Moving Research From the Bedside Into Practice

Evidence-based practice (EBP) is firmly entrenched in the lexicon of physical therapist practice,^1,2 but beliefs about how best to translate scientific evidence into clinical practice are far from settled. There are major gaps in our scientific knowledge; however, even more disturbing is the fact that an enormous amount of existing scientific knowledge remains unused in practice. As noted in the Institute of Medicine (IOM) report titled Crossing the Quality Chasm, “Between the health care we have and the care we could have lies not just a gap, but a chasm.”³

Thankfully, the infamous 264-year period between the discovery of citrus's benefit in preventing scurvy and the widespread use of citrus on British ships is no longer the norm.⁴ But the frequently quoted statement about the lag time between publication and adoption of research—only 14% of original research is applied for the benefit of patient care, and that takes 17 years^5,6—is alarming enough. There is consensus that the transfer of evidence from proven health care discoveries to patient care is unpredictable and highly variable and needs to be accelerated.^4,7,8

For those of us who want to speed the adoption of EBP in physical therapy and across health care more broadly, Naylor⁹ described 4 distinct phases or strategies that are instructive:

Phase 1, the “Era of Optimism,” is characterized by a belief in passive diffusion of scientific evidence into practice. In this (still-dominant) phase, students and clinicians are trained to critically appraise the scientific literature to identify valid new information that could be applied to practice.

Phase 2, the “Era of Innocence Lost and Regained,” acknowledges that much of clinical practice is not evidence based …