|Year : 2020 | Volume
| Issue : 1 | Page : 13-16
Evidence-based practice versus experience-based practice in orthopedics
Ganesan Ram Ganesan1, Raghav Ravi Veeraraghavan2
1 Department of Orthopaedics, Velammal Medical College, Madurai, Tamil Nadu, India
2 Department of Orthopaedics, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India
|Date of Submission||29-Dec-2019|
|Date of Acceptance||20-Apr-2020|
|Date of Web Publication||26-Jun-2020|
Dr. Ganesan Ram Ganesan
Department of Orthopaedics, Velammal Medical College, Madurai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Evidence based medicine helps in improving medical decision and service conveyance to patients. Experience based medicine depends on the unequivocal and verifiable learning regulated by the past clinical encounters other than the other social, lawful, and moral systems of the practice. The aim of our study is to find out the evidence-based practice amongst the orthopaedic fraternity and to compare the magnitude of evidence-based practice in different groups allotted based on the experience in the field. Materials and Method: It is a Prospective study done amongst Orthopaedic surgeon in two cities in Tamilnadu Madurai and Chennai. The study populations were Orthopaedics practicing doctors with minimum of 3-year experience. The Orthopaedic Surgeons were given a questionnaire and were asked to fill it. The questionnaire was self-explanatory and they have to tick the best response, which they think was the most appropriate. Questionnaire was prepared based on the AAOS guidelines of clinical orthopaedic practice. The AAOS strong recommendation guidelines were considered as gold standard and the response from the Orthopaedicians were collected and corrected. The main emphasis was given to the second component only. Out of the 120 doctors 14 of them had either one or more wrong answer and only 106 orthopaedicians had given correct answer and their answers only were evaluated. Results: The total percentage of evidence-based practice in our study was 43.4% and experience-based practice was 56.6%. Conclusion: Experienced based practice is comparably more amongst the practicing orthopaedic surgeons. Upcoming Orthopaedic surgeons rely more on evidence to treat their patients than their experience.
Keywords: American Academy of Orthopaedic Surgeons guidelines, evidence, experience, literature, orthopedicians
|How to cite this article:|
Ganesan GR, Veeraraghavan RR. Evidence-based practice versus experience-based practice in orthopedics. J Orthop Traumatol Rehabil 2020;12:13-6
|How to cite this URL:|
Ganesan GR, Veeraraghavan RR. Evidence-based practice versus experience-based practice in orthopedics. J Orthop Traumatol Rehabil [serial online] 2020 [cited 2020 Sep 21];12:13-6. Available from: http://www.jotr.in/text.asp?2020/12/1/13/287720
| Introduction|| |
The standards of evidence-based medicine (EBM) are quickly picking up acceptance in the field of orthopedic medical procedures. This way to deal with persistent consideration requires a cautious, deliberate survey of the writing to properly esteem the value of studies. EBM helps in improving medical decision and service conveyance to patients. EBM implies relating individual clinical signs, individual clinical involvement in the best logical confirmations received by the clinical research. Experience-based medicine depends on the unequivocal and verifiable learning regulated by the past clinical encounters other than the other social, lawful, and moral systems of the practice. The aim of this study is to find out the evidence-based practice among the orthopedic fraternity and to compare the magnitude of evidence-based practice in different groups allotted based on the experience in the field.
| Materials and Methods|| |
This is a prospective study done among orthopedic surgeon in two cities in Tamil Nadu Madurai and Chennai. The study populations were orthopaedics practicing doctors with a minimum of 3-year experience. The orthopedic surgeons were given a questionnaire and were asked to fill it. The questionnaire was self-explanatory, and they have to tick the best response, which they think was the most appropriate. The questionnaire contains two components. The first component is the question, and the second component is also a sub-question, which the surgeon has to specify how the option was derived based on evidence or experience of the particular surgeon.
The questionnaire was prepared based on the American Academy of Orthopedic Surgeons (AAOS) guidelines of clinical orthopedic practice. It comprised of ten guidelines from the AAOS website, which were converted into questions., The AAOS guidelines have their evidence level described in their website. It was divided into three levels of evidence – Strong, moderate, and poor. Only strong evidence guidelines were converted into questions and used in this study. The questionnaire model used for the study is tabulated in [Table 1]. The topics covered were trauma, arthroplasty, arthroscopy, pediatric, and surgical site infection. The questionnaire was distributed to 120 orthopedic surgeons with varying experience from 3 to 20 years.
The AAOS strong recommendation guidelines were considered as the gold standard, and the response from the orthopedicians was collected and corrected. The main emphasis was given to the second component only. The first question was considered as a qualifier, and those who answer all the ten correctly were included in the study. Even if one question was answered wrongly, then it was excluded from the study. The importance was only given to the sub-question, which decided whether answered was done based on their experience or evidence. Of the 120 doctors, 14 of them had either one or more wrong answer and only 106 orthopedicians had given the correct answer, and their answers only were evaluated. They were divided into three groups Group I: 3–5 years, Group II: 5–10 years, and Group III: >10 years of experience. To find the significant difference in the multivariate analysis, Kruskal–Walli's test followed by the Mann–Whitney U-test was used. To find the significance in the categorical data Chi-square test was used. In all the above statistical tools, the probability value 0.05 is considered as significant level.
