too much evidence?what about how we reason?

[jesspt]

neurospast -
Your statements actually make a significant point for EBP.

You state the Tinetti is an EBP tool, but then go on to state that has not been proven to have any predictive value for falls. As an EBP you realize that this tool has faults, i.e. no validity for the ability to predict falls, and are more than likely using other examination tools to help ascertain whether the patient you are examining is at a high risk for a future fall. This is the way an evidence-based practitioner works - they are familiar with the measurement properties of the tests they use, and use other additional test when appropriate. When there is a lack of evidence to support any test, they use their clinical reasoning to determine the apporiate way to predict, in this case, the liklihood that a patient will experience a fall.

[neurospast]

jesspt,
You should have read on and you would have understood what I am trying to say. Tinetti was a real example of how things can go wrong and we are just at the beginning of evidence based. I used as well pain as an example which we still have no clue of and already with a simple test as Tinetti we as a community go wrong well that does promise a lot of good wouldn't you say? i try to prevent to go into how it should be I look at how it is. Humans cannot be put into research and if someone can massage the results on anti depressants which is far easier to research than whatever we do what do you expect of our so called evidence based? Why do we still use Bobath as far as I know it is not the best method to treat CVA (according to multiple researches), why don't we use accupuncture for headaches (about the only well researched on acupuncture and bogus acupuncture is not possible otherwise japanese acupuncture would be bogus and acupressure aswell) And we are depending on mathematicians to provide us with the statistics, we have no clue, and I would think that a mathematician will have his problems with more than 3 variables. Most likely to happen within our settings (patient, practisioner, time of day [homonal influences], time of year [hormonal influences] just to name a few) And we do not know what we measure. Yes I fully agree with you; use common sence!

[Canuck Physio]

Evolve or devolve:

We don't just sit back on our asses waiting for answers to be presented. Progressive rehabilitation research is all about seeking out and piecing together recent advances in rehabilitation, muscular biochemistry/endocrinology, muscular physiology to form a substantiated logic that supports a hypothesis. Then you apply it, either in real life or a clinical setting. It is not about making assumptions from one research paper. Anyone can recite research findings.

Analyzing research data, examining the effectiveness of a study, and applying its results to real world training situations is an entirely different matter.

Research studies are continuing to show that what we thought or perceived work (Ultrasound, massage, acupuncture, electrotherapies, etc.) may not work in specific settings or cases. Lack of evidence does not mean they do not work, but perhaps we need to utilize our CLINICAL Knowledge, examine specific physiological variables or outcome measures, and apply a hypothesis to determine in which setting/situation each modality is important. If we can specifically cite research to back this up, it will only add to the clinical reasoning/justification that is available unto us.

Wake up people, chiropractic is not going to survive forever considering the onslaught it has been taking from the medical/scientific community in the past few decades.

Physiotherapy must adapt to ensure it's survival. Maybe this way professors at college will stop blurting to students that 'oh we don't know how it works, but we think it does', or 'it just works'.

The need for evidence is important, but let us also bridge the gap between clinical reasoning and clinical research, let's use the hypothesis as the basis to conduct good, no High quality research that can make sure we stay a strong profession for years to come.

[neurospast]

I would like to use Canucks imput because I think he has a good point here. What I have added is in capital letters

Evolve or devolve:

We don't just sit back on our asses waiting for answers to be presented.
BEFORE EVEIDENCE BASED PRACTICE NO ONE EITHER SAT ON THEIR BACKS.

Progressive rehabilitation research is all about seeking out and piecing together recent advances in rehabilitation, muscular biochemistry/endocrinology, muscular physiology to form a substantiated logic that supports a hypothesis.
THIS ALL WAS ALSO DONE BEFORE EVIDENCE BASED PRACTICE.

Then you apply it, either in real life or a clinical setting. It is not about making assumptions from one research paper. Anyone can recite research findings.
ASWELL DONE PRIOR TO EVIDENCE BASED PRACTICE, AT LEAST THE ENVIRONEMT I GREW UP IN.

Analyzing research data, examining the effectiveness of a study, and applying its results to real world training situations is an entirely different matter.
EVEN WITHIN MATHEMATICS NOT EVERYTHING CAN BE PROVEN, E.G DEFINITION OF A POINT, A STRAIGHT LINE, A FLAT SURFACE CANNOT BE PROVEN BUT IS EXPECTED TO BE TRUE.

