Evidence Based Practice

[Tommy77]

Hi all

just a quick question for my colleagues around the globe on evidence based pratice in Physiotherapy. Where I live (Australia) a major push has developed over my career for our work to be more and more evidence based. ie, having research, figures, data and other evidence to prove that what we do is effective and worth funding. At the hospital where my partner works, this push has become so strong that the entire occupational therapy department lost their jobs, and only a few were re-hired. (We also have some interesting new industrial relations laws!)

Bearing this is mind, recently I have requested people on this site to cite research to support their points of view, and have received a range of answers from "Sorry, I didn't mean any ACTUAL research, just common sense", to calling me arrogant for... well, I'm not really sure what for!

If I was discussing cases with colleagues over here and justified my position with "well its just common sense", that would surely be the end of my rise up the corporate ladder!

Anyway, as my physiotherapy experience has largely been confined to a relatively finite geographical location, I am very interested in where other parts of the world stand on Evidence Based Practice??

Any takers??

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[physiobob]

Anyone replying to this topic, please stick to the topic. Any personal attacks will just be removed. For the record, EBP is a useful adjunct but the methods and conclusions often do not fit what we are, individual beings.

Much of this is done for the purpose of insurance and the demands of insurance companies and government big wigs. It is time that the whole Allied Health profession stciks together and says that EPD, like it always has been part of our professional education, mostly to investigate what we have learnt empirically. Yet as the recent advances in pain management suggest, it is the brain that might cause the pain, and perhaps relieve it. What then for placebo and the difficulty in measuring success consistently. Double blind RCTs are not the only way to assess what is good, for that certainly cannot predict with any certainty what is not.

[carolino]

Hi,

In Holland we also are "pushed" to work Evidence Based. It's pushed by the insurance companies but also by our own professionals. We have to give more and more Quality in our treatments. Which you can get trough EBP. I have to say, it works well for me.
Carolino.

[emad]

Hello Tommy :

Well , I am not living in a country pushes for EPB ,as well I did not study EBP during my undergraduate study ,but I felt there is something lost when I tried to apply for registration as Physiotherapist in other countries ,I think espicially NZ and Canada put EBP as condation of curricula , so that I decided to study by myself what Evidence-based Medicine is ....It took me sometime to understand what EBP is and what self-learning is .

Just I like to say that Evidence-Based Practice is not only up-to-date research but as well includes the Practionner,s experience .So that ,insurance companies should encourage therapists to apply EBP not losing their jobs as therapists .

The other point is , It is fact we are sometimes apply approaches which still have not been researched , no evidence supports ...but for me the outcome Of the technique is very good .
Just look at it from its positive perspect ..just my view .

cheers
Emad

[alophysio]

Hi - Why is this under Paediatric Physiotherapy??

Anyway, hi.

The absence of evidence is not proof enough that something does not work.

Where possible, we use RCTs and Systematic reviews to support our work.

We may not understand why what we do works. But we know that what we do works (Level 4 evidence).

What we need are researchers who are prepared to change their study designs to show we can do.

We need to try to do research where the results are not diluted because of poor classification of patients (e.g. Chronic LBP).

There are those doing that now in the States (Childs, Cleland, Fritz etc). We need to keep up!

[Tommy77]

Hi and welcome to the world of paeds physio!! :-)

Well basically I put this post under paediatric physiotherapy because I am primarily interested in the views of other peadiatric therapists... none of whom I could see had any input into the other evidence based therapy approaches. (Although I must admit to not having read all of them).

I consider what I do as a paeds physio so astronomically removed from what most people understand physiotherapy to be that most of those other threads are completely irrelevant to my particular situation.

I also noticed a particularly long evidence-based thread under musculo-skeletal physiotherapy, but didn't see anyone asking why that thread wasn't under general physiotherapy discussion. Interesting....

Anyhoo, back to the subject at hand... Yes I am aware that no evidence doesn't mean something doesn't work. I haven't seen any evidence supporting the fact that tying your shoes up decreases your risk of falling over, yet I know it to be so! However, if I was providing the funding for charitable organisations or government departments (where most paediatric services hail from) the fact that there is no proof something doesn't work would hardly be enough reason for me to think paying for it was justified.

However, as a clinician and a researcher I am more than aware of the difficulties of doing legitimate research with the tiny numbers and the vastly heterogenous populations within the one "diagnosis". I have also seen some horendously generalised conclusions drawn from tiny studies that make me wonder how these things get published in the first place.

Anyway, the purpose of this thread was not for me to espouse EBP, but more to find out whats going on in other parts of the world. More specifically, other parts of the paediatric physiotherapy world.

Hope this cleared things up a little.

[alophysio]

Thanks - it did. I wasn't sure if you were a paeds physio or not. Sometimes posts get put in funny places.

EBM for MS physio is appropriate when it is MS related though :P !!

