Evidence based medicine (EBM), or evidence based practice (EBP), are concepts which propose that healthcare professionals should base their understanding and clinical frameworks on scientific evidence.
Within our field of exercise science and specifically clinical exercise physiology we follow this idea closely in multiple ways however there also exists within that concept a broader understanding that also includes our clinical experience and the lived experience of the person seeking healthcare.
For example within the framework of EBP we have a very good understanding in the treatment of broken, fractured bones. You cannot massage or load a bone back into place or heal it faster. The treatment is to assess the damage, ensure the bone is located well, surgically fixate if needed, and then immobilise and protect until the bone is strong enough to load.
There is very little grey area and we think all clinicians, doctors and scientists agree on this. A contrasting example where EBP is not as clear is with conditions such as Fibromyalgia. Fibromyalgia is a complex invisible illness that may or may not benefit from a range of different treatment options. However there is no one way that scientific research has concluded that it is the best treatment approach. In this situation the clinicians must rely on their own experience in treating other people with the condition and also rely on the patient’s own preferences and understanding.
Both conditions (broken/fractured bone and fibromyalgia) can cause disability, loss of function, time off work, mental health symptoms, financial stress, loss of sleep and many other things. However the treatment approach for Fibromyalgia cannot rely on scientific evidence alone as the research is just not as clear.
This is a good working definition of applied science where we cannot turn someone away and say “wait for the science to catch up” we must draw on the existing understanding of similar conditions, the biology of human beings, the science of pain, the science of exercise, and on the lived experience of people in that situation. This will allow us to come up with management options, exercise programs and advice that can help reduce symptom severity and improve quality of life and function straight away where possible.