“The 3Rs are dead; long live the 3Rs.” So might a herald cry from the battlements of an evidence-based hill. Sharon Straus and Brian Haynes have captured beautifully the need to move beyond just publishing your paper to making evidence available that is ‘reliable, relevant, and readable’.
Why these three Rs? Well, evidence that isn’t valid and important is going to be no use to a practising clinician. Information that doesn’t apply to our population’s irrelevant. And if we can’t understand what’s been done in the study – what the intervention actually consisted of or what the outcomes actually mean – then that’s unhelpful too.
While this might all be incredibly obvious, it’s also concealing some subtle truths… If we switch the order, and instead look for stuff that’s readable, relevant and reliable we may end up with a different cut of studies. If we throw out all the tough to read, I guess we’d loose about a third of the stuff that’s useful! If we looked next at the relevant, and found it was readable and relevant to our patients, we’d be quite sold into that study. It might well be that we may well be a little more lenient on the critical appraisal than we ought to. So the order suggested makes the best use of our time: seek (without ‘buy in’) reliable evidence, see how relevant it is to out practise, and if we can’t work out how everything works in the study we can always contact the authors to clarify details.
Sharon Straus & R Brian Haynes. Managing evidence-based knowledge: the need for reliable, relevant and readable resources. CMAJ • April 28, 2009; 180 (9). doi:10.1503/cmaj.081697