the title) as long as we’re using evidence as a significant part of our practice. A big thanks to Matt Phillips for his gentle nudge in this direction. You’ve got to love colleagues that help you change. And let’s make sure there’s ALWAYS a human element to our treatments and interactions. 

References: 

1. Miles A, Loughlin M. Models in the balance: Evidence‐based medicine versus evidence‐informed individualized care.
2. Nevo I, Slonim-Nevo V. The myth of evidence-based practice: Towards evidence-informed practice. British Journal of Social Work. 2011 Sep 1;41(6):1176-97. 
3. Gambrill E. Evidence-informed practice: Antidote to propaganda in the helping professions?. Research on Social Work Practice. 2010 May;20(3):302-20.