Henry,
Good point. I am not enamored with evidence based practice like so many of
my fellow colleagues. I believe if we continue on this path, we will
"evidence base" ourselves out of practice. Marcel Proust stated it best -
"love those who seek the truth, beware of those who have found it." There
are too many inferences made when interpreting the literature for clinical
practice. We need to abandon this quest for absolute truth. Instead, we
need to emphasize clinical research, qualitative and quantitative, as
methods to develop our unique philosophy about compassionate care
(Principle 1 - Code of Ethics). As an example, the evidence based
literature states there is insufficient biophysical evidence for the
clinical use of ultrasound, and that there is little evidence the
ultrasound is any more effective than a placebo. However, during my 30+
years of clinical practice I have found ultrasound to be a very sound
adjunctive modality. In my hands, for my patients, using the appropriate
parameters and technique, the selective use of this modality has been very
beneficial for me and my patients. Do you think for one moment that I will
stop using it, or for that matter, stop teaching it - I don't think so. I
would hope there are other clinicians that have had the same experience and
feel the same way. Just a small example. I'm sure this war and battle will
rage on. If we are to win this war that we are being forced to fight, then
we must realize that in this complex world of biology and patient care
there are very few absolute truths!
Rege
At 08:43 PM 1/25/2003 +1000, you wrote:
>Hi everyone,
>
>Something that came out of Ben's patient with the neurological disorder that
>I have been thinking. All this discussion on evidence based practice has
>seen physio's present trials and studies in the literature that either show
>a particular management's benefits, or show that the management is no better
>than placebo or no treatment. What I have seen commonly on forums is
>physiotherapists using the literature to either back or reject a particular
>therapy.
>
>I think I just like to remind everybody that evidence based practice is not
>just looking at clinical trials and RCT's, but actually incorporating this
>with clinical expertise and the patient. What comes out of the literature is
>important, but only when the other two factors are also considered. This is
>because clinical trials, RCT's, treatment guidelines presume homogeneity
>with the population... it presumes that everyone with acute right sided low
>back pain with radiculopathy will respond to a certain management style.
>Therefore, to merely state a particular approach is the best because there
>is evidence for it is not evidence based practice... rather, one must
>clinically reason and decide based on each patient's situation. Too often I
>see Physio's make this mistake and argue back and forth by throwing
>literature at each other... in the example of Ben's patient, the Mckenzie
>Physiotherapy approach was in the lime light. We must remember that there is
>always individual variability and this I believe makes Physiotherapy a
>challenging but fulfilling profession.
>
>Henry***
>
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