Evidence-based practice takes into consideration the patient and the current best evidence for the treatment and/or diagnostic practices that the patient needs. It is easy to use evidence as a staunch all or nothing answer, but unfortunately that leaves out the PATIENT part of the evidence-based paradigm. For example, there is a recent systematic review (highest level of evidence) that supported TPLO as the only surgical intervention to have evidence that achieve results close to normal. Given this,it can be argued that a surgeon should recommend a TPLO or nothing. This is a fantastic idea in a perfect world, but there are a multitude of patient factors that take the matter from black and white to grey.
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