Will:
We are not alone when it comes to apparent contradictions that need
further understanding. The use of NSAID meds and the potential effect on
cartilage healing/health is a good example. Antipyretics have also gone
through some degree of controversy. Fever might be helpful in some
cases. The analogies go on.
The paradoxical relationships between exercise and energy, exercise and
the reduction of pain in osteoarthritis, producing oxidants and having
net anti-oxidants confuses many people including myself.
Interesting stuff
Murray
Murray E. Maitland PhD PT
University of South Florida
School of Physical Therapy
12901 Bruce B. Downs Blvd
MDC 077
Tampa, Florida, USA
33612-4766
Telephone (813) 974-1666
Fax (813) 974-8915
Email [log in to unmask]
-----Original Message-----
From: - for physiotherapists in education and practice
[mailto:[log in to unmask]] On Behalf Of Will Remigio LLU
Sent: Thursday, February 05, 2004 1:04 PM
To: [log in to unmask]
Subject: Re: contradictions
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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