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Improving Delivery of Care With EBC

By Ronald Feise, DC

Evidence-based chiropractic (EBC) applies the best available scientific evidence to health care decisions in order to increase the probability of favorable patient outcomes. However, EBC doesn't offer chiropractors a thought-proof mechanism for improving care. All evidence must be interpreted sensibly, applied with discretion and subjected to careful clinical judgment.

Practitioners using an evidence-based model rely upon both their clinical expertise and the best available clinical evidence when making decisions about patient care. EBC is not a cookbook process in which patients are treated according to some strict scheme derived exclusively from research and randomized clinical trials.1 Research is just one component of clinical decision-making. Other important components include patient evaluation, patient preferences and the clinical judgment of the doctor. Taken together, these factors provide a valuable decision framework for practitioners that helps them achieve the primary benefit of evidence-based care - better patient outcomes.

Applying EBC gives practitioners the enhanced knowledge to provide a higher level of care and improved outcomes for their patients. Because these practitioners know which research findings are reliable and valid, they have distinct advantages over their peers. Fortunately for chiropractic patients, a growing number of practitioners are using EBC.

The following example involving orthopedic surgeons underscores how an evidence-based approach can benefit patients. For decades, hundreds of thousands of patients have received surgical arthroscopic treatment for osteoarthritis of the knee. However, until recently, no research team had explored whether arthroscopic treatment provided benefit beyond the placebo effect. In ground-breaking studies, patients were randomized to either a placebo arthroscopy group (a surgical incision followed by closure), an arthroscopic lavage group (a surgical incision followed by a fluid rinse and closure) or a standard arthroscopic debridement group.2,3 The patients, as well as the physicians performing the postoperative assessment, remained blinded as to treatment.

These high-quality studies concluded that outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure, and that placebo patients actually thought their procedure was worthwhile and would recommend it to family and friends. These findings were confirmed by another study published in TheNew England Journal of Medicine last year.4

The compelling message from this example is that we can spare our patients from ineffective and costly interventions if we consider relevant research findings. Moreover, there are several effective nonsurgical strategies available to our patients, and recent research findings have provided the direction. Using evidence-based care, you can to determine which of these strategies are supported by evidence, and which nutritional supplements, physical modalities and specific exercises to apply (and which to avoid) to get the best results. This enhanced knowledge allows EBC practitioners to provide a higher level of care and achieve better outcomes, which in turn, leads to greater patient loyalty and enhanced market share.5


  1. Sackett D, Richardson W, Rosenberg W, Haynes R. Evidence-Based Medicine: How to Practice and Teach EBM. New York: Churchill Livingstone, 1997.
  2. Moseley JB Jr., Wray NP, Kuykendall D, et al. Arthroscopic treatment of osteoarthritis of the knee: a prospective, randomized, placebo-controlled trial. Results of a pilot study.Am J Sports Med, 1996;24:28-34.
  3. Moseley JB, O'Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee.N Engl J Med, 2002;347:81-8.
  4. Kirkley A, Birmingham TB, Litchfield RB, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee.N Engl J Med, 2008;359:1097-107.
  5. Feise RJ. Cross-Sectional Assessment: Patient Sources. Prescott, Ariz.: RJF Consulting, 2002.

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