Lead ArticleEvidence-based Physiotherapy: Some thoughts on ‘best evidence'
Section snippets
Incompatibilities
Having committed ourselves to the principles of EBM it is perhaps timely to try to develop our thinking a little further. A re-examination of the evidence-based medicine movement will show that there are some fundamental incompatibilities which prevent us from following the medical model.
Although the notion that medical practice should be based on evidence is not new, EBM is an apparently recent idea. It is regarded by some as a ‘new paradigm' in medical teaching and practice (Bork, 1992). It
Variability
Western medicine has largely adopted a reductionist concept of research, derived from the physical sciences, which seems to become ever less appropriate to the array of factors which influence the outcomes of physiotherapy. Clinicians trying to implement findings from large group studies may well find that they do not apply to their patients. Statistical techniques, although necessary, may not be readily understood by some clinicians. Generalising and summarising data, removing outliers or
The Voice of Experience
A further source of disquiet raised by the methodological hierarchy proposed by Hadorn et al (1996) is the relegation of expert opinion to the lowest rung in the evidential ladder. This is beginning to receive some critical comment in the medical literature. Tonelli (1999) argues that expert opinion could easily be regarded as the highest form of clinical experience and judgement and suggests that it is misplaced in an hierarchy of methods to derive evidence. He argues that experts and
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Cited by (54)
Attitudes, skills, and use of evidence-based practice: A cross-sectional survey of Swedish osteopaths
2020, International Journal of Osteopathic MedicineCitation Excerpt :It is now acknowledged that EBP should incorporate wider-ranging research methodologies along with greater appreciation for the role of clinical judgement and the patient perspective [2]. Despite calls for physical and manual therapies to adopt EBP, uptake has been inconsistent, particularly in osteopathy where it is not clear how EBP theory, skills and knowledge are operationalised in clinical practice [3–6]. For example, some UK osteopaths perceive research and EBP as threats to their practice style and professional identity [7].
Qualitative research: Its relevance and necessity in physiotherapy
2016, KinesitherapiePerceptions of physiotherapists towards research: A mixed methods study
2016, Physiotherapy (United Kingdom)Citation Excerpt :Although this finding verified that this paradigm is accepted and used in the physiotherapy profession as a research utilisation tool, it could inhibit physiotherapists wanting to perform research as systematic reviews and RCTs are not generally easy to do. Other types of research that were not considered, such as case studies and qualitative studies, should not be discarded as these provide an entry point to learning research in a time-restricted environment, and so a voice to clinical experiences [34]. The second theme related to the amount, language and quality of the available literature.
The suitability of sham treatments for use as placebo controls in trials of spinal manipulative therapy: A pilot study
2013, Journal of Bodywork and Movement TherapiesCitation Excerpt :Whilst trying to develop a suitable sham for use in larger studies investigating the effectiveness of MT, one must bear in mind that not all consider protocolised studies pertinent to real-world practice (Churchill, 1999; Vernon et al., 2005). They produce limited findings, often only applicable to specific groups of patients (Koes and Hoving, 1998; Bithell, 2000). Furthermore, generalisations made from RCT's are in conflict with the individualistic approach of many MT's (Milanese, 2011; Walker et al., 2008).
Disability in patients with chronic patellofemoral pain syndrome: A randomised controlled trial of VMO selective training versus general quadriceps strengthening
2009, Manual TherapyCitation Excerpt :The pragmatic nature of the interventions in this study means that the relative importance of different elements of the rehabilitation program cannot be evaluated. However, physiotherapists often use a range of treatment approaches (Bithell, 2000; Grimmer et al., 2000); therefore, single research interventions are uncharacteristic of ‘routine’ clinical practice (Grimmer et al., 2004). Hence, the nature of the interventions used in this study enhances the external validity and generalisability of the results.