When the best is the enemy of the good - The nature of research evidence used in systematic reviews and guidelines
October 28, 2008, 2:00 PM (CDT)
The Task Force on Systematic Review and Guidelines develops and presents consensus/position statements and recommends strategies associated with systematic reviews/clinical practice guidelines in disability and rehabilitation research. The Task Force is made up of experienced NIDRR-funded researchers who volunteered to work in this capacity.
Beginning its work in 2006, the Task Force has developed two papers that are now ready for public review and comment. The first paper focused on Systematic vs. Traditional Reviews and was presented in a webcast on September 3, 2008. The second paper looks at Evidence in Systematic Reviews (Oct. 28, 2008).
Copies of the papers were disseminated following the introductory webcasts.
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 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.
About the Presenters
Marcel P.J.M. Dijkers, PhD, FACRM, is the Facilitator for the Task Force on Systematic Review and Guidelines. He is senior investigator in the NIDRR-funded Rehabilitation Research and Training Center on TBI Interventions, as well as for the New York TBI and SCI Model Systems at Mount Sinai School of Medicine. Dr. Dijkers is Research Professor in the Department of Rehabilitation Medicine. He has published more than 80 articles and chapters on the social and functional consequences of SCI/TBI, the delivery of health services for these conditions, outcome measurement, and methodological and statistical issues in rehabilitation research. Evidence-based practice has been an area of interest for the last decade, and he has published a number of quantitative reviews and meta-analyses. Dr. Dijkers served as methodological consultant on a project by the Consortium for Spinal Cord Medicine to develop a clinical practice guideline in the area of upper extremity injuries of individuals with spinal cord injury.
Tamara Bushnik, PhD, is Director of the Rehabilitation Research Center at Santa Clara Valley Medical Center (SCVMC) and co-Director of the Northern California Traumatic Brain Injury Model System of Care. Dr. Bushnik is the Program Chair for the American Congress of Rehabilitation Medicine and Chair of the TBI Model Systems' Dissemination Committee. In addition to the TBI Model System research program at SCVMC, she was recently awarded a new NIDRR-funded Field-Initiated Project, "A New Measure of Subjective Fatigue in Persons with TBI."
Mark Sherer, PhD, ABPP-Cn, is Clinical Professor of Physical Medicine and Rehabilitation, Baylor College of Medicine, and Senior Scientist and Director of Research and Neuropsychology at TIRR-Memorial Hermann. Dr. Sherer has served as principal investigator for grants on TBI recovery, impaired self-awareness, telephone counseling for persons with TBI, TBI community integration, and rehabilitation of brain tumor patients and currently serves as the principal investigator for the Texas TBI Model System of TIRR. He has published more than 100 peer reviewed articles and book chapters including an evidence-based review on the prognostic validity of neuropsychological assessment for persons with TBI. He is now working with a team conducting an evidence-based review of instruments used for assessment of patients in vegetative or minimally conscious states.
Download Materials from Webcast
Paper discussed in the webcast: Evidence Level in Systematic Reviews (PDF 180kb)
Download: Transcript of the Webcast (MS Word 128kb)
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.
Last Updated: Monday, 16 June 2014 at 09:17 AM CST