Volume 85, Issue 9 , Page 1561, September 2004
Evidence-based PM&R? yes!
Article Outline
Only now have we had the opportunity to analyze the correspondence of Pittler and Ernst,1 published in Archives in 1997, and we came to other conclusions. The study consisted of the search for the term evidence-based in the title or abstract of articles indexed, between 1990 and 1997, in the MEDLINE database and the 9 major impact factor-rated physical medicine and rehabilitation (PM&R) journals (Archives of Physical Medicine and Rehabilitation, American Journal of Physical Medicine and Rehabilitation, Physical Therapy, Scandinavian Journal of Rehabilitation Medicine, Journal of Rehabilitation Research and Development, Supportive Care in Cancer, Prosthetics and Orthotics International, Journal of Orthopaedic and Sports Physical Therapy, Journal of Manipulative and Physiological Therapeutics). Pittler and Ernst concluded that there was a significant increase of interest in evidence-based medicine (EBM) in the total biomedical literature but not in the PM&R literature. Their conclusions were based on analyses of the absolute number of articles found in their search.
Use of absolute frequency biased the interpretation of the results. In the considered period, there is an enormous discrepancy between the number of indexed articles in the chosen journals (5584) and the entire MEDLINE database (3,345,171). It is not clear whether the total number of articles and those retrieved as containing the term evidence-based in the PM&R journals were part of the total MEDLINE database in the analyses.
We replicated the research, using the same methodology Pittler and Ernst described.1 Our analyses, however, were based in the relative frequency of publications, which are mutually exclusive. We considered in the denominator the total number of indexed articles. We also updated the data to the year 2003 (fig 1). For this new period, the impact factors of PM&R journals varied between 0.75 and 1.15.2 Moreover, with the intention of enriching the theme, we adopted the same strategy for the 5 most important journals in general medicine (New England Journal of Medicine, Lancet, JAMA, BMJ, Annals of Internal Medicine) for which the impact factors varied between 6.63 and 29.07.2
Fig 1.
Percentage of articles using the term evidence-based in the title or abstract in the journals with the highest impact factors in general medicine, PM&R, and the rest of the biomedical literature, all indexed in MEDLINE.
The results obtained showed that, in relative terms, evidence-based started being used in general medicine journals in 1993. Only 3 years later, the PM&R journals, first, and later the rest of the biomedical literature, joined this movement. Surprisingly, from 2000 on, this terminology was implemented more frequently in the specialized PM&R literature. We noticed that the Pittler and Ernst letter, up to now, has received 5 citations.2 In at least 1 of these citations, the context intended to show the scarcity of publications about EBM in PM&R literature,3 an affirmation with which we disagree.
Even though it has been 6 years since Pittler and Ernst reported their findings,1 we believe there is always time for reconsideration. EBM is among the most stimulating and well-known practices in medicine, including PM&R.4, 5 Critical evaluation of the literature, including letters, is among the premises of EBM.
References
- . Evidence-based PM&R? [letter] . Arch Phys Med Rehabil . 1997;78:1281
- . Journal citation reports . Philadelphia: ISI; 2001;
- . The 31st Walter J. Zeiter Lecture. Issues and challenges for physiatry in the coming decade . Arch Phys Med Rehabil . 1999;80:1–12
- . Shaping the future of medical rehabilitation research (using the interdisciplinary research model) . Arch Phys Med Rehabil . 2004;85:531–537
- . Physiotherapists’ use of evidence based practice (a cross-national study) . Physiother Res Int . 1997;2:17–29
PII: S0003-9993(04)00867-6
doi:10.1016/j.apmr.2004.07.131
© 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Volume 85, Issue 9 , Page 1561, September 2004
