Thanks for your clarification. I take your point that research does not
necessarily affect the behaviour of PTs.
There is a saying from behavioural psychology that trying to change
behaviour through using information is like trying to knock down a brick
wall by throwing custard at it.
Might it be that the withdrawal of funding by healthcare companies for the
use of unproven modalities could be the motivation PTs need to change their
----- Original Message -----
From: "Douglas White" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, August 08, 2002 6:34 PM
Subject: Re: A question of posture
> Thanks for your reply. Please allow me to clarify my comments. See below.
> Dear Douglas and Barrett
> Whilst I am enjoying the debate on Sahrman's recent pronouncements I find
> myself in diametric opposition to you in one specific of your criticism of
> her call for research, namely:
> > White:
> Sharman seems to be advocating what many other PTs advocate. Lets
> > design a study(s) that demonstrate that what I do works. As opposed to
> > looking at specific conditions and attempting to find answers to
> > and what interventions are the most efficacious, safest and cost
> > Dorko-
> It seems to me that this effort to come up with research to justify
> > traditional practices is uncalled for, not that anybody has asked my
> > opinion.
> John replies:
> Well, in the UK as in USA there has been a great demand from the people
> pay for our services for what we call Evidence Based Medicine (EBM). This
> really a response to all these Drs and therapists out there who seem to
> argue (as you do) - "These practices are traditional therefore research
> justify them is uncalled for". This seems to betray the belief that if a
> practice is traditional it is effective and therefore no research is
> to show that it's use is justified.
> White: Its not that I don't think research that asks the question, "do
> postural interventions provide meaningful benefit?", would add to the body
> of knowledge. Rather I would prefer to see what of the many potential
> interventions are the most "efficacious, safest and cost effective."
> Potentially one could do more studies looking at posture or
> relationships but is this best use of limited research resources? I think
> not based on what we know today. Perhaps someone will publish something
> would make such a study higher on my personal list of research priorities.
> But as it stands now poring more resources into an intervention that, to
> date, empirically and anecdotally has not been very efficacious doesn't
> seem to be the best thing to do.
> Unfortunately a lot of EBM shows that this belief is unjustified, that
> 'traditional' techniques are not as effective as we think. I believe that
> the general public have the right to insist that, as a profession, we
> justify our 'traditional' techniques by producing research that indicates
> their effectiveness. Remember that some techniques seen as 'traditional'
> years ago have now been discarded because research has shown them to be
> ineffective or possibly damaging.
> White: I agree. However, many PTs and other practitioners refuse to alter
> their practice based on the evidence we currently have. Rather there is
> constant call for more research, different designs etc. etc. The use of
> Ultrasound is a classic example. Based on the current body of knowledge US
> should be an experimental treatment and not routinely used. However, that
> not the case. PTs continue to routinely use US. If there is one study
> supporting the use of treatment people will use it. If there are 10
> showing a treatment isn't beneficial then people continue to use it and
> for more studies....
> Does this clarify my earlier comments?
> Douglas M. White, PT, OCS
> 191 Blue Hills Parkway
> Milton, MA USA 02186
> P: 617.696.1974
> [log in to unmask]
> As to Douglas's assertion that Sahrman is saying; - "Lets design a
> that demonstrate that what I do works", This seems to reflect a
> misunderstanding as to what good research is capable of. Research actually
> sets a hypothesis and tries to disprove it. Research (and by this I mean
> good research) doesn't set out to 'prove a point', it sets out to find the
> truth in a situation.
> If Ms Sahrman is saying that an area of our practice is unproven in it's
> effectiveness and research would be useful to indicate its effectiveness
> lack of effectiveness I can't understand your dissaproval.
> > <http://barrettdorko.com>
> > *******************************************************
> > Douglas M. White, PT, OCS
> > 191 Blue Hills Parkway
> > Milton, MA USA 02186
> > P: 617.696.1974
> > [log in to unmask]
> > www.DouglasWhite.org