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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