What is Evidence-Based Practice?

Evidenced-based practice is a buzz word being used in most health and education fields. Evidenced-based practice is an integration of the best available evidence (research) combined with clinical expertise. This approach includes five steps, illustrated nicely in an article posted on the Music Therapy Research Blog:

  1. Forming a question (For a child with Autism, is it better to use a fine motor intervention or sensory integration?)
  2. Identifying articles and other resources that answer the question [Pfeiffer et al. (2011)]
  3. Evaluating the evidence (“This was a nice pilot study on SI for children with ASD; however, a diagnostic testing for a more homogeneous participant sample would have made the study stronger.” from the article by Blythe Lagasse)
  4. Applying the evidence (“As a MT clinician, I use therapy balls and sensory supports for children with ASD.”)
  5. Re-evaluating the application of evidence (“I won’t change my use of sensory accommodations based on these studies (too preliminary)”)

Refer to the full discussion for the best illustration of evidenced-based practice.

Technology is what made evidence-based practice the standard. Because of online searches and the ability to get information fast, we can now look at new research easily and apply it. The major role of evidenced-based practice is to identify what we know and what we don’t know. Lagasse stated at the end of the article, “I would like to see a study that incorporated rhythm in order to determine if this auditory modality can enhance sensory experiences for children with ASD.” So she looked at the research, identified some information that may inform her practice, but also identified an area for further research.

Evidence-based medicine was first mentioned in the Journal of the American Medical Association in 1992. Prior to that, doctors often practiced “eminence-based medicine.” In other words, they did what their professors taught them to do, combined with their own clinical judgment. I think most music therapists are using eminence-based practice currently, probably because while the current music therapy research is very good, it is still developing. Due to the nature of our work, studies often use very small sample sizes and have not yet been replicated.

From evidence-based practice, evidence-based guidelines are developed. These are usually best-practice guidelines that are created by a committee of experts in the field that analyzes the research and uses their clinical judgment to publish guidelines for treatment. The American Music Therapy Association has some publications that move towards evidence-based guidelines, but again music therapy is still developing the research to create these guidelines.

Here are some questions you can ask your music therapist (or doctor, or educator) to find out about the evidence supporting the treatment:

  • Why are you recommending that treatment for me?
  • How extensively has this treatment been studied?
  • Has this treatment been studied in people like me (in terms of gender, race, age, diagnosis)?
  • Is there evidence for this treatment?
  • What is the kind and quality of that evidence?
  • What does the evidence say about the risks and possible side effects?
  • Has the treatment been studied by a music therapy (or physician, or education) committee and incorporated into an evidence-based guideline? If so, what does the guideline recommend?

(Adapted from Neurology Now, November/December 2010, p. 28)