Evidence-based practice, the magic words that I have been hearing buzzing around for the last 10 years. “Is your work evidence-based?” “We have to work evidence-based, otherwise……”
I heard it from physical therapists, doctors and sport scientists.
As a coach my reply to the first question was: “no, definitely not”, and to the second one: “I don’t have to do that, and I am grateful for that……”
And no, I am not hiding behind the often heard statement of coaches that “their evidence is in their medals or victories of their athletes and teams”.
A long time ago I used to have a colleague who was very good coach. He decided to go and study exercise physiology. A few years later he came to the track and questioned the idea that I was trying to increase the ATP and CP levels and the activity of the related enzymes in the muscles of my sprinters. Not a lot of research has been done in that area. And I answered him: “Look, my athletes need to be trained now. I just can’t wait until everything is proven by science, but if you want to do the research and tell in 5 years’ time that I was right, please go ahead…..”.
Most coaches aren’t directly interested in the mechanisms behind the improvement of their athletes. They know, they assume, they have learned from reality that it works, at least for some of their athletes. Most of the time they find out by accident, by copying other coaches’ programs or by trial-and-error.
Coaches are always under time pressure, there is always a short-term goal to accomplish, a tournament, a championship within the next weeks or months. They are not interested in generalized research that hardly applies to their specific athletes, research derived from basic science, from test tubes, rats or sport students.
In many cases coaches see little value to be derived from science with its myopia, its models, its simplifications of the real world and its singular variables.
And in the short term they are right: science and coaching have different agendas, different goals, and different time frames. But in the long-term, coaches should be interested in science in order to improve their knowledge and understanding of their field, otherwise they can be blamed for myopia, and relying on simple models and singular variables like medal counts.
Ok, let’s talk about evidence, but what is the value of evidence
Nowadays it is hard to find consensus on a specific subject or an intervention, especially when there are so many limitations to research: e.g. the effects of an intervention in the short-term e.g. a few weeks of intervention in research, but not in the long-term e.g. the career of an athlete.
Or the value of research coming from the average athlete or sport student, applied to the elite athlete, the genetic freak that you happen to coach.
But anxiety, uncertainty, insecurity and the fear to take responsibility seem to have become the markers of modern society. We love evidence-based, protocols, prescriptions, simple and clear-cut solutions for complex problems. So if it fails we can say: “we followed this protocol, so …..”. In other words, you learn not to think and be critical, not to have your brain work out a creative solution yourself. Yes, there is safety in numbers.
Evidence-based is also leading to lack of creativity, and to slowing down of innovative thinking. Innovative solutions don’t carry much evidence, otherwise it wouldn’t be innovative. Evidence based practice creates marginally effective interventions or training, and is based on population averages instead of individual needs.
Evidence-based practice, while it started off with good intentions, is in crisis. It is an illusion to think that all of our decisions and actions can be based on rational evidence only, especially in medicine, where anything that was not based on randomized, double-blind, placebo controlled trials would be viewed with suspicion.
Smith and Pell in their article gave a good example of the fact that there has never been a thorough research done on the effectiveness of the use of a parachute, while jumping out of a plane, compared to not using a parachute.
Smith, G.S.C; Pell, J.P: Parachute used to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trails; Br.Med.J. Vol.327, pg.1459-1461.
Williams, D.D.R; Garner, J: The case against “the evidence” a different perspective on evidence-based-medicine; Br.J.Psychiatry; Vol.180, 2002, pg.8-12.
Greenhalgh, T; Howick, J; Maskrey, N: Evidence based medicine: a movement in crisis? Br.Med.J. Vol.348, g3725, 2014, pg.1-7.