It is funny sometimes how we selectively decide to set the permeability level
of our belief membranes to accept or reject things because we feel we are all
for good evidence. And we want so bad to be certain and to be on the Right
side.
Things in PT that are considered simple we tend to accept face value such as
the application of RICE principle. Ice for instance, ( this has puzzled me
for a while and maybe someone might have an explanation). We like to recomend
and apply to people after trauma. People after trauma are usually seen by an
MD who prescribes Anti inflamatory drugs. Then they come to PT. we apply ICE
because we don't presecribe AIDrugs. We want ice to be effective so we really
try to cool down the metabolism of the tissue involved and thereby block
circulation there, maybe inhibiting sypathetic efference. Then we are doing a
disservice to the Anti inflamatory drug because THE DRUG is not getting there
since we have been periodically applying ice ( A vaso constrictor ) to the
tissue .
On what side are we?
For us to be evidence based there is a pre requisite, as I see it : That we
are sensible and use good common sense and intuitiveness AS WELL and don't
discard things based only on someone elese's judgements or accepted stardards
about THings but be willing to try, test to learn and unlearn as well.
There is more to science than meets the eyes, specially medical science!
That's what my experience tell me over and over. Being open to this is being
vulnerable to and probably that's a safer place.
Will
> Well said, Blaise, and thanks for your thoughtful comments (and
> support).
>
> Regards -
>
> Billi
>
> At 02:39 PM 1/22/2004, you wrote:
> >Dear Contributors
> >
> >This has indeed been a fascinating thread to follow. At the risk of being
> >burned by the list for adding my own comments...
> >
> >I am a great believer in the application of the best current evidence...to
> >a point. Some elements have always troubled me about the models which
> >have been hastily embraced from other disciplines (particularly
> >the 'heirarchy of evidence' from EBM - systematic reviews of RCTs ++good,
> >empirical evidence ++ungood) for they seem to reject elements of the
> >evidence continuum that are in my own opinion, extremely important; namely
> >qualitative research and clinical (empirical) evidence.
> >
> >I am heartened by some of the comments that much more esteemed and
> >experienced professionals than I have contributed to the thread. Mainly
> >because I agree with them. RCTs obviously work for drug trials, but I am
> >less convinced when there are multiple variables - as there are in most PT
> >treatments.
> >
> >After much reflection, my own way of rationalising this, which I hope is
> >not just hokum but a way of balancing available evidence, goes like this:
> >Looking at evidence as a constellation, with the patient at the
> >centre...and evaluating the available quantitative and qualitative studies
> >(in recommended ways) I can see what gravity they exert on the presenting
> >problems of the person I'm treating. Presently, I rely heavily on studies
> >that I read, but my anticipation is that once I build up a bank of
> >clinical/experiential knowledge, this will come into play as an equally
> >valid form of evidence.
> >
> >
> >Practitioners like Billi, it appears to me, keep the curiosity of applied
> >scientific practice alive by evaluating/developing new methods in
> >practice. As a profession we still rely on things that do not respond
> >well to being analysed by double blind RCTs, but that doesn't prove that
> >it's quackery either. But, I also know it's also down to us to find
> >methods that are robust to evaluate the merit of new methods
> >
> >Hmmm. Questions, questions...always questions...If I found the answers
> >I'd probably pack it in.
> >
> >Once again, many thanks
> >
> >Blaise Doran
> >Student Physiotherapist
>
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