A lot of empty talk, Henry.

You: "Physiotherapy [...] goes beyond randomized controlled trials and
systamatic reviews."
Me: Sure. Tell it to the jury.

You: "for Physiotherapists, it is an integration of the best evidence with
with one's clinical expertise as well as the patient's
expectations and beliefs."
Me: You integrating the best evidence? There's a systematic literature
review saying manipulation as (indiscriminate) therapy does not produce
clinical benefits for the patient, yet after I brought the (very recent)
article to your attention, and clearly so, the only thing you had to say
was: "I will say this again, nothing has been shown"!

You: "[W]e need to get rid off names such as McKenzie [...] People such as
Louis Gifford are correct in my opinion [...]"
Me: Is there <any> evidence to substantiate that? Play at least by the
<minimal> rules, Henry, or stay out of the game. I asked whether Gifford
backs up anything he says in his book with references to scientific
evidence; the answer was zilch. Try McKenzie's books: 48 (that was in 1981!)
and 175 (1990) references, with the revised version of the lumbar book
probably exceeding 300. Either Gifford has a no memory, or he is just
letting his imagination run free. The last time I checked the dictionary,
there is very little difference between letting imagination run free and
fooling oneself.

You: ""David Butler's "The sensitive nervous system" [is a] good example of
[...] integrations of pain science into Physiotherapy""
Me: ??? You must have a bad recollection (as well). See the discussion a
while ago about the <ineffectivity> of indiscriminately applying neural
mobilization to post-operative spinal patients.

You: "I believe McKenzie will not survive if it does not begin to
incorporate a neurophysiological model, which a lot of other manual
therapy approaches have already done"
Me: Are they the same on-a-neurophysiological-model-based (spinal) manual
therapy approaches that were found to be doubtful at the most, to plain
ineffective, in conditions like asthma (1), epicondylitis (2), and last but
not least, back complaints (3,4)? I've been trained by, and worked with,
(modern) manual therapists, chiropractors and osteopaths, but what they do
in practice is virtually identical. Besides that, McKenzie <does> include
manual therapy, in select patients, so identified by the assessment (and the
developments during the course). He just stays away from theories that are
not backed up by (at least sufficient circumstantial) evidence.


References:
1. Hondras MA et al, Manual therapy for asthma (Cochrane Review). Cochrane
Database Syst Rev 2002;(4):CD001002.
2. Rompe JD et al, Chronic lateral epicondylitis of the elbow: A prospective
study of low-energy shockwave therapy and low-energy shockwave therapy plus
manual therapy of the cervical spine. Arch Phys Med Rehabil 2001;
82(5):578-82.
3. Hurwitz EL et al, A randomized trial of medical care with and without
physical therapy and chiropractic care with and without physical modalities
for patients with low back pain: 6-month follow-up outcomes from the UCLA
low back pain study. Spine. 2002 Oct 15;27(20):2193-204.
4. Ferreira ML et al, Does spinal manipulative therapy help people with
chronic low back pain? Aust J Physiother. 2002;48(4):277-84.


R.,
Frank

F.J.J. Conijn, PT
Editor, Physical Therapist's Literature Update
The Internet Journal of Updates for Clinicians in Non-Operative Orthopaedic
Medicine
www.ptlitup.com



----- Oorspronkelijk bericht -----
Van: Henry Tsao
Aan: [log in to unmask]
Verzonden: zaterdag 1 februari 2003 23:43
Onderwerp: Re: evidence based practice [Olawale]


Olawale,

Evidence based practice was originally devised for used in pharmacology,
to ensure that medicine was more effective than simply placebo or self
recovery, based on controlled trials and systematic reviews. Over the
years, Physiotherapy has adopted this evidence based approach. what needs
to be noted is that evidence based practice is not simply based on the
evidence available... it goes beyond randomized controlled trials and
systamatic reviews. As the father of evidence based medicine stressed time
and time again, for Physiotherapists, it is an integration of the best
evidence, with one's clinical expertise as well as the patient's
expectations and beliefs.

For further reading on this topic:

Bogduk, N., (2001) "Beyond evidence based practice" New Zealand Journal of
Physiotherapy 29(3): 4-5

Grant, R. Chapter 21: Reflections on clinical expertise and evidence-based
practice". In: "Physical Therapy of the cervical and thoracic spine" ed 3.
2002, Churchill Livingstone.

Hopwood, V., et al (2001): Poor reviews may not give a true reflection of
the evidence" Physiotherapy 87 (10) 549-551

Moore, et al (2001): "Evidence based practice - getting a grip and finding
a balance." Manual therapy 6(4): 195-196

Sackett, D.L. et al: Evidence Based Medicine, ed 2, Edinburgh, 2000,
Churchill Livingstone.

Henry***