John:
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 etiology,
> and what interventions are the most efficacious, safest and cost
effective.
>
> 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 who
pay for our services for what we call Evidence Based Medicine (EBM). This is
really a response to all these Drs and therapists out there who seem to
argue (as you do) - "These practices are traditional therefore research to
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 needed
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 interesegmental
relationships but is this best use of limited research resources? I think
not based on what we know today. Perhaps someone will publish something that
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' 100
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 this
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 is
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 studies
showing a treatment isn't beneficial then people continue to use it and call
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]
http://DouglasWhite.org
As to Douglas's assertion that Sahrman is saying; - "Lets design a study(s)
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 or
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
>
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