So far in this series, you’ve learned why research is important and how to find free, quality sources. But, how do you know if the study you’re referencing is unbiased and high-quality? Thanks to the raging climate debate that’s been going on for years, most of us understand that research can be skewed to support an agenda.
We can’t simply trust the conclusion of a study or published paper without investigating the quality of the study itself. The future of veterinary medicine lies in evidence-based medicine, which means we should tailor our practice to follow proven, reliable research.
A gold-standard study will:
- Include a high number of studied participants (>1,000 is a good number)
- A smaller study may have intriguing results but will always require a larger number of participants to prove statistically significant results.
- Be repeated in different locations (called a multi-center or cohort study)
- Be modeled as one of the following:
- Prospective — The researchers conceive of and design the study, recruit subjects, and collect baseline evidence. This is better than a retrospective study, where researchers look backward, because retrospective studies:
- Include more potential sources of bias and confounding variables
- Cannot control for the random variables that develop from each unique case
- Placebo-controlled — An inert substance is given to one group of participants (control group), while the other group gets the treatment prescribed by the study (experimental group).
- Double-blinded — Designed so researchers and participants do not know who is in the experimental group and who is in the control group. This is better than an unblinded study because:
- It reduces the “placebo effect” from participants
- It eliminates bias from the scientist
- With a placebo control, results are not as easily manipulated
- Prospective — The researchers conceive of and design the study, recruit subjects, and collect baseline evidence. This is better than a retrospective study, where researchers look backward, because retrospective studies:
I know that learning all these terms for the first time can be overwhelming, so take your time to investigate each until you feel comfortable. Once you have a good handle on the definitions of the terms, you can move on to the next steps.
The more nuanced details of evaluating studies are important. Find additional information at “Critical Appraisal of Scientific Articles” on the National Center for Biotechnical Information website, which is also a free reputable source for full-text studies (but each study must still be evaluated for its quality).
When evaluated by an expert third-party council, studies are assigned a specific level of evidence score. Following a level of evidence score is beneficial because that means all of the evaluating has already been conducted by a reliable, unbiased person. Here’s what the scoring system means:
- Level I: A high-quality prospective cohort study with adequate power or systematic review of the studies
- Level II: A lesser-quality prospective cohort, retrospective cohort, untreated controls from an RCT, or systematic review of these studies
- Level III: A case-control study or systematic review of these studies
- Level IV: A case series
- Level V: An expert opinion; case report or clinical example; or evidence based on physiology, bench research, or “first principles”
These third-party councils take the now-graded research and use it to provide recommendations. They indicate the strength of the recommendation based on a grade:
- Grade A:
- Strong recommendation
- Based on level I evidence or consistent findings from multiple studies of levels II, III, or IV
- Grade B:
- Recommendation
- Based on levels II, III, or IV evidence, and findings are generally consistent
- Grade C:
- Optional
- Based on levels II, III, or IV evidence, but results are inconsistent
- Grade D:
- Optional
- Based on level V evidence, with little or no systematic empirical evidence
Finding these levels of evidence and recommendations can help shortcut your research, but plenty of research within the veterinary community has not been evaluated, so being able to do it on your own is important.
Now that you’ve conducted some great research, it’s time to present it to your practice leadership so you can affect positive change. Stay tuned: The final post in this series will tell you how.
Erin is an ECC specialty certified technician living in beautiful Fort Collins, Colorado. She shares her home and heart with her boyfriend, Bradford, and their chatty kitty, Kevin. While dangerously close to a workaholic, Erin and Bradford still find time to travel together. Erin also enjoys being an amateur home chef, taking photographs, and riding her horse, Katie. Professionally, Erin is passionate about the subject of technician empowerment.