| Results|| |
The total percentage of evidence-based practice in this study was 43.4%, and experience-based practice was 56.6%. Out of all the surgeons who chose the answers based on evidence, 3–5 years group tops with 68.92% followed by 5–10 years (18.44%) and the last >10 years group (12.63%). The graphic representation of the evidence-based practice group and the experienced group are depicted in [Figure 1] and [Figure 2], respectively. Amongst the experienced-based practice side, >10 years group shows nearly 44% rely their treatment based on their experience.
| Discussion|| |
Evidence-based treatment which rely on measurements, diagrams, outlines, and reports satisfied with information might be useful and valuable in justifying why something is being done, or ought to be executed, those information's need not to be always correct. EBM characterized itself as the coordination of clinical experience and patient qualities and inclinations and desires with the best accessible clinical proof. Tuning in to once experience about a choice he has to make has its advantages and disadvantages. Going with that one will think and feel depending on his experience and related knowledge was a lot faster approach to settle on a choice than going through evidence based literature which can have both upsides and downsides of a subject.
[Table 2] clearly implies that experience-based practice is more prevalent when compared to evidence-based practice amongst practicing orthopedicians. Even though the margin of difference was less it is statistically significant from [Table 3]. It also showed that the learned surgeons use more of their experience for drawing conclusions or making decision in diagnostic and therapeutic dilemmas. This experience is also from baseline evidence and cannot be termed as a myth as such. The results from the gold standard answers show that the surgeons are clear about what is to be done irrespective of the way the acquainted the knowledge. Another trend noted in our study is that the upcoming surgeons have chosen to answer based on evidence more than the far experienced doctors. This shows that the prevalence and awareness of evidence-based practice has increased a significant amount.
Drawbacks of our study are that the sample size of each group is varied and thus is difficult to compare and that the knowledge of each surgeon will vary based on the experience. Thus, the ability of giving the gold standard answer may also vary. For clinicians, when experience is confronted with evidence, that's a bummer. Much the same as science, experience is hard to decipher and regularly off-base. The perfect decision can be made only by blending both evidence-based and experience-based knowledge. At the point when a choice should be made, as opposed to depending on one's instinct, a good orthopedician should correlate with relevant and important information from the research literature. The information can then broke down and transformed into pertinent bits of knowledge that can yield better results. The ideal treatment for an individual should be a wise utilization of current best proof on choices about the consideration of individual patients and coordinating with individual clinical experience with the best accessible proof from research.
| Conclusion|| |
The experienced-based practice is comparably more among the practicing orthopedic surgeons. Upcoming orthopedic surgeons rely more on evidence to treat their patients than their experience.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Masic I, Miokovic M, Muhamedagic B. Evidence based medicine – New approaches and challenges. Acta Inform Med 2008;16:219-25.
Sackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine: How to Practice and Teach. 2nd
ed. Edinburgh: Churchill-Livingstone; 2000.
Balaji SM. Role of research evidence in clinical decision-making: Intuition versus clinical experience versus scientific evidence. Indian J Dent Res 2018;29:543-4.
] [Full text]
Clinical Practice Guidelines by the American Academy of Orthopaedic Surgeons. Available from: https://www.aaos.org/cpg/
. [Last accessed on 2019 Aug 01].
AAOS Published Clinical Practice Guidelines And/or Systematic Review Recommendations in a User-Friendly Website, Please Visit. Available from: http://www.orthoguidelines.org
. [Last accessed on 2019 Aug 01].
Sharma UK, Shrestha BK, Rijal S, Bijukachhe B, Barakoti R, Banskota B, et al
. Clinical, MRI and arthroscopic correlation in internal derangement of knee. Kathmandu Univ Med J (KUMJ) 2011;9:174-8.
Monzón DG, Vazquez J, Jauregui JR, Iserson KV. Pain treatment in post-traumatic hip fracture in the elderly: Regional block vs. systemic non-steroidal analgesics. Int J Emerg Med 2010;3:321-5.
Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med 2000;132:173-81.
Armstrong T, Dale AM, Franzblau A, Evanoff BA. Risk factors for carpal tunnel syndrome and median neuropathy in a working population. J Occup Environ Med 2008;12:12.
Lundsgaard C, Dufour N, Fallentin E, Winkel P, Gluud C. Intra-articular sodium hyaluronate 2 mL versus physiological saline 20 mL versus physiological saline 2 mL for painful knee osteoarthritis: A randomized clinical trial. Scand J Rheumatol 2008;37:142-50.
Robinson KS, Anderson DR, Gross M, Petrie D, Leighton R, Stanish W, et al
. Ultrasonographic screening before hospital discharge for deep venous thrombosis after arthroplasty: The post-arthroplasty screening study. A randomized, controlled trial. Ann Intern Med 1997;127:439-45.
Holen KJ, Tegnander A, Bredland T, Johansen OJ, Saether OD, Eik-Nes SH, et al
. Universal or selective screening of the neonatal hip using ultrasound? A prospective, randomised trial of 15,529 newborn infants. J Bone Joint Surg Br 2002;84:886-90.
Lambert RG, Hutchings EJ, Grace MG, Jhangri GS, Conner-Spady B, Maksymowych WP. Steroid injection for osteoarthritis of the hip: A randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2007;56:2278-87.
Smith EB, Cai J, Wynne R, Maltenfort M, Good RP. Performance characteristics of broth-only cultures after revision total joint arthroplasty. Clin Orthop Relat Res 2014;11:3285-90.
Oakley E, Barnett P, Babl FE. Backslab versus nonbackslab for immobilization of undisplaced supracondylar fractures: A randomized trial. Pediatr Emerg Care 2009;25:452-6.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]