Margaret,
Well said. Gentelmen, stay with us please.
Netta Harries
Israel
----- Original Message -----
From: "physio" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, August 27, 2001 7:34 PM
Subject: Sorry - Ultrasound Debate
> I am very sorry to see that heated debate on a physio topic would get to
the
> point that the protagonists would end up leaving the list altogether! The
> web gives us a chance to have debate like this with colleagues world-wide
> and it is important to allow opinions to be expressed without resorting to
> personal insult no matter how 'jokey' it is put.
> Please let's not lose this medium of communicatiion because of side
comments
> to the issue which cause offence.I urge you Bruce and Kevin to stay with
us
> and gives us , your colleagues, the benefit of your opinion and expertise
> in the future
>
> Margaret (Revie)
> Scotland
> ----- Original Message -----
> From: "Bruce- Australia" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: 27 August 2001 09:14
> Subject: Re: Ultrasound and Electro discussions
>
>
> > Hi Kevin
> >
> > Probably my last time too.....
> >
> >
> >
> > Dear Bruce
> >
> > One last time then I'm off.
> > I do not participate in the list as I used to as discussions rarely stir
> me
> > to a response. This you have managed to do and that is why I appreciated
> > your post.
> >
> >
> > ok, sorry I thought it was Pommy sarcasm.
> >
> >
> >
> > The point I have been making is that it is hard to make black and white
> > decisions regarding modalities when evidence for their efficacy is so
poor
> > in either direction. I believe the hypothetical deductive model the RCT
is
> > based on is philosophically and intellectually flawed, I believe the
5per
> > cent threshold produced for crop germination may not be so applicable to
> the
> > human condition, I believe the research to date on most physio
modalities
> is
> > not good enough to say categorically it is good or bad because it does
not
> > attract the drug money to produce a decent trial. The reasons for doubt
go
> > on and on. Therefore I am unable to strong black and white decisions as
> you
> > can.
> >
> >
> >
> > Despite your lack of strong decisions for or against, you manage to live
> > and work with the paradox that what you are doing as a physio may or may
> > not be making a difference. Gee Kevin, how do you sleep at night?
> >
> >
> >
> >
> >
> >
> > I am unconvinced by US but will not totally discard it because the
> evidence
> > to do this is not total. We are not at the research position in EBM to
do
> > this yet and for that reason we must be careful.
> >
> >
> >
> >
> >
> > And conversely, if there is no strong evidence for electrotherapy, then
> why
> > should this generation perpetuate a mistake made by previous
generations.
> I
> > suppose at heart, I am a person who is not into idol or personality
> > worship, and I do not take for granted what universities teach based on
> > poor methodlogical studies from the 60s and 70s. Also, I think you might
> > find in general, that the onus of proof lies with the side advocating a
> > specific intervention, not the side trying to disprove it. Otherwise, we
> > may as well all go and do whatever takes our fancy.
> >
> >
> >
> >
> >
> > Looking at my patients in audit 90 per agree with me that they a
> > significantly (clinical) better than when they came in. I use
> symptomology,
> > movement directions and function as the measures and so do they. How
this
> > comes about I could not say for sure. I am not 100 per cent sure of any
of
> > the modalities I use, I could be a good MT or exercise therapist, a good
> > conduit for placebo or counselling, I don't know and it is this element
of
> > doubt I would encourage you to embrace.
> >
> >
> >
> >
> >
> > Yes it is an element of doubt I wholeheartedly embrace. I also embrace
the
> > fact that most acute musculoskeletal injuries get better with no
> > physiotherapy, as do most chronics over time.
> >
> >
> >
> >
> > Therefore there is so much doubt in my practice regarding evidence or
> > procedure, how do I square all this. Well the first thing you do is
> > recognise the doubt, trust what you understand, your own clinical
evidence
> > and be happy that I am helping 90 percent of the people I see.
> >
> >
> >
> >
> > And if an aura reader was to reply the same to you, does that validate
his
> > reality and desire to impart it onto others who are suffering?
> >
> >
> >
> >
> >
> > I also
> > recognise that I have a life long journey to explore what I do, evolve
and
> > modify or discard, read the papers and keep an open mind to new ideas
and
> be
> > a wise skeptic. We are not at the this is rubbish and this is brilliant
> > stage rather the shades of grey asI tried to hint.
> >
> > In your post I was curious. Do you have some knowledge I crave or have
you
> > jumped on the EBM bandwagon of this is great and this is rubbish. When I
> ask
> > for your thought processes you say read the literature, so it looks like
> the
> > latter.
> >
> >
> >
> >
> >
> > The ideas I espouse and prompt you to read the literature of, are well
> > known outside the realm of physiotherapy. As someone who has not come to
> > physiotherapy straight out of high school, I consider myself to be maybe
> > more objective than those who have no other paradigm or source of ego
> > strength other than the indoctrination and practise of physiotherapy.
> >
> > So doI have knowledge that you crave? all I can reply is that it is a
big
> > world outside physiotherapy, with people who have great insight, maybe
> even
> > greater than that offered by a life of physio in the NHS, and you could
> do
> > worse than to read some of the literature validating popular
physiotherapy
> > practise. Indeed you acknowledge yourself that physiotherapy is an area
> > that suffers from a lack of funding to source quality research. All the
> > more reason to read the lit. outside of physio to clarify your
perspective
> > on many of the practices of physiotherapists and how these might be
> > validated or put into disrepute by fields that understand the human
nature
> > at a more subtle level.
> >
> >
> >
> >
> > You have convinced me of one thing. If I do look forward to your
responses
> > perhaps my downtime has become a little sad, especially when I am
> described
> > in such terms as POM (I know sufficient about its aetiology to know it
is
> > not a nice phrase). So I will say goodbye to the list and the friends
and
> > enemies I have made on it and Bruce I hope the passage of time mellows
> your
> > thinking.
> >
> > Warm Regards Kevin
> >
> >
> >
> >
> > OM
> > Bruce
> >
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