Due to diminishing healthcare dollars and the need to streamline the delivery of healthcare, evidence based practice (EBP) has become the buzz-term of the last decade. Even the medics are subjected to greater scrutiny, resulting in patients being charged for medical certificates (so don’t be sicker than 2 consecutive days on your placements).
The cardiopulmonary component of our program is quite good at bringing to surface EBP issues, such as questioning the effectiveness of chest physio to prevent post-op complications. It appears to me that EBP has been less of an emphasis in the musculoskeletal coursework. At my musculoskeletal placement, soft tissue massage, muscle release, mobilizations and SNAGS are used all the time. Yet there doesn’t seem to be much discussion on the effectiveness of these treatment modalities. For example, we are not taught or encouraged to look up Cochrane reviews for the effectiveness of one treatment modality over another for the shoulder, or the lower back. Do you know what I mean? Maybe it is just assumed that if we could delve into it if we were interested in that area.
The other day, I heard someone demonstrated some Mulligan’s techniques and said there is little clinical reasoning backing it, but it definitely works. On another occasion, I inquired as to the validity of SI motion palpation testing and the response was 'there are little validity to these tests'. My supervisor elaborated that it is used as a part of generating the whole clinical picture. Fair enough, but I think the EBP PT assessment and treatment techniques should be discussed in greater detail. I am beginning to ramble now. My argument is simply that EBP is important and that it should be emphasised in the clinical placements. Is that not what separate us from other quacks in the healthcare industry?
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Hi Minh,
You bring up a very good point. One in which has been on many of our minds lately, I'm sure. I agree with you in that we should strive to seek for EBP in our practice. I do, however, strongly agree with the other side of this argument in that we must put great emphasis on the clinical picture.
Research these days has so many limitations and even some things that have been proven over and over again in the past are now being disproven due to "research flaws" and "new" theories. Try, for example, comparing clinical pracice to say something like sports or exercise training. There is so much research out there and EBP on what the best way to train is and how to develop or become the best athlete. However! As a coach for many years, I saw that what works for some may not work for others and that you must trust your clinical instinct to treat each patient with what you believe (and have seen with your own eyes!) works. I have used this theory to coach teams to gold and will continue to use it in my practice as a physio. Something else to ponder....
See ya tommorow,
Nic
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