Rating the Levels of Evidence in Sports-Medicine Research

Dolan, Michael G.; Medina, Jennifer M.; Hertel, Jay

doi:10.1123/att.11.5.38

Cited by 26 publications

(9 citation statements)

References 2 publications

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“…One aspect of the CAT that is important to informing clinical practice is the strength of recommendation. 3 The strength of recommendation is based on the quality and consistency of the external evidence that was used to develop the clinical bottom line. While the sources of external evidence may be high quality, the answer may not necessarily be implemented easily or efficiently.…”

Section: A Cat's Life In Clinical Practicementioning

confidence: 99%

How Many Lives Does a CAT Really Have?

McKeon¹

2018

International Journal of Athletic Therapy and Training

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Section: A Cat's Life In Clinical Practicementioning

confidence: 99%

How Many Lives Does a CAT Really Have?

McKeon¹

2018

International Journal of Athletic Therapy and Training

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“…Patientoriented evidence-outcomes that were selected because of their direct impact on patients-is considered more favorable when compared to disease-oriented evidence. 2 (For a quick review on patient-oriented vs. disease-oriented evidence, see Table 1.) Additionally, studies that tend to limit the threats to internal validity (studies that have low risk of bias) are also considered more favorable than studies with more risk of bias.…”

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confidence: 99%

“…Additionally, studies that tend to limit the threats to internal validity (studies that have low risk of bias) are also considered more favorable than studies with more risk of bias. 2 Ultimately, from the SOR perspective, evidence that is generated from patientoriented outcomes, and has little risk of bias, is ranked higher. Finally, there are elements of quantity and consistency that have to be incorporated into the SOR grade.…”

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From Strength of Recommendation to Clinical Implementation: Weighing and Considering the Evidence

McKeon

2019

International Journal of Athletic Therapy and Training

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Read not to contradict and confute, nor to believe and take for granted . . . but to weigh and consider." -Francis Bacon A highly promoted element of evidence-based practice (EBP) is the Strength of Recommendation (SOR). The SOR is usually a letter grade (A, B, or C) and is a composite mark based on the quantity, quality, nature, and consistency of the external evidence. These SOR grades are most conspicuous to readers who are consuming Critically Appraised Topics (CATs) and Systematic Reviews, as well as Position Statements and Consensus Statements. The Strength of Recommendation Taxonomy (SORT) 1 was developed by a consortium of family medicine physicians, and was designed to help clinicians rate the available external evidence (research) when used for clinical decision-making. Patientoriented evidence-outcomes that were selected because of their direct impact on patients-is considered more favorable when compared to disease-oriented evidence. 2 (For a quick review on patient-oriented vs. disease-oriented evidence, see Table 1.) Additionally, studies that tend to limit the threats to internal validity (studies that have low risk of bias) are also considered more favorable than studies with more risk of bias. 2 Ultimately, from the SOR perspective, evidence that is generated from patientoriented outcomes, and has little risk of bias, is ranked higher. Finally, there are elements of quantity and consistency that have to be incorporated into the SOR grade. The SOR grade is not created in the vacuum of a single study. The more studies that are included and the more studies included that "say the same thing" will also enhance the SOR grade. Briefly, the SOR is generated through a synthesis of the (1) quantity of external evidence used to answer a clinical question, (2) quality of the external evidence, (3) nature of the outcomes of interest, and (4) consistency of the results.Before we go into what the SOR means, we will quickly outline these four SOR inputs (see Figure 1):1. The quantity of the external evidence:One of the hallmarks of scientific research is the reproducibility of results, especially through independent investigations. In general, the SOR is based on more than one research study. In other words, "all" of the studies that address a particular research question are taken into account to generate the SOR grade. Multiple investigations on independent samples that all come from the same population of interest help to paint a clearer picture of the actual behavior likely found in that population. With quantity of the external evidence, more is better. . . but, not the only determining factor. 2. The quality of the external evidence:As we have outlined in past editorials and papers, 3,4 study designs can be ranked on a hierarchy that is based on potential bias that might be introduced by investigators. These biases can alter the interpretation of the internal and external validity of that study. There is an appreciable balancing act between control (internal validity) and generalizability (external vali...

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“…We tended to look shamefully upon the foundation of our EBP pyramid (undocumented clinical experience) and praise the glory of the randomized controlled trial. 1,2,4,5 This is not a completely inappropriate way of thinking, but it certainly was too limited. Even though we would repeatedly state, "the three elements of EBP-the best-available research, clinician expertise, and patient values-are all weighted equally", we tended to believe that "evidence-based" really meant "research evidence-based".…”

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Patient Evidence (AKA, Boy, Patients Complicate Our Clinical Practice)

McKeon¹

2017

International Journal of Athletic Therapy and Training

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he mission of IJATT is to publish peer-reviewed reports pertaining to clinical applications of research findings; procedures found to be effective in the recognition, rehabilitation, and prevention of sport-related injuries; and professional practice issues. The major tenet of our mission is to help clinicians find balance between the best available research evidence and their own clinical expertise when making clinical decisions. Over the past 3 years, we have developed a series of editorials to highlight the delicate balance between control and generalizability in clinical research, 1 the importance of the integration of external evidence (best available research) and internal evidence (clinical expertise) when making clinical decisions, 2 and the necessity of outcomes in legitimizing our professional knowledge and ability.3 However, we have not yet provided framework for patient values and preferences, the often forgotten component of evidence-based practice and practice-based evidence.In the midst of adding EBP continuing education requirements for athletic trainers, there emerged a trend to consider clinicians as "in the wrong" by using interventions that were not "evidence-based"… and by 'evidence', it is implied that this is actually 'research-evidence'. We tended to look shamefully upon the foundation of our EBP pyramid (undocumented clinical experience) and praise the glory of the randomized controlled trial.

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Rating the Levels of Evidence in Sports-Medicine Research

Cited by 26 publications

References 2 publications

How Many Lives Does a CAT Really Have?

How Many Lives Does a CAT Really Have?

From Strength of Recommendation to Clinical Implementation: Weighing and Considering the Evidence

Patient Evidence (AKA, Boy, Patients Complicate Our Clinical Practice)

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