3/10
Best available external evidence.
Unfortunatley this is based on availability of resources, skill of the therapists, workload, enthusiasm etc etc. I remeber attending a casemix lecture at the John Hunter Hospital, Newcastle Australia, back in 1994. There I stood up and protested loudly against such type of research based, yes on statistical methods, but on only a average approach to common problems being administered by burnt out healthcare professionals.

We all know that the "guru" therapists are outliers on the bell curve, even though they get the best results. Why then do we measure the average or what the majority do? It is simply a dollars and cents issue. i.e. Research what is the best, average approach for the limited resource (people, equipment and financial) that a health system can provide. Then you get a streamlined approach to the health dollar. Some call it "Best Practice"! But surely it is not the best treatment!

This is where we should acknowledge the very real difference..