Understanding evidence-based medicine using a funnel analogy

Abstract

The framework of evidence-based medicine (EBM) consisting of the best available external evidence, clinical expertise, and patient values/circumstances is often described by educators and clinicians as “three legs to a stool”. Unfortunately, this analogy seems to be easily misunderstood as separate pillars equally weighted and considered independently from each other. This may be causing confusion and imperfect adoption by physical therapists. EBM may be better described as a sequential “funneling down” of information instead of as a three-legged stool. The totality of the evidence goes in at the top to be synthesized by clinical expertise into manageable concepts that can then be presented as options to the patient who is the ultimate decision maker. This may be a better way to process information into a more usable format for the support of patients.