I am glad that paeds physios exist. I personally don't like dealing with it unless it is on someone from about 7 years or older with sports injuries or growing pains etc (real MS type stuff, not the congenital problems).

Thanks! I hope more evidence turns up in your field. I now have children so i need the paeds physios to be well-backed to help my kiddies if they ever need one!! haha

[Aisha_kb]

Evidence based Practise.....
WHATS ALL this JAZZ ABOUT!!!!!!

Sometimes i feel we do need it and at times when i read the researches that have been published, i think what RUBBISH!!!!

[alophysio]

I share your frustration.

However, to be fair, i would like to know if a treatment worked for a condition - even if we don't know WHY it works. I don't think we need to understand why something works to be able to prove that that something works. They are 2 different things.

e.g. willowbark (where asprin comes from) was thought to "cool" the inflammation "heat" but it is an anti-inflammatory for a different reason. Still works the same.

So we can whinge about it or we can contribute to GOOD research. I hope someday to contribute - it's too easy to whinge!

[wutti]

hi, the problem in my country is, like in most countries i think, money is getting less and less. so the insurances want to know, what they are paying for and if it really works. so EBP is getting bigger and more important.
I think a mixture would be great, give some evidence but never loose common sence. I think that sounds great...! anyhow, especially in paeds EBP is really hard to get, my experience is that a lot of treatment/therapy is based on fun, playing etc. which i thing is the best way to get the childs to improve. and I thing others like bobath for childs and voijta are great, but voijta needs to be prooved more.

cheers

[phunphysio]

Hi Tommy77,
I am absolutley astounded that the majority of the OT department lost their jobs. Is this in the public or private system? John Howard will not be getting my vote this year. My area health service definately pushes for evidence based practice. We have a proffessor associated with a university who oversees all our allied health research and assists us with our financial submissions, ethics approvals and alike. However, I find to get the time to conduct research as well as keeping up with my clinical load is impossible. My bosses say "yes yes" do the research but it seems they expect the majority of the early work to be done in my own time. With a family, this is where my ideas fall through the cracks. I would never be able to substantiate everything I am doing in my clinic by research so if it came down to "prove what you can do or your gone" I'm afraid I would be gone. Are these the same frustrations you share and does your area health service support you in clinical research.

[alophysio]

Hi,

Again, to be fair, do we actually know what the exact situation is regarding how these people lost their jobs or why? Who are the sources? What is the other side of the coin?

Hospitals are run by the STATE government in Australia. ALL the State Governments are Labour Party whereas the Federal Government is Liberal. Therefore, already there is an unlikely situation developing where the state government would not want to be seen doing something that supports a fed govt initiative. Look at how they fight every year about health.

Secondly, the fed govt rules about unfair dismissal are there to help businesses of less than 100 employees. The laws do not apply to those in larger businesses including hospitals. As for the laws regarding enterprise bargaining agreements, the employee CANNOT be worse off than if they were on the state award. Therefore, they shouldn't have a problem.

Lastly, there is evidence that what we do works. It is ourselves. We are Level 4 and 5 evidence. Sure it is not up the food chain of EBM but it is still evidence.

I am not here to defend anyone - i just want to be fair and hear the whole story before i make my mind up about something. Otherwise we are just a bunch of old men and women gossiping about something (which is someone i do not want to become!).

Tommy77 can you give us more information - hospital, state, article, newspaper reference, union bulletin, memo, etc???

Thanks

[estherderu]

dear colleagues,
I'm dutch, grew up in australia, studied to become a physiotherapist (later paed. physio) in holland, worked in germany and now in spain.
Yes in holland and germany the pressure to work in an evidence based manner only is building.
In spain interest is growing.
Yes I agree research is fine and necessary.
Yes I know many of the european FT organisations have agreed to work together to get education on an equal levels (Bologna agreement).
Yes I know that many people preach EBP but do they practise?

I am one of more colleagues who ( having worked 30yrs) have a healthy suspicion of the background of much research ( read What docters don't tell you by Lynne McTaggert )
AND every research doesn't take into account that that my *touching a patient* changes something in that persons being. Therefore the reaction to my therapy will never be the same (compaired to the therapy my colleague gives ) even if we use *the same* technique. The parent's trust, their first impression of you, the way you handle their child are also of imminent importance to the whole process and cannot be easily assessed and compaired.

So I am a firm believer of education and keeping yourself educated. In my opinion in our profession that means following many different post graduate education programmes, reading, visiting colleagues with extra expertise, looking in during treatment and treating together if and when possible. We need to keep the the theoretical knowledge process going without forgetting to keep the practical flow going as well.
I hope our researchers will keep their your feet on the ground and keep using common sence and listening to the many very experienced people our there.

I have the feeling that many people underestimate that the working conditions in different countries are VASTLY different and we have to keep this in mind when we discuss EBP.
esther