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
>