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Evidence Based Medicine
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Evidence Based Medicine - January 17, 2005 2:46:00 PM
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Jon Newman
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From: Amherst, WI
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I'm creating this thread so as to create some room from another thread that split from the original topic. Hope all attending there will add their comments here as appropriate.
I posted this article some time back during what I had hoped would become a productive thread. That thread went no place. I'm hoping, now that the topic seems exciting again, that I'll get more feedback on what people think.
Here's the article:
http://www.biomedcentral.com/1472-6963/3/14
Thanks,
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Evidence Based Medicine - January 17, 2005 5:01:00 PM
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ericm
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From: Nanaimo, BC
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Phew, there's alot to think about in that one Jon. I must ask aloud "How do you come up with this stuff!?" Surely you must hear me shouting Don't! Stop! Don't! Stop! Don't stop!
Jokes aside. Where to start. How about by trying to bringing some conceptual clarity to Quine's web of belief as it applies to physiotherapy. It would seem separating observational statements from theoretical claims would be a good place to start. Any takers?
eric
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Re: Evidence Based Medicine - January 19, 2005 4:11:00 AM
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PTupdate.com
Posts: 1477
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From: Pittsburgh, PA USA
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Jon,
Printed and tried to read that article, but it lulled me into a coma. I need one of those days where I have nothing to do, and just sit outside with a cigar and read that.
As far as EBM, here are my thoughts:
First, somebody needs to form a group that reviews all literature, and only permits those that stand up to the crituque to pass on to the "evidence" file. Just because something is published in a peer review journal does not mean it can be referenced to as EBM. Rarely does anybody challenge this material and note the factors that make it too questionable. Just look at all the crap with Vioxx/Celebrex/Bextra. Plus we have to consider the fact that some people may be "cooking the books" to give us the data they want us to see.
Second, someone needs to start publishing material in a more complete manner. The article we are all discussing on the other thread is a good example. If a group is going to be performing exercises, then I want to know exactly what they are, how often they were performed, down to the reps and holding times for the stretches.
I discussed this same point on another thread dealing with "manual therapy" to a knee with OA. Don't just say "manual therapy"...tell me and show me exactly what was done. If I end up doing something different than the article, my outcomes may be different, and therefore ridiculous to even site the study in the first place.
Plus, who can afford access to all the material published? A PT could spend thousands to subscribe to all the journals that have studies pertaining to PT. Just reading abstracts is no good, as the methods of the study cannot be critically reviewed. On top of that, how many PT's are truly proficient with research studies and skills to know what type of analysis should have been used in the study?
I almost wish someone would just send me a nice news letter each month after all the above work was done. I'd pay for that if I truly felt it was done right.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Evidence Based Medicine - January 19, 2005 4:44:00 AM
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Diane
Posts: 1507
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From: Vancouver, B.C., Canada
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Duffy,
[QUOTE]I almost wish someone would just send me a nice news letter each month after all the above work was done. I'd pay for that if I truly felt it was done right.[/QUOTE]Bahram Jam does just that. He sends out email newsletters and paper ones too. He is a one-man 'digestive system' for studies pertaining to PT, and a course offerer based on whatever he has found to be solid out there. You can contact him at [URL=http://www.aptei.com]www.aptei.com[/URL] and get on his mailing list for a small remittance.. in Canadian $ too. Bar-goon.
Jon, haven't waded through the article yet.
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Re: Evidence Based Medicine - January 19, 2005 5:01:00 AM
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OrthoSam
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Duffy,
Check out the PEDro data base web site. You may know of this already, but I'll attach the link for those who haven't heard of it yet.
The database allows you to search for citations and abstracts of rated randomized controlled trials and systmatic reviews in physical therapy. PEDro is a creation of the Centre for Evidence-Based Physiotherapy (CEBP) located at the University of Sydney.
Sam B.
ptwww.cchs.usyd.edu.au
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Re: Evidence Based Medicine - January 19, 2005 2:20:00 PM
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Jon Newman
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From: Amherst, WI
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Hi Duffy,
What's that saying? If you want something done right....
