EBM (Evidence-Based Medicine), EBP (Evidence-Based Practice), and PBE (Practice-Based Evidence): Bridging the Gap Between Research and Clinical Practice

Introduction: The Current Landscape of "Evidence" in Healthcare and Rehabilitation

In the fields of healthcare and rehabilitation, the importance of providing treatment based on 'scientific evidence' has become a universally accepted standard that no one would deny. However, when we hear the word 'evidence,' do we truly understand its meaning and how it connects to the clinical floor?

In this article, we will sort out the differences between the frequently heard terms EBM (Evidence-Based Medicine) and EBP (Evidence-Based Practice), alongside the perspective of Practice-Based Evidence (PBE), which has been gaining attention in recent years.

Basics of EBM and EBP: What Is the Difference?

• "What is EBM (Evidence-Based Medicine)?
  • According to the definition proposed by David Sackett and colleagues in 1996, EBM is 'the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients^1-3'.
  • It does not simply mean following journal data, but rather refers to an approach that integrates three elements: 'best available external clinical evidence,' 'individual clinical expertise,' and 'patient's rights and preferences in making clinical decisions about their care¹'.
• The Expansion to EBP (Evidence-Based Practice)
  • While EBM primarily developed with 'medicine' as its central focus, EBP (Evidence-Based Practice) is used as a broader term that covers the entire spectrum of clinical practice across multiple professions, including physical therapists, occupational therapists, and nurses³.
  • However, in actual clinical settings, the 'Evidence-Practice Gap'—the difficulty of effectively integrating research results into daily care—remains a significant challenge³.

From 'Evidence to Practice' to 'Practice to Evidence

The mainstream of traditional scientific approaches has been a top-down perspective of how to bring evidence proven by randomized controlled trials (RCTs) down to the clinical floor (Evidence-to-Practice).

However, the actual real-world clinical setting, unlike a laboratory under strict control, is a complex place visited by patients with diverse backgrounds. This is where difficulties in communication between researchers and clinicians, as well as gaps, arise.

This is why the reverse direction, the concept of 'Practice-to-Evidence,' becomes important⁴.

The New Option of Practice-Based Evidence (PBE)

Proposed as an alternative approach to traditional RCTs and conventional observational studies is 'Practice-Based Evidence (PBE)' by Susan Horn and colleagues⁴.

• Characteristics of PBE⁴:
  • It focuses on data from real-world clinical settings where daily routine care takes place, rather than in controlled environments.
  • It addresses practical questions such as 'What interventions have what risks and benefits, and what outcomes do they lead to in actual clinical practice?'
  • It serves as a powerful means for clinicians, patients, and researchers to learn from everyday clinical practice and mutually improve clinical care.

Summary: Not Being Misled by the Word 'Evidence

Neither the top-down perspective of how to bring research-proven interventions down to the clinical floor (Evidence-to-Practice) nor the bottom-up perspective of spinning data from the realistic practices of daily clinical work (Practice-to-Evidence / PBE) is an absolute, sole correct answer. Rather than being mutually exclusive, these are recognized internationally in clinical and research settings as complementary to one another.

When emphasizing the importance of PBE, there is a risk of becoming overly conscious of traditional EBM and EBP and falling into a trap of verbal opposition. What matters most is that we continue to engage in careful, respectful communication across professions and roles regarding 'which evidence we are capturing, how we perceive it, and how we apply it to the patient right in front of us.' Particularly when the word 'evidence' is left to walk on its own, it often becomes difficult to share the nuances behind each perspective, leading to misunderstandings.

Even if expressions and approaches differ, the underlying essence remains unchanged: we are all striving toward the goal of 'providing better care for our patients.' Without being swayed by the sound of words or temporary trends, understanding the strengths of each concept and continuing to face our patients with sincerity is, I believe, what matters most in clinical practice moving forward.

References

1. Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. BMJ (Clinical research ed.), 312(7023), 71–72. https://doi.org/10.1136/bmj.312.7023.71
2. Isaac, C. A., & Franceschi, A. (2008). EBM: evidence to practice and practice to evidence. Journal of evaluation in clinical practice, 14(5), 656–659. https://doi.org/10.1111/j.1365-2753.2008.01043.x
3. Kim, S. Y. (2025). Evidence-based practice and evidence-practice gap: status, challenges, and solutions. J Evid-Based Pract, 1(1), 1-6. https://doi.org/10.63528/jebp.2025.00001
4. Horn, S. D., DeJong, G., & Deutscher, D. (2012). Practice-based evidence research in rehabilitation: an alternative to randomized controlled trials and traditional observational studies. Archives of physical medicine and rehabilitation, 93(8 Suppl), S127–S137. https://doi.org/10.1016/j.apmr.2011.10.031