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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