What constitutes good trial evidence?
In this paper the authors will discuss the randomised controlled trial, in the context of evidence-based practice. This paper aims to provide clinical midwives with some insight into what makes a good trial paper, highlighting the main areas where there are often misunderstandings of the appropriateness of trial methodology within individual studies. Being able to determine what constitutes good trial evidence is important in determining which evidence should be applied to practice.
Evidence-based practice has been the mantra within health settings over the last 2 decades. It is a phrase that can be found in the majority of academic texts and assignments of most midwifery students. Several definitions have been proposed to describe evidence-based practice; the most often cited is that by Sackett et al (1996: 71), who stated that evidence-based health care is:
‘…the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients [women]. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.’
This definition includes the woman at the centre of care and integrates clinical expertise with the best available research evidence, making it appropriate for midwives. However, given the volume of evidence being produced through research and the limited resources and/or ability of some midwives to assess the research thoroughly, determining what the best evidence is can remain a challenge. Moreover, perhaps the over usage of the term ‘evidence-based practice’ as a blanket justification for the care provided, undermines the importance of determining what constitutes strong or poor evidence.
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