Evidence-based Sports Medicine

Evidence-based Sports MedicineMedicine and Physical Fitness, and Physical Therapy, randomisedcontrolled trials comprised around 10% of all original researcharticles. Cohort, case control and single case study designs comprisednearly 46% of published work across all four journals, withobservational descriptive and case studies making up the remaining43%. This compares with published methods used in otherdisciplines.More than 50% of studies published in a five year period in threeUK primary care journals, the British Journal of General Practice (BJGP),Family Practice and the British Medical Journal (BMJ) were eitherqualitative studies or surveys of attitude and opinion. 3 A greaterproportion of randomised controlled trials were published in theBMJ (16%), although only 6% of studies overall were randomisedcontrolled trials. The proportion of randomised controlled trialspublished in US family medicine 4 is also relatively small at 3·4%.Other disciplines show a similar pattern. In a review of nine generalsurgical journals, 46% were case series with only 7% randomisedcontrolled trials. 5 In six community health journals, 4% wererandomised controlled trials and the authors suggested that 42%percent of the other trials could have used a randomised studydesign. 6 In a study of seven leading rheumatological journals 16%were classified as randomised controlled trials. 7Clinical medical care should, ideally, be based on robust evidence.This is not always possible but every attempt should be made to usethe highest quality evidence available. The strongest evidencesupporting clinical intervention is through a meta-analysis orsystematic review of randomised controlled trials. But, in many cases,this evidence is not available in a form appropriate to every case andclinicians must decide for themselves based on the best availableevidence. Researchers can provide evidence, but the challenge, formost clinicians, is in interpreting this evidence. We should all,therefore, have some knowledge of the skills required to read criticallyand evaluate the evidence presented in a paper. This chapter looks atthe principles of evidence-based medicine and how to appraise thesports medicine literature.Sifting and appraising the literatureWe cannot read everything so we must triage the literature by itsrelevance to our clinical practice, educational value, and how effectivelyit can be applied in practice. The READER acronym 8 is a useful modelfor literature assessment and is one of the few methods that have beenformally validated. 9 It offers a foundation upon which we may buildour critical evaluation skills but the final interpretation of research4