Evidence Based Physiotherapy

[mads]

What is good evidence within our profession? Afterall many of our intervention methodes involve important subjective factors reguarding the therapis-patient relationship. How can this be prooven?

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[perfphysio]

Physiotherapy is about helping people to lead a better daily life than they re currently. This comes in many different forms and has multiple dimensions. Perhaps the psychological questionaire approach is more appropriate on the whole than measuring pain (a small component of the gamet of things that pohysio deals with). I am sure if continued research showed that an overwhelming amount of subjects who received physiotherapy felt better about their lives, were able to cope more and return to their optimal function then we would get more global support than showning miniscule positive significance in pain reduction. Much of our evidence based research collects fantastic data but the data has little to do with the issues or how we might change our practise to address the functional realities of what we tried to measure in the first place?..........rich

[pisio]

In reality, if we strictly follow evidence- based physiotherapy, we won't be able to practise our profession. The reason is because most of our EPAs and techniques are not supported by RCTs. But what is based on evidence today could be completely reversed by another research in the future. Some examples are hormone therapy, arthroscopic surgeries, mammography, Williams flexion exercises, the value of stretching and even the McKenzie technique for backs failed in the Malmivaara study. In our profession, RCTs (randomized control trials) are harder to achieve because we are dealing with human subjects all the time not like in Medicine where they can use mice and monkeys first to produce positive results. For obvious reasons, it is impossible to do Bobath techniques on monkeys. Most of the experiments done on mice and monkeys using our EPAs produced positive results but unfortunately produced different results in human subjects because monkeys do not go back to work. Our treatments are always subjected to monetary constraints. We cannot give our treatments 2 or 3 times a day while a very expensive drugs or medications are given 3-4 times a day. There are studies with RCTs that say patients who are injured in MVAs go back to work in 3 to 6 months time on average but insurance companies deliberately make their own conclusions without evidence to reduce cost. The American College of Sports Medicine and exercise physiology state that it takes at least 3 months to get a definite improvement from exercises. But the proponents of Return to Work( work conditioning and hardening) say that patients can go back to work in 4-6 weeks. This is beneficial to insurance companies but not to the patients because most neck and back patients will have recurrences. But to industrial rehabilitation therapists going back work using FCEs means they are functionally better which in actuality does not really mean they are medically better. So where is the evidence in what we call evidence-based practice? Evidence-based physiotherapy therefore is being dictated by the people who are holding the purse and not by the patients who are experiencing the pain and discomfort of being injured.The very people who demand evidence(insurance companies and allies) deliberately ignore evidence when the evidence is against them. This is the reality of rehabilitation these days.