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When the Best is the Enemy of the Good – The Nature of Research Evidence used in Systematic Reviews and Guidelines

About the Webcast

Evidence-based practice, according to authoritative statements by the founders of the approach to health care, involves using the “best available” evidence (in addition to clinical expertise, and patient preferences) to make decisions on the care of patients. However, many systematic reviewers read this as “best possible,” and exclude from their reviews any evidence produced by research of a grade less than the highest possible (e.g. the randomized clinical trial (RCT) for interventions), even if that means making no recommendations at all. Voltaire’s comment that “the best is the enemy of the good” is applicable here. Rehabilitation would be disadvantaged especially, as it can boast few RCTs, due to its nature. The myopic focus on the “strongest” designs also may steer researchers away from asking: “What is the best design to answer this research question?” Lastly, rehabilitation and other clinicians need to know not just which interventions are effective, but also how these need to be delivered; information relevant to this latter aspect of knowledge translation is typically produced using “weak” research designs.

This webcast is supported through the National Center for the Dissemination of Disability Research (NCDDR), which is funded by the National Institute on Disability and Rehabilitation Research (NIDRR) in the U.S. Department of Education, and is supported in part by ILRU. The opinions and views expressed are those of the presenters and no endorsement by the funding agency should be inferred.

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