Does Evidence-Based Practice Mean Only Doing What Has an RCT Behind It?

A Frequently Misunderstood Term

"Evidence-based practice" is sometimes interpreted — by critics and overly rigid practitioners alike — to mean that a clinician should only ever use techniques with a large randomised controlled trial directly supporting them, and nothing else.

What the Term Was Actually Meant to Describe

This is a significant distortion of the concept's original definition. The foundational paper establishing evidence-based medicine explicitly defined it as the integration of the best available external evidence with individual clinical expertise and the specific values and circumstances of the patient — a deliberate three-part model, not a demand for trial evidence alone (Sackett et al., 1996).

Why the Full Definition Matters in Everyday Practice

Under this original, correct definition, a clinician practising genuinely evidence-based care reasonably draws on general physiological principles, their own clinical experience and pattern recognition, and the individual patient's preferences and presentation, particularly in situations — common throughout musculoskeletal practice — where a specific, perfectly matched randomised trial simply does not exist for the exact clinical scenario in front of them.