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The importance of RCTs
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The importance of RCTs - October 18, 2001 8:02:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
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Group:
The latest thread on the Philadelphia panel has highlighted an important issue. Many of you do not see the need for RCTs. In my opinion, this issue is critical for our future. And the failure of our rank and file to recognize this could be a factor in the downfall of the profession.
Look at the case of the new low back intervention IDET. IDET is used in cases of inernal disc derrangement where there is no access to the disc surgicaly. Resistant cases of ID are really difficult to deal with. So two physiatrists in California invented the IDET system. This involves threading a wire through the disc and heating the tissues supposedly sealing the annular fissure and stablizing the disc a bit.
Early trials had great success probably around the 90% range. When it was studied clinically the success rate remained fairly high, probably around 85%. When a controlled trial was performed the sucess rate dropped but was still impressive. But these trials were not properly randomized. And, finally, when a true placebo controlled, randomized trial was performed recently a similar treatment demonstrated NO BENEFIT. And.....recent biomehanical studies indicate that the proceedure may actually reduce the stability of the motion segment.
So there you have it. Why subject people to this invasive, potentially detrimental intervention when a good rehab program may produce the same results. This is why you CAN NOT rely on your outcome data, your opinions, your uncontrolled trials and your theories. It just isn't good enough. For any healthcare professional!!!!!!!!!
Some of you may reply that our interventions are less invasive and there is less potential for harm. This may be true. But seeing a P.T. has important psychological implications even if the treatment is biomechanically benign. How do you know you are not making the patient more dependant, more fearful, and more reliant on healthcare for guidance. If you are improving the range of motion of a joint or the flexibility of a muscle where it isn't really warrented, this could have a detrimental effect on biomehanics in the future.
The point is that we just don't know!!!!!! Why don't we stop complaining and justifing and own up to the situation. When people hear about reports like the philadelphia panel perhaps we should be embarrassed instead of angry.
mcap
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Re: The importance of RCTs - October 18, 2001 9:24:00 PM
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henryryry
Posts: 100
Joined: September 6, 2000
From: Brisbane, Australia.
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mcap,
I too was disappointed at some of the responses from the last topic, and at the lack on emphasis on RCT's. I hear many physio's say "as long as it works, then that is all that matters," and this saddens me. It seems as though we are splitting a big gap between clinicians and academics, where as there should be a merge of the two. If we do not go on the ride of RCT like the rest of the medical profession, we will not have enough good evidence to show we are more effective than other alternative therapies, and be left behind.
Henry***
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Re: The importance of RCTs - October 19, 2001 6:45:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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Henry:
It is amazing to me that PTs demonstrate such blatant disregard for RCTs. What are they teaching them in school? And aren't they reading any journals??
I agree that we need more of a merger between the academics and the clinicians. If/when I try to get a faculty position, I will try to keep treating a little. And I always try to give my clincal classes an academic orientation.
Furthermore, I think that PTs should make a regular habit of reading journals other than JOSPT and PT. If you look at journals like Spine, Am J Sports Med, Cochrance reviews, etc, you get a better idea of what the rest of the medical establishment is looking for in trials.
Rather than making everyone perform some sort of research project - programs should be ensuring that every student can pick a study apart, point out the deficiencies, know that statistical tests and whether they were appropriate, etc.
Just my 2 cents......again...
mcap
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Re: The importance of RCTs - October 29, 2001 5:34:00 PM
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henryryry
Posts: 100
Joined: September 6, 2000
From: Brisbane, Australia.
Status: offline
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mcap,
I have been on holidays (actually, I am still on holidays).
As with what you said, I totally agree. However, when I graduated 2 years ago from Uni of Queensland, we were not told what to do. There was no emphasis placed on continual education and on reading journals! I graduated thinking I had everything I needed, but without a real direction on where to go. I was lucky to have met a few older Physio's who suggested the internet and a few journals for me to start reading. Forums such as this and other discussion rooms helped me along the road. This is why I am going back do my Master's of Manip next year, which is more evidence based.
Henry***
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Re: The importance of RCTs - October 29, 2001 6:46:00 PM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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Henry:
Still on holiday????? I am jealous. It seems like the Australians have a much better view of appropriate vacation time although I can't really complain about that with my current position [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
I am surprised that you weren't more prepared after entry level education. University of Queensland seems to produce some excellent research. It seems like you found your way very quickly. Here in the states, all of the PT programs are now graduate level with many shifting to the DPT. There is no excuse here for people not be more evidence oriented, although, it does seem like things are changing for the better.
The older, rank and file therapists, in many cases, don't seem to care much about research.
Enjoy the rest of vacation.....
mcap
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Re: The importance of RCTs - October 30, 2001 12:14:00 AM
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henryryry
Posts: 100
Joined: September 6, 2000
From: Brisbane, Australia.
Status: offline
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mcap,
I was actually planning to do the DPT in the US, but after talking to a few people, I decided to stick with the Masters. It seems that many schools in Australia will eventually introduce the DPT program. I will wait until then (plus the Australian $$ is not doing so well at the moment). Post-graduate course at uni of queesland is much more EBM oriented compared to the undergraduate course.
I agree with you (and this is not a generalisation, just an observation), it seems that the older the PT, the more ignorant they are of new research and RCT. One of the physio who work with me responded to my questioning of his clinical reasoning by stating that "as long as it work, I don't care!' I am glad I won't be working with him next year [IMG]http://www.rehabedge.com/forums/biggrin.gif[/IMG]
Henry***
ps- one more week left and its back to work again for me!
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