Advancing evidence based musculoskeletal physical therapy.

Evidence-based practice is defined as the “integration of the best research evidence with clinical expertise and patient values” (Sackett et al., 2000. p1). Central to this definition are both the development of an evidence base and the use of that evidence in practice to inform decision-making. It is widely acknowledged that the evidence base of physical therapy is improving, with for example, increasing numbers of trials and systematic reviews detailed within the Physiotherapy Evidence Database PEDro. However, studies suggest that a delay exists for implementing evidence in practice (Grimshaw and Eccles, 2004) and that clinical practice does not fully reflect this evidence base. Many issues contribute to this evidence-practice gap, including access to evidence and problems in evaluating the evidence (Maher et al., 2004), as well as organisational, educational and health policy issues (Haynes and Haines, 1998). The current international economic difficulty contributes further to the many challenges to research and clinical practice in musculoskeletal physical therapy. It is therefore important to recognise our pioneers, who themselves have faced many challenges throughout their careers, and yet have advanced musculoskeletal practice both through research to provide evidence, and through facilitating its implementation into practice over several decades. The following descriptions of contributions from three such pioneers remind us of their importance: