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Evidence-based practice or practice-based evidence? Why pursuing level 1 evidence is leaving lymphoedema behind

Jan Douglass
15 August 2022

Randomised controlled trials (RCT) have been held as the pinnacle of evidence for health interventions for over half a century and are frequently used in research on lymphedema, yet little in lymphoedema management is suited to an RCT. Nevertheless, multiple systematic reviews (SR) have been conducted, delivering results which are sometimes at odds with clinical observation and leaving therapists and patients confused. Chronic conditions require complex management integrating patient and environmental considerations, so the way that data on interventions is aggregated and synthesised needs to reflect this. In general, evidencebased public-health is moving rapidly towards accepting other levels of evidence for chronic conditions, however SR on interventions for lymphoedema are yet to include these methods.

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