* Many of these research studies note a low cost of treatment. They are not using the same scale of measure a client would likely use; thus you may find the cost of treatment is not necessarily inexpensive.
* It is important to understand that while there is research on many of these therapies which suggest the therapy is effective, the research is often not done to a large enough scale, thus may not hold the same weight in terms of quality of evidence of effectiveness. For example, below is a chart of how medical research is rated to determine the level of evidence for a particular treatment yielding a particular result.
* To further understand, when a therapy or treatment is said to be evidence based practice in medicine and nursing, it has been deemed by a large committee of physicians who have collaboratively reviewed a vast array of pertinent literature prior to describing the therapy and treatment protocols that ought to be used for specific patients. Part of this process is also known in the mediconursing industry as peer review of literature, meaning that it was not just one physician or nurse who developed treatment or therapy guidelines.
* This high level manner of determining the evidence as described in literature or research has not occurred at this time in the progression of most areas of aesthetic medicine. Examples of this process described above in full effect can be seen in the American Diabetes Association recommendations for providers caring for patients with Diabetes Mellitus or Joint National Committee’s recommendations referred to as JNC 8, for treating high blood pressure.
Frequently used guidelines to grade the quality of research include the Oxford (UK) Center for Evidence Based Medicine (CEBM) Levels of Evidence and the United States Preventive Services Task Force (USPSTF) guidelines. Each system then grades the level of recommendation of treatment based on the level of evidence.
Oxford UK CEBM Levels of Evidence:
- 1a: Systematic reviews (with homogeneity) of randomized controlled trials
- 1b: Individual randomized controlled trials (with narrow confidence interval)
- 1c: All or none randomized controlled trials
- 2a: Systematic reviews (with homogeneity) of cohort studies
- 2b: Individual cohort study or low quality randomized controlled trials (e.g. <80% follow-up)
- 2c: “Outcomes” Research; ecological studies
- 3a: Systematic review (with homogeneity) of case-control studies
- 3b: Individual case-control study
- 4: Case series (and poor quality cohort and case-control studies)
- 5: Expert opinion without explicit critical appraisal, or based on physiology, bench research or “first principles”
https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/
USPSTF Levels of Evidence:
- Level I: Evidence obtained from at least one properly designed randomized controlled trial.
- Level II-1: Evidence obtained from well-designed controlled trials without randomization.
- Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
- Level II-3: Evidence obtained from multiple time series designs with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
- Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Refined Lines 