Rev Bras Fisiol Exerc 2020;19(3):178-79
EDITORIAL
Safe
and effective praxis without scientific evidence: is it possible?
Jefferson Petto1,2,3,4,
Igor Macedo de Oliveira1,3,5, Alice Miranda de Oliveira1,2,
Marvyn de Santana do Sacramento1,2,3
1ACTUS CORDIOS Reabilitação Cardiovascular, Respiratória e Metabólica, Salvador, BA, Brasil
2Centro
Universitário Social da Bahia, Salvador, BA, Brasil
3Faculdade do Centro
Oeste Paulista, Bauru, SP, Brasil
4Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
5Centro Universitário UniRuy, Salvador, BA, Brasil
Corresponding author: Marvyn
de Santana do Sacramento, Av. Anita Garibaldi, 1815, CME, Sala 13 Ondina 40170-130
Salvador BA
Jefferson Petto:
gfpecba@bol.com.br
Igor Macedo de
Oliveira: igormacedoliveira@hotmail.com
Alice Miranda de
Oliveira: alicemofisio@gmail.com
Marvyn de Santana do
Sacramento: marvynsantana@gmail.com
The earliest accounts of scientific thought date back to thousands of
years BC, where problems in the daily lives of our predecessors led to the
search for effective and replicable forms of resolution. Nowadays, in the
advent of science and technology, health professionals' decision making has
been organized based on the analysis of the diverse evidences available in the
scientific literature. This process has been identified like Evidence Based Practice
(EBP).
EBP originated in Canada around the 1980s. It emphasizes the use of
research to guide clinical decision making [1] in order to provide the patient
with the best treatment and to avoid iatrogenesis. However, for EBP to work,
health professionals are required to critically analyze the available
scientific literature. This analysis involves aspects such as the observation
of the study designs, identification of possible methodological biases,
analysis of the applied statistics and the similarity between the study
population and the one to be treated [1]. But when is the existing evidence
insufficient?
Sometimes, given certain clinical situations, health professionals do
not figure out clear and forceful answers in the scientific literature. We, who
advocate for Cardiovascular Rehabilitation, are often supported by a vast
literature that helps us to make safe and effective therapeutic decisions.
However, we come across cases where we do not get this support. We recently
received a case of Ebstein Syndrome and a
non-Ischemic Ventricular Aneurysm case in our clinic. Two cases in which the
scientific literature is scarce and almost nonexistent in the prescription of
physical exercise. So, we come across questions like: Is there any
contraindication regarding the practice of exercise in these cases? What is the
benefit of exercise for these patients? What should the exercise prescription
be for these patients if there is no contraindication?
Faced with such pictures, we ask - how to proceed? In such situations,
resources can be valuable biological rational and accumulated practical
practice. The biological rationale is grounded in a vast and long knowledge of
the core disciplines in the field of exercise. The disciplines of histology,
anatomy, kinesiology, physiology, pathophysiology, and exercise physiology are
essential for practitioners who use physical exercise as our therapeutic
resource health promotion. Therefore, note that it is impossible to acquire
this knowledge in a short time. This is a continuous and often arduous process
that must be perpetuated throughout our professional journey. In the examples
we cited, we could only decide because we had the basic knowledge to infer
answers to the questions that arose before the cases in question. We did not
have the time to review all the background literature for a later therapeutic
decision. The knowledge accumulated through constant improvement has enabled
proper scrutiny.
Unfortunately, few students and professionals understand the importance
of continuing qualification. This culminates in improper therapeutic decisions
that place a burden on patients, institutions and governments because they are
sometimes ineffective, sometimes harmful. Even when it is possible to exercise
EBP, it is necessary that there are professionals with leather knowledge and
who are in a permanent intellectual growth to apply it. Just as there is no
biological rational decision-making without consistent reasoning, there is no
EBP performed by professionals with poor knowledge.
The second aspect, experience, is a virtue acquired during time.
Exposure to practice improves judgment because it allows us to accumulate
experience that will inform future decisions. When we encounter rare cases,
such as the ones we mentioned earlier (Ebstein's
Syndrome and non-ischemic ventricular aneurysm), previous or unsuccessful
experience guide the conduct of a new case with the same problem. Even with the
inherent peculiarities, previous similar cases generate important support in
the adoption of future therapeutic decisions.
That is why we consider it so important to share experience among
professionals, whether at congresses, symposiums or expert meetings. Perhaps,
for a short time, this is an uncommon practice. A good solution for this is
sharing experience by publishing case reports in scientific journals.
Professionals should be encouraged to record and report on their experience. A
case report can serve as a basis (practical biological rationale) for other
professionals facing a similar situation, as well as for compelling and
cause-effect observational studies that will one day be the basis of EBP.
Finally, in response to the title of this article - yes, it is possible
to exercise safe and effective praxis even in the absence of scientific
evidence supporting the treatment. However, whether for the exercise of EBP, or
for treatments based on biological rationale and practical experience, it is
necessary not to forget the need for coexistence of professionals who excel for
a profound knowledge and renew themselves in continuity. Therefore, we invite
your student or professional, to put another brick in the construction of your
knowledge, with the careful and critical reading of this new edition of the Revista Brasileira de Fisiologia do Exercício.