Research studies are continuing to show that what we thought or perceived work (Ultrasound, massage, acupuncture, electrotherapies, etc.) may not work in specific settings or cases. Lack of evidence does not mean they do not work, but perhaps we need to utilize our CLINICAL Knowledge, examine specific physiological variables or outcome measures, and apply a hypothesis to determine in which setting/situation each modality is important. If we can specifically cite research to back this up, it will only add to the clinical reasoning/justification that is available unto us.
HOW FAR DO WE WANT TO GO WHEN IS ENOUGH ENOUGH. WHEN CAN WE SAY WE DO NOT KNOW BUT AFTER OUR EXPERIENCE IT DOES WORK?

Wake up people, chiropractic is not going to survive forever considering the onslaught it has been taking from the medical/scientific community in the past few decades. I EXPECT IT SIMPLY TO GO ON, IT MIGHT CHANGE NAMES OR GOING UNDERGROUND AS HAS HAPPENED WITH OTHER MODALITIES. MEDICAL WORLD IS UNABLE TO JUSTIFY ALWAYS WHAT THEY ARE DOING, WE GOT ENTANGLED IN THEIR WAY OF REASONING AS THE ONLY WAY. WHY DO WE ACCEPT A REFERRAL OF LBP OR OA OF THE LOWER BACK ( MAYBE 90% OF PEOPLE OVER 40 HAVE SOME OA OF THE LOWER BACK)

Physiotherapy must adapt to ensure it's survival. Maybe this way professors at college will stop blurting to students that 'oh we don't know how it works, but we think it does', or 'it just works'.
LIKE IN MATHEMATICS WE HAVE ACCEPTED A STRAIGHT LINE IS THE SHORTEST DISTANCES BETWEEN 2 POINTS, IT JUST IS SO.


The need for evidence is important, but let us also bridge the gap between clinical reasoning and clinical research, let's use the hypothesis as the basis to conduct good, no High quality research that can make sure we stay a strong profession for years to come.

EVIDENCE IS VERY IMPORTANT.
IF THE PATIENT IS BETTER OFF AFTER A TREATMENT WHICH IS BASED LIKELY ON OUR INVOLVEMENT AND WE ACCEPT OUR RESTRICTIONS.

WHAT WE TEND TO FORGET WE ARE DEALING WITH PEOPLE AND THE ELEPHANT IN THE ROOM COULD MAKE US FORGET ABOUT THEM.

[jesspt]

Neurospast -
In reference to your previous post:

You should have read on and you would have understood what I am trying to say. Tinetti was a real example of how things can go wrong and we are just at the beginning of evidence based

No, I understood what you were getting at, but I think you, as well as some of the other posters on this thread, actually are taking issue with how clinicians misunderstand EBP, rather than EBP itself. The practitioners you mention who are using the Tenetti as a falls predictor are NOT practicing EBP. I am not that familiar with the Tenetti, but from a precursory literature review I performed, it seems like it is only a valid predictor of falls in patients who have parkinson's disease. Those physios who use the test for other patient populations need more education on how to impliment EBP. In fact, most of your arguments seem to indicate that you have seen numerous practitioners misuse the term EBP due to poor understanding of 1) what EBP is, and 2) how to impliment it.

EBP is not blindly following the results of one research article. It is familiarity with a body of evidence that has good external validty to your patient population (or in essence, good clinical utility), and applying that evidence to drive your examination and/or intervention. When there is a lack of evidence, EBP requires the EBP practitioner to fall back onto sound scientific theory to drive ther exam and intervention, or essentially to use clinical reasoning.

EBP is not abandoning clinical reasoning. It is combining clinical reasoning with the appllication of a body of current best evidence.

You state that implimentation of progressive rehabilitation research was already occuring prior to the current push for EBP. I agree that it was happening as well, but not nearly to a large enough extent. For example, passive management of patients with modalities still occurs to a large extent within our profession, despite the large amount of evidence that suggests that this is not only not helpful to achieving a positive outcome, it is in fact detrimental to the patient. How do we change this, without getting our profession to accept the changes that widespread EBP will bring.

In short, our profession needs to better understand what EBP is. From better understanding will come acceptance of its principles.

[neurospast]

Quote;
In short, our profession needs to better understand what EBP is. From better understanding will come acceptance of its principles.[/QUOTE]

Tell me if I am wrong, is it true that clinical reasoning is a major part of Evidence based practice?
If so I would like to refer to a book "clinical reasoning for manual therapists" edited by Mark Jones and Darren Rivett. A book in which several examples of clinical reasoning are given. I would like to know of the people who are really in favor of EBP, the direction it is taking, do their assessments as the contributors of the book like e.g. james butler and Brian Mulligan. I would like to know out of curiosity.