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Re: Evidence Based Practice
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Re: Evidence Based Practice - August 21, 2006 8:22:00 AM
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mcap56
Posts: 619
Joined: October 26, 2002
From: New York, NY
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Thanks Nari and Eric. I agree. If you look for studies on something and don't find it but decide you have a sound rationnale for proceeding - you have just practiced evidenced based medicine in my opinion. You are aware of the research.
After all, if an RCT was needed for each thing you try, hardly anyone would ever perform surgery. Almost none of the techniques currently in use have been subjected to placebo controlled RCTs. Also, the next time you take a drug, look carefully at the package insert. Look at the studies that were performed. You would be shocked how small the benefit for some of these drugs compared to placebo is.
Have a look at the trial that compared Nexium to Prilosec and see if you see anything that seems odd to you.
Marc
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Re: Evidence Based Practice - August 21, 2006 9:07:00 AM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
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Eric,
I think we owe it to our patients to provide an intervention that is backed by well accepted published research in the form of at least an RCT. When they do not exist (which for many things we see they do not) we should try and use stuff that is lower on the totem pull in the hierarchy of evidence such as case series or a case study. When nothing exists in the literature or if the patient has not progressed at all with intervention with backed evidence then I think it is ok to try these "fringe" techniques that you describe. I just don't think that these "fringe" techniques such as total motion release should be the first thing we go to when treating a patient.
I think if we as PTs stick to this type of strategy then our consistency among each other will improve along with outcomes. I think Proud on another thread brought up the point about a patient with back pain receiving 10 different interventions from 10 different PTs. If we utilized the above strategy I think we would see more consistent treatments among PT and ultimately better outcomes. I personally think that this is the direction that we need to go with EBM.
Just my thoughts.
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: Evidence Based Practice - August 21, 2006 9:40:00 AM
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yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
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Alex:
I don't disagree with your thoughts. Please don't confuse my recent posts as a continuation of a defense for Total Motion Release. I have moved on. The real meat and potatoes of what I'm talking about revolves around a lack of research specific to various manual and exercise techniques. I agree with Proud, I am not 100% comfortable with the fact that we can get 10 different assessments and treatment plans for someone with LBP. But, to operate only by techniques subjected to RCT's? Impossible. We have to find a way to prove treatment rationale and assessment, in my opinion, more so than actual treatment technique. Why? Because we can get a patient with LBP better with 10 different treatments! What are the causitive factors contributing to the pain.
Good thoughts.
Eric
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Eric Yarrington, PT, MPT, OCS
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Re: Evidence Based Practice - August 21, 2006 5:55:00 PM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
Status: offline
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Just a thought....LBP is probably a bad example because, for the most part, we don't actually know what is causing it. Thus the discrepancy in treatment. It's a catch-22. Maybe we should be trying to understand the cause before we can treat it effectively.
I doubt 10 different therapists would treat a TKA 10 different ways. I seem to remember large threads on this board about LBP and the ways different people treat it. But I agree that we need a little more scientific rationale and consistency in our approaches overall.
Sarah
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