Go get that cigar. But if you're going to sit outside, you're either going to wait a long time or you'd better dress for ice fishing.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Evidence Based Medicine - January 19, 2005 3:53:00 PM
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PTupdate.com
Posts: 1477
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Nah, I won't have to wait. Snow two times in the past 3 days gives me an excuse to go shovel and smoke my stogey, with today being a Bacaarat Robusto.
Am very familiar with the above listed sites, but have not joined to determine if I can trust them to do my legwork for me. Are you guys members here, and have you crosschecked their reviews to determine if there is a good trust factor?
Duffy
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Evidence Based Medicine - February 8, 2005 3:07:00 PM
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Jon Newman
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From: Amherst, WI
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I'm not sure how I came across this. I may have been referred or found it myself.
I couldn't decide where to post it but since it mentioned evidence based medicine (what doesn't these days?), I decided to post it here.
I thought it had some balanced thinking within.
[URL=http://www.emia.com.au/MedicalProviders/EvidenceBasedMedicine/afmm/ch6.html]link[/URL]
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Evidence Based Medicine - February 9, 2005 4:47:00 AM
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Alex Brenner PT MPT OCS
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Jon,
I cant seem to get your link to come up. Could you double check it? Thanks.
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Alex Brenner, PT, MPT, OCS
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Re: Evidence Based Medicine - February 9, 2005 6:43:00 AM
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JLS_PT_OCS
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From: USA
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Link worked well for me...
Great stuff, really reminded me of Waddell's Back Pain Revolution.
Highly recommended reading for anyone into EBM. Or those who need to be. :)
I'm sure it is a familiar text to many others...
Advocates a "biopsychosocial model" for caring for back pain, a lot of education in conjunction with the treatment, addressing some of those fear- avoidance type issues.
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Evidence Based Medicine - February 9, 2005 9:26:00 AM
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Matthew
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From: Regensburg, germany
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Hi!
I haven`t read the entire article yet - but here are my thoughts on EBM:
1) education plays a big role in EBM; but how to educate clients that are from another country? That`s one of the biggest problems I had in my last job. A lot of patients were from Russia, the Balkans, ... - they couldn`t even describe their problems/symptoms; so how do you educate somebody about pain, ...? This is something that hasn`t been adressed yet.
2) EBM only works in certain health care systems. In Germany EBM is actively discouraged; therapists are punished if they work according to EBM principles. That way clients tend to stay sick and get even sicker.
EBM research needs to recognize that it goes against everything that has been around for hundreds of years and that it tends to threaten a lot of people - clients and therapists alike.
What we need is a better way to "sell" it properly.
Matthias
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Re: Evidence Based Medicine - February 10, 2005 7:11:00 PM
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Randy Dixon
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Matthias,
Your answer seems a little confusing to me. Are you sure we are using the term EBM (Evidence Based Medicine) in the same way?
It seems to me that you are talking about the "biopsychosocial model".
I don't know about you but I would be very happy if we had terms we could all agree on when dealing with the latter.
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Re: Evidence Based Medicine - February 11, 2005 12:44:00 AM
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Matthew
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From: Regensburg, germany
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Hi!
I understand how my answer could be confusing - sorry for that.
The biopsychosocial approach/model is just one aspect of EBM based treatment that is backed up by lots of research - especially the role of education in (chronic) pain.
I just wanted to show that if we are to incorporate EBM into daily practice we have to find ways to overcome certain obstacles that the original researchers haven`t thought of - like clients who do not speak the same language as the therapist.
Matthias
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Re: Evidence Based Medicine - February 11, 2005 2:26:00 AM
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childsjd
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PTupdate.com (John Duffy):
Unfortunately, I don't have time to engage this disucssion in detail, but many of the sentiments you express in your earlier post about the need for a concise summary of current evidence (ie, monthly newsletter) resonate perfectly with what we're doing in the development of the Evidence in Motion concept (www.evidenceinmotion.com). There is not sufficient time here to lay out the vision, but suffice it to say that a newsletter that does exactly what you're asking for is on the way soon. The newsletter is also merely a small part of what eventually will be a stream of evidence-based information in a variety of formats.
