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