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Critically appraising the evidence to help our patients with overload syndromes: should we prioritise knowledge from observational studies and focus on ‘the essentials’?
  1. Marinus Winters
  1. Correspondence to Dr Marinus Winters, Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; marinuswinters{at}hotmail.com

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Sarah enjoys 10K runs on Saturdays and Sundays. After the summer, she decided to prepare for the London Marathon. Within 1 week, she increased her loading to 35K in the weekends and added 8K on Wednesdays. Today, she presents with shin pain. She has continued running for 3 months with deteriorating pain. History and physical examination reveal that Sarah has bilateral medial tibial stress syndrome (MTSS).1 The marathon is only 4 months away; how can we help Sarah best?

Critically appraising the evidence: can it inform your practice?

Evidence-based practice (EBP) ‘…is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients’.2 Systematic reviews and randomised controlled trials (RCTs) form the highest levels of evidence to inform clinical practice. A key aspect of EBP is to critically appraise the evidence. To this end, there are four considerations to inform the care for your patient with an overload syndrome:

Is the evidence trustworthy?

Most RCT outcomes are at high risk of bias, meaning that we cannot …

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