In the short-run, folks are welcome to join for free an EBP listserv where we share current evidence related to physical therapy practice. Folks are welcome to join and just receive information. No pressure to contribute anything. Those of us with immediate access to full text articles are sharing articles in real-time with members. Essentially, it acts as a filter to weed out all the noise in the literature that does not come close to resembling what is meant by evidence-based practice. You can find the procedures for joining at [URL=http://www.evidenceinmotion.com.]www.evidenceinmotion.com.[/URL] Let me know if you have any questions.
John Childs
john@evidenceinmotion.com
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Re: Evidence Based Medicine - February 11, 2005 2:32:00 AM
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SJBird55
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From: Michigan
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Matthias...
With my last employer I had a high percentage of non-Americans. I know Spanish somewhat... but I don't know Korean, Indian or Chinese. Personally, I know I couldn't practice EBM effectively. I couldn't talk or explain anything. I had the least amount of connection with the patients. I couldn't understand fully what they wanted and couldn't understand fully where they were at in their symptoms. I couldn't do any differential diagnosis. I'd get blank stares and confused looks. And I didn't know their culture... and I didn't know their belief system. And, there was no way for me to learn or understand it. Sure, I read on the net about their cultures and did try to make sure that I for example spoke to the husband instead of the wife patient... but when there is no way to easily communicate, what do you do? I could see fear and confusion and I felt so useless. And I would see the spousal interactions - interactions that maintain dependency of the injured. What I wanted to do was so foreign to them and it had no component of "home" in it... so, I actually would attempt and then would refer the patient to a physician who practiced accupuncture. In my mind, that was the best thing to do... give them the familiarity of home and hope that they can move forward and have a return of function at the level they were used to enjoying.
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Re: Evidence Based Medicine - February 11, 2005 3:46:00 AM
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Yogi
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From: San Antonio, Tx., USA
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Jon, I finally got to the first link. It does much to explain things. In the second link, I noticed that leg pain is listed as relatively immutable. To me, that falls under our treatment realm, the highlighted psych stuff is not. In fact, the question comes to mind, which came first, the pain or the coping/distress (style) which they say is relatively remedial. I suspect those categories should be reversed. I alluded to that on another thread once when I asked how much we can overcome the effects of a lifetime of living with the body/mind we're born with. Or the culture we're imprinted with.
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Re: Evidence Based Medicine - February 11, 2005 8:34:00 AM
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Synergy
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From: Texas
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A correction to John's link:
[URL=http://www.evidenceinmotion.com]Evidence in Motion[/URL]
That period on the end is often the culprit. :)
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Chris Adams, PT, MPT
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Re: Evidence Based Medicine - February 13, 2005 3:10:00 AM
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Jon Newman
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From: Amherst, WI
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Hi Yogi,
People sure are asking more thoughtful questions these days.
What I found most interesting about the article is how it categorized things as mutable or not. Duration of symptoms and childhood trauma for example are not at all mutable. How one copes with childhood trauma is mutable but not within the scope of our practice. How one copes with their pain and its effect on movement is within the scope of our practice--it is what we do. Now it just might happen that influencing how the person copes with pain may also influence how one copes with other things but that is not our intent.
The biologically mutable factors first have to be detected in order to be remediated. In the absence of frank pathology, the medical community is terrible at detecting the "first cause" secondary to the presence of so many confounding factors. Although many continuing ed providers beg to differ.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Evidence Based Medicine - February 13, 2005 4:49:00 AM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
Status: online
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Jon,
[QUOTE]Now it just might happen that influencing how the person copes with pain may also influence how one copes with other things but that is not our intent.[/QUOTE]I think focusing on how the person copes with pain is a huge piece that ramifies all over the brain, if it is true (and pain researchers say it is) that physically felt pain and emotional pain use the same pathways, and could then logically ramify throughout someone's life.
On a side note, in your EBM link (which I see is from 2002) there are many chapters.. I took a look at chapter 16 which was on manual therapy, where they noted that there were more reviews available that blinded trials.. Thay looked at reviews from 1990, 1991 and 1996, and concluded no difference whatsoever in length of time off work when treated by any type of manual treatment vs: exercises. They did note however that with osteopathic forms of manual treatment there were way fewer drugs consumed. (That's gotta be better for the liver, at least..)
